External Hemorrhoids


External hemorrhoids (piles) occur distal to the dentate line and develop as a result of distention and swelling of the external hemorrhoidal venous system (see the first image below). Engorgement of a hemorrhoidal vessel with acute swelling may allow blood to pool and, subsequently, clot; this leads to the acutely thrombosed external hemorrhoid, a bluish-purplish discoloration often accompanied by severe incapacitating pain.

Thrombosed external hemorrhoids are a common problem but remain a poorly studied topic. Reported risk factors for thrombosed external hemorrhoid include a recent bout of constipation and traumatic vaginal delivery.

Although conservative nonsurgical treatment (stool softeners, increased dietary fiber, increased fluid intake, warm baths, analgesia) ultimately results in improvement of symptoms for most patients, surgical excision of the thrombosed external hemorrhoid often precipitates resolution.

Newer conservative treatments, such as topical nifedipine, show promise of having advantages over traditional conservative treatments, such as lidocaine ointment; however, in comparison with surgical excision, they have not yet been shown to shorten the time to symptom resolution or reduce the frequency of recurrence.

Surgical excision of the acutely thrombosed external hemorrhoid is within the purview of an office-based or emergency practitioner. This safe procedure offers low recurrence and complication rates and high levels of patient acceptance and satisfaction.

External Hemorrhoids: Causes, Symptoms, Treatments

The most common cause of external hemorrhoids is repeated straining while having a bowel movement. Hemorrhoids develop when the veins of the rectum or anus become dilated or enlarged and can be either “internal” or “external.” External hemorrhoids are usually found beneath the skin that surrounds the anus.

Recognizing the symptoms of external hemorrhoids

There is a range of symptoms that can affect a person with hemorrhoids. Symptoms tend to vary depending on the severity of your hemorrhoids. Some of the symptoms that you may have include the following:

  • itching around the anus or rectal area
  • pain around the anus
  • lumps near or around the anus
  • blood in the stool

You may notice bleeding when using the bathroom. This includes seeing blood on toilet paper or in the toilet. Lumps around the anus may feel as if they are swollen.

These symptoms may also occur because of other conditions. But if you experience these symptoms, you should schedule an exam with your doctor.

What are the causes of external hemorrhoids?

The most common cause of hemmorhoids is repeated straining while having a bowel movement. This is often caused by severe cases of constipation or diarrhea. Straining gets in the way of blood flow into and out of the area. This results in the pooling of blood and enlargement of the vessels in that area.

Pregnant women may also be at an increased risk of hemorrhoids because of the pressure that the uterus places on these veins.

Who is at risk for external hemorrhoids?

If your parents have had hemorrhoids, you may be more likely to have them as well. Hemorrhoids may also be caused by pregnancy.

As we age, hemorrhoids can occur due to increased pressure caused by sitting a lot. And anything that causes you to strain during bowel movements can lead to external hemorrhoids.

If you’re not sure what the cause of your hemorrhoids may be, your doctor might be able to determine why.

How are external hemorrhoids diagnosed?

Because many of the symptoms of external hemorrhoids can also be caused by other conditions, it is necessary to have an in-depth exam. Your doctor may use a series of tests to confirm the presence of external hemorrhoids near the anus. These tests may include:

  • proctoscopy
  • digital rectum exam
  • colonoscopy
  • sigmoidoscopy
  • anoscopy

Your doctor may begin with a physical exam. In cases of external hemorrhoids, they may be able to see the hemorrhoids.

If your doctor suspects that you have internal hemorrhoids instead of external hemorrhoids, they may use an anoscopy to examine the inside of the anus. Internal hemorrhoids can also be seen with colonoscopy, sigmoidoscopy, or proctoscopy.

Treating external hemorrhoids

Hemorrhoids can be treated a few ways depending on severity. Your doctor may ask if you have any preference for certain types of medications or treatments.

Some general treatments that your doctor might suggest include ice packs to reduce swelling, suppositories, or hemorrhoid creams.

These options can offer relief to individuals who have a milder case of hemorrhoids. If you have a more severe case, your doctor may suggest treatment with a surgical procedure.

Surgical treatments include:

  • removal of hemorrhoids, known as hemorrhoidectomy
  • burning of hemorrhoid tissue with infrared photo, laser, or electrical coagulation
  • sclerotherapy or rubber band ligation to reduce the hemorrhoids

How can I prevent external hemorrhoids from developing?

The main factor for preventing external hemorrhoids is to avoid straining during bowel movements. If you have severe constipation, you may want to try using aids such as laxatives or including more fiber in your diet.

Stool softeners are another popular over-the-counter option that can help you with temporary constipation due to pregnancy or other factors. If these options don’t help, you may want to talk with your doctor about other options to reduce strain.

What is the long-term outlook for external hemorrhoids?

Hemorrhoids are a fairly common condition. Many people recover with proper treatment. In severe cases of external hemorrhoids, surgical methods may be necessary for treatment. People who have severe external hemorrhoids may only notice a reduction as a result of these types of treatment.

External Hemorrhoid Thrombosis

Hemorrhoids refer to swollen blood vessels that are found in and around the rectum and anus and it’s mostly as a result of bowel movements. When the veins swell, the walls get thin, stretched and irritated. Those who suffer from external hemorrhoids will mostly find it to be very uncomfortable. In some instances, blood clots may be formed in the swollen areas therefore causing thrombosis, a painful condition. By getting thrombosed, the swelling will turn blue or yellow and may also lead to bleeding. This might make you frightened, however, even when left untreated; it will resolve itself in about a week’s time. However, if the pain becomes unbearable, it’s advisable that you seek help from a doctor. If the pain becomes too much and anal bleeding is experienced, it’s imperative that you seek medical assistance because this could be a sign of a life threatening condition. A comprehensive evaluation from your primary care physician will be highly necessary.

Symptoms of External Hemorrhoid Thrombosis

There are a number of symptoms that indicate the possibility of external hemorrhoid thrombosis and some of them include:

  • Swelling in and around the anus.
  • Painful or sensitive lump around the anus.
  • Occasional leaking of feces.
  • Irritation or itching on your anal area.
  • Painless bleeding when you go to the toilet.

Possible Causes of External Hemorrhoid Thrombosis

External hemorrhoids affects people of all ages and more than half of all people will experience it at some point in their lifetime. However, it’s more prevalent in pregnant women and in elderly persons. Scientific researches have not shown what the real cause is, but it’s believed that it could be due to weak veins and genetic factors among others. Diet is also believed to be a factor that may lead to this condition. Those who mostly eat fiber rich foods are less likely to suffer from hemorrhoids than those who eat processed foods. Inadequate intake of fluids may cause constipation which triggers external hemorrhoids by causing straining while in the toilet and by producing hard stools which may further aggravate the situation.

Cure For External Hemorrhoid Thrombosis

There are a number of treatments for external hemorrhoid thrombosis. The most common of these are non-surgical treatments such as using stool softeners, increasing your intake of fiber, taking more fluid everyday and adopting warm baths.

Also, there are some newer and more conservative treatment options that are available today and among them are topical nifedipine. This treatment offers better and quick results than lidocaine ointment which has been the preferred choice of treatment for many years now.

Surgery is also an effective choice of treatment for external hemorrhoid thrombosis. This is especially the case if it’s in an acute condition. This kind of surgery can be done in an outpatient department of a hospital or in the doctor’s clinic. The result for those who opt for surgery is quick and has scored a high level of satisfaction and acceptance among patients.

Your doctor will recommend a method of treatment after evaluating you. Depending on whether the condition is mild, serious or moderate, the right treatment will be recommended.

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