External vs. Internal Hemorrhoids: Symptoms and Treatment Options

Is this a case of external hemorrhoids or internal hemorrhoids?

Hello, Dr.
Huang.
I originally had a small external hemorrhoid, but the doctors have said it was very small, almost negligible.
I have had a rubber band ligation for an internal hemorrhoid in the past.
During my last check-up on September 11, the doctor mentioned that there is still a small internal hemorrhoid, but it is too close to the dentate line and very small, so they do not recommend ligation at this time and suggested monitoring it instead.
However, for the past month, I have been feeling a tightness or a foreign body sensation at the anal opening.
I have noticed that where the external hemorrhoid used to be, there is now a soft, small lump of tissue.
This lump often shrinks to almost nothing after I wake up, but sometimes after a night’s sleep, it shrinks but still leaves a small portion.
It seems that it does not enlarge due to bowel movements, but rather increases in size over the course of the day.
However, I do not experience any pain.
Warm sitz baths and applying hemorrhoid ointment do not seem to have any effect on this small lump.
Could you please tell me what type of hemorrhoid this might be? How should it be treated? Thank you for taking the time to respond.

P.S.
I do not have constipation and usually complete bowel movements within 5 minutes.
Afterward, I always take a warm sitz bath.
Additionally, I would like to ask if it is acceptable to place the basin on the floor during the warm sitz bath, or is it necessary to sit with the basin on a chair or toilet?

Zhe shi jingmai qu zhangxing wai zhi ma? Hai shi nei zhi?, 30~39 year old female. Ask Date: 2015/09/21

Dr. Huang Zhihui reply Surgery

Based on your description, it may be excess tissue left at the anal opening after a hemorrhoid flare-up.
Sometimes, this excess tissue does not go away but is not painful.
The only way to completely remove it is through surgical excision.
Therefore, if it is causing you discomfort, it is advisable to consult a surgeon for evaluation and treatment.
As for the position for sitz baths, there are no strict limitations; as long as you can submerge your buttocks in warm water and feel the heat, it is acceptable.

Reply Date: 2015/09/21

More Info

Understanding the differences between external and internal hemorrhoids is crucial for effective management and treatment. Hemorrhoids are swollen veins in the lower rectum and anus, and they can be classified into two main types: external and internal.

External Hemorrhoids are located under the skin around the anus. They can cause discomfort, itching, and pain, especially during bowel movements. Symptoms may include:
- Pain or discomfort around the anus
- Itching or irritation in the anal region
- Swelling around the anus
- Bleeding during bowel movements, which may appear as bright red blood on toilet paper or in the toilet bowl
Internal Hemorrhoids, on the other hand, are located inside the rectum. They are usually not visible and often do not cause pain, but they can lead to bleeding. Symptoms may include:
- Painless bleeding during bowel movements
- A feeling of fullness or pressure in the rectum
- Prolapse, where the hemorrhoid protrudes outside the anus during bowel movements
In your case, you mentioned having a small external hemorrhoid and a small internal hemorrhoid that your doctor advised monitoring rather than treating surgically. The sensation of tightness or a foreign body feeling around the anus could be attributed to the external hemorrhoid, especially if you notice a soft lump that changes size. This lump may represent the external hemorrhoid, which can swell or shrink based on various factors, including activity level and blood flow.

Treatment Options:
1. Conservative Management:
- Dietary Changes: Increasing fiber intake can help soften stools and reduce straining during bowel movements, which is crucial for managing hemorrhoids.

- Hydration: Drinking plenty of water can also help prevent constipation.

- Warm Sitz Baths: Soaking in warm water for 15-20 minutes several times a day can relieve discomfort and promote healing.

- Topical Treatments: Over-the-counter creams or ointments specifically designed for hemorrhoids can provide relief from itching and discomfort.

2. Medical Treatments:
- If conservative measures fail, medical treatments such as rubber band ligation, sclerotherapy, or infrared coagulation may be considered for internal hemorrhoids.

- Surgical options may be necessary for larger or more problematic hemorrhoids.

Regarding your question about the position during a sitz bath, it is generally recommended to sit comfortably in the bath to allow the affected area to be submerged in warm water. Placing the basin on the floor is acceptable as long as you can maintain a comfortable and stable position. However, many people find it easier to use a basin on a chair or the toilet for convenience and to ensure that the affected area is adequately soaked.

In conclusion, it is essential to monitor your symptoms and maintain communication with your healthcare provider. If you experience increased pain, significant bleeding, or changes in your symptoms, it is advisable to seek further evaluation. Regular follow-ups with your doctor can help ensure that your condition is managed effectively and any necessary interventions are timely.

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