External Hemorrhoids: Treatment Options and Concerns

First-time external hemorrhoids?

Hello Dr.
Ke:
In early June of this year, I discovered a growth near my anus while showering.
It is a painless, non-itchy lump that does not bleed.
After a few days, it seemed to swell slightly, and I could feel its presence.
I then made an appointment at Shihpai Veterans General Hospital, where the doctor diagnosed it as an external hemorrhoid.
Subsequently, I was prescribed a topical ointment and a medication called Pingzhilong.
In the following days, after having a bowel movement, I soaked in warm water and applied the medication, and the swelling sensation quickly subsided.
However, the external hemorrhoid is still present today; I can only feel it when I touch it, and it is roughly the size of half a peanut.
Although it does not affect my daily life, it still weighs on my mind, especially when I am intimate with my partner.
I would like to ask the doctor if external hemorrhoids can only be eliminated through surgery, or if they can also be managed with medication and lifestyle changes.
Thank you.

JJ, 20~29 year old female. Ask Date: 2012/06/25

Dr. Ke Fangxu reply Surgery

External hemorrhoids are classified into two types.
One type is acute thrombosed external hemorrhoids, which occur due to the formation of a blood clot within the hemorrhoidal tissue.
If the clot is not too large, this type of external hemorrhoid typically resolves within about a month as the blood clot is absorbed.
The other type is chronic external hemorrhoids, which are caused by prolapsed hemorrhoidal tissue and excess skin at the anal opening.
This type of external hemorrhoid usually requires surgical excision for treatment.
Therefore, whether surgery is necessary depends on which type of external hemorrhoid is present.

Reply Date: 2012/06/25

More Info

External hemorrhoids, commonly referred to as external piles, are swollen veins located around the anus and can cause discomfort, itching, and sometimes bleeding. In your case, it seems that you have been diagnosed with an external hemorrhoid that has not caused significant pain or bleeding but has led to some swelling and discomfort.

Treatment Options for External Hemorrhoids
1. Conservative Management:
- Dietary Changes: Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and reduce straining during bowel movements. Staying well-hydrated is also crucial.

- Topical Treatments: Over-the-counter creams and ointments containing hydrocortisone or witch hazel can help reduce inflammation and provide relief from itching and discomfort.

- Warm Sitz Baths: Soaking in warm water for 10-15 minutes several times a day can help soothe the area and reduce swelling.

2. Minimally Invasive Procedures:
- Rubber Band Ligation: This involves placing a small rubber band around the base of the hemorrhoid to cut off its blood supply, causing it to shrink and fall off.

- Sclerotherapy: A chemical solution is injected into the hemorrhoid to shrink it.

- Infrared Coagulation: This technique uses infrared light to coagulate the blood vessels, leading to the shrinkage of the hemorrhoid.

3. Surgical Options:
- If conservative treatments and minimally invasive procedures do not provide relief, surgical options may be considered. This includes hemorrhoidectomy, where the hemorrhoid is surgically removed. This is typically reserved for larger hemorrhoids or those causing significant symptoms.

Concerns and Considerations
- Persistence of Symptoms: It's not uncommon for external hemorrhoids to persist even after treatment. If the hemorrhoid is not causing significant discomfort or bleeding, many healthcare providers may recommend continued conservative management rather than immediate surgery.

- Psychological Impact: Your feelings of discomfort regarding the presence of the hemorrhoid, especially in intimate situations, are valid. It's important to communicate openly with your partner about your concerns, as this can alleviate some of the anxiety associated with the condition.

- Follow-Up: If the hemorrhoid continues to be a concern or if you experience any changes in symptoms (such as increased pain, bleeding, or changes in bowel habits), it is advisable to follow up with your healthcare provider. They can reassess the situation and discuss further treatment options.

Conclusion
In summary, while external hemorrhoids can often be managed with conservative measures, they may not always resolve completely without surgical intervention. If the hemorrhoid is not causing significant issues, you may choose to continue with dietary and lifestyle modifications. However, if it remains a source of anxiety or discomfort, discussing surgical options with your healthcare provider may be beneficial. Remember, open communication with your partner and healthcare provider can help you navigate this condition more comfortably.

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