External Hemorrhoids: Symptoms, Causes, and Treatments

External hemorrhoids

Hello, Doctor: At the beginning of December, I experienced sudden swelling and pain in my anus after straining during a bowel movement, accompanied by some bleeding.
It seemed like a thrombosed external hemorrhoid.
I took medication, applied ointment, and did warm sitz baths, and it has since resolved.
However, recently I noticed a movable lump at the end of my anus, which feels like another external hemorrhoid.
I'm worried that it might be due to hard stools and possibly another thrombosis.
Previously, I didn't know I had external hemorrhoids, but sometimes if I go too many days without a bowel movement, I experience sharp pain in my anus before I feel the urge to go.
Is that also related to external hemorrhoids? Please help me, thank you.

Xiao Yu, 20~29 year old female. Ask Date: 2012/01/16

Dr. Ke Fangxu reply Surgery

Thrombotic external hemorrhoids occur when a blood clot obstructs the tissue of the hemorrhoid, causing swelling.
Over time, the blood clot gradually liquefies and is absorbed by the body.
What you may be feeling is likely the blood clot that is in the process of being absorbed.
If the location is different from the previous one, it is possible that a new thrombus has formed.
It is recommended to take warm sitz baths.
However, if you experience fever, swelling, or pain, you should seek medical attention promptly, as there is a possibility of an anal abscess.
As for the sharp pain during bowel movements, it may simply be a sensation from the contraction of the sphincter muscle, or it could indicate a mild anal fissure, which can also cause such symptoms.

Reply Date: 2012/01/16

More Info

External hemorrhoids, also known as external piles, are swollen veins located around the anus and lower rectum. They can cause a variety of symptoms, including pain, discomfort, itching, and bleeding during bowel movements. Understanding the symptoms, causes, and treatments of external hemorrhoids is essential for effective management and prevention.

Symptoms of External Hemorrhoids
1. Pain and Discomfort: One of the most common symptoms is pain around the anal area, especially when sitting or during bowel movements. This pain can be sharp and may worsen if a blood clot forms within the hemorrhoid (thrombosed hemorrhoid).

2. Swelling: You may notice a lump or swelling around the anus. This lump can be sensitive to touch and may feel hard or tender.

3. Bleeding: Bright red blood may appear on the toilet paper or in the toilet bowl after a bowel movement. This bleeding is usually painless and indicates that the hemorrhoid has been irritated or damaged.

4. Itching: The area around the anus may become itchy, which can lead to discomfort and further irritation.

5. Mucus Discharge: Some individuals may experience a mucus discharge from the anal area, which can contribute to itching and irritation.

Causes of External Hemorrhoids
External hemorrhoids are primarily caused by increased pressure in the veins of the rectum and anus. Common factors that contribute to this increased pressure include:
1. Straining During Bowel Movements: This is often due to constipation or hard stools, which can lead to excessive pressure on the anal veins.

2. Prolonged Sitting: Sitting for long periods, especially on the toilet, can increase pressure in the anal area.

3. Pregnancy: The increased weight of the uterus and hormonal changes can lead to swollen veins in the rectal area.

4. Obesity: Excess body weight can put additional pressure on the pelvic veins.

5. Heavy Lifting: Regularly lifting heavy objects can strain the anal area and lead to hemorrhoids.

6. Age: As people age, the tissues supporting the veins in the rectum and anus can weaken, making hemorrhoids more likely.

Treatments for External Hemorrhoids
1. Home Remedies:
- Warm Sitz Baths: Soaking the anal area in warm water for 10-15 minutes several times a day can help reduce pain and swelling.

- Over-the-Counter Creams: Creams or ointments containing hydrocortisone or witch hazel can provide relief from itching and discomfort.

- Cold Compresses: Applying a cold pack to the affected area can help reduce swelling and numb the pain.

2. Dietary Changes: Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and reduce straining during bowel movements. Staying hydrated is also crucial.

3. Medications: Oral pain relievers, such as acetaminophen or ibuprofen, can help manage pain and discomfort.

4. Minimally Invasive Procedures: If home treatments do not provide relief, procedures such as rubber band ligation, sclerotherapy, or infrared coagulation may be recommended to remove or shrink the hemorrhoids.

5. Surgery: In severe cases, surgical options such as hemorrhoidectomy may be necessary to remove the hemorrhoids.

Conclusion
It is understandable to be concerned about the symptoms you are experiencing, especially if you have previously dealt with thrombosed hemorrhoids. The presence of a movable lump could indicate a variety of conditions, including a thrombosed hemorrhoid or a skin tag resulting from previous hemorrhoid issues. The pain and discomfort you feel before bowel movements could also be related to your hemorrhoids, particularly if you are experiencing constipation or hard stools.

If you continue to have symptoms or if you notice any changes, such as increased bleeding or significant pain, it is important to consult with a healthcare professional. They can provide a thorough examination and recommend appropriate treatment options tailored to your specific situation. Early intervention can help prevent complications and improve your overall comfort.

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