Is This External Hemorrhoids? Symptoms and Treatment Options

Is this an external hemorrhoid?

About two years ago, I suddenly noticed bright red blood when using the restroom, and later discovered a small protrusion inside the anus, which I believe is an internal hemorrhoid.
After improving my lifestyle habits, I did not experience any further issues for over two years, except for two or three instances triggered by lack of sleep.
About a week ago, after straining during a bowel movement, I saw small blood stains on the toilet paper and felt some pain.
I initially thought it was due to hard stools causing injury to the anus.
However, a few days later, after drinking a high-fiber beverage, my stools became soft, but I still experienced pain during bowel movements.
I suddenly felt a growth near the anus; on the first day, it felt like a round ball that I could touch while standing.
A few days later, it seemed to flatten out but was still palpable and appeared to be connected to the anus.
When I touched the area near the anus, it felt a bit prickly, but not very painful.
Now, the first part of my bowel movement causes a slight stinging sensation, so I take my time to continue.
Generally, it doesn’t feel too uncomfortable, and wiping does not hurt.
I can feel the growth whether sitting on the toilet or standing, but if I slightly tighten my buttocks, I can’t feel it anymore.

Could this be a worsening of internal hemorrhoids leading to external hemorrhoids? How should I manage this? If I don’t see a doctor, will I continue to experience slight pain during bowel movements in the future? Why has my condition been relatively stable for two years, and how could straining during one bowel movement lead to this situation?

A Bu, 20~29 year old female. Ask Date: 2010/09/30

Dr. Ke Fangxu reply Surgery

Hello, in response to your question, based on your description, this appears to be an anal fissure.
When an anal fissure occurs, a granulation tissue may appear at the edge of the wound.
A typical symptom is a sharp pain, and there may be slight bleeding during wiping, although the amount is usually minimal.
The common causes are constipation or diarrhea.
The treatment involves the use of topical ointments, and taking warm water baths can also aid in wound healing and improve bowel habits.
If the pain is severe, surgical intervention may be recommended.
Wishing you safety and well-being.
Dr.
Ke Fang-Hsu, Keelung Hospital.

Reply Date: 2010/09/30

More Info

Based on your description, it seems that you are experiencing symptoms that could be related to hemorrhoids, specifically external hemorrhoids or possibly a progression of internal hemorrhoids. Hemorrhoids are swollen veins in the lower rectum and anus that can cause discomfort, pain, and bleeding during bowel movements.

Symptoms and Diagnosis
The symptoms you described, such as bright red blood on toilet paper, pain during bowel movements, and the presence of a lump near the anus, are commonly associated with hemorrhoids. The fact that you have experienced these symptoms intermittently over the past two years, with a recent exacerbation following straining during bowel movements, suggests that your condition may have worsened.

1. Internal vs. External Hemorrhoids:
- Internal hemorrhoids are located inside the rectum and usually do not cause pain unless they protrude outside the anal opening (prolapse). They can cause bleeding during bowel movements.

- External hemorrhoids are located under the skin around the anus and can cause pain, itching, and swelling. If a blood clot forms in an external hemorrhoid, it can lead to a painful condition known as a thrombosed hemorrhoid.

Treatment Options
1. Conservative Management:
- Dietary Changes: Continue to maintain a high-fiber diet to prevent constipation and reduce straining during bowel movements. Drinking plenty of fluids is also essential.

- Over-the-Counter Treatments: You may consider using topical treatments such as hydrocortisone creams or witch hazel pads to relieve itching and discomfort.

- Warm Baths: Soaking in a warm bath can help alleviate pain and discomfort associated with hemorrhoids.

2. When to See a Doctor:
- If your symptoms persist or worsen, it is advisable to consult a healthcare professional. They can perform a physical examination to confirm the diagnosis and rule out other conditions that may cause similar symptoms, such as anal fissures or rectal prolapse.

- If the lump you feel is indeed a hemorrhoid, your doctor may recommend additional treatments, such as rubber band ligation, sclerotherapy, or, in more severe cases, surgical removal.

Potential Complications
If left untreated, hemorrhoids can lead to complications such as:
- Thrombosis: A painful clot can form in an external hemorrhoid, leading to severe discomfort.

- Infection: In rare cases, hemorrhoids can become infected.

- Anemia: Chronic bleeding from hemorrhoids can lead to anemia, which is a decrease in red blood cells.

Conclusion
While it is possible that your hemorrhoids have become more pronounced due to straining, it is essential to monitor your symptoms closely. If you continue to experience pain or if the lump changes in size or appearance, seeking medical advice is crucial. Early intervention can prevent complications and improve your quality of life.
In summary, while lifestyle changes and home remedies can be effective for managing mild symptoms, persistent or severe symptoms warrant a professional evaluation to ensure appropriate treatment and to rule out other potential issues.

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