What should I do if a thrombosed external hemorrhoid is bleeding?

Written by Deng Heng
Colorectal Surgery
Updated on May 14, 2025
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After the skin of a thrombosed external hemorrhoid ruptures, small blood clots may be exposed, leading to bleeding. Generally, resting, diet adjustment, and maintaining soft and smooth bowel movements can be effective. Additionally, local use of hemorrhoid creams and suppositories can typically help achieve healing and stop the bleeding. Thrombosed external hemorrhoids often occur after intense physical activity or straining during bowel movements due to the sudden rupture of subcutaneous veins around the anal margin, forming an oval lump. (The use of medications should be carried out under the guidance of a professional doctor.)

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Written by Deng Heng
Colorectal Surgery
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External hemorrhoids are divided into several types.

External hemorrhoids refer to hemorrhoids below the dentate line and are divided into four types. The first type is the connective tissue type of external hemorrhoids, which are formed by the proliferation and bulging of excess skin at the anal margin. The second type is the varicose vein type of external hemorrhoids, formed by the dilation and bending of the venous plexus below the dentate line. The third type is inflammatory external hemorrhoids, which is a state where external hemorrhoids become inflamed. The fourth type is the thrombosed external hemorrhoid, which is formed by bleeding due to the rupture of the subcutaneous veins at the anal margin, resulting in a blood clot.

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Written by Yu Xu Chao
Colorectal Surgery
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Can external hemorrhoids be pinched?

In clinical practice, external hemorrhoids can be classified into skin tag hemorrhoids, varicose vein hemorrhoids, thrombosed hemorrhoids, and inflammatory hemorrhoids. Among these, skin tag hemorrhoids can be pinched, but do not exert excessive force to avoid skin damage and causing anal pain. On the other hand, varicose vein hemorrhoids, thrombosed hemorrhoids, and inflammatory hemorrhoids should not be pinched, as pinching may easily cause subcutaneous vein damage, exacerbate thrombosis, and lead to anal distension and pain. External hemorrhoids can be gently massaged and rubbed, but should not be pinched forcefully. Moreover, clinically, treatments for external hemorrhoids often involve the use of anal washes or potassium permanganate solution for sits baths, and it is recommended to take a sitz bath for five to ten minutes after defecation to help reduce external hemorrhoids and prevent their enlargement. Maintaining good bowel habits is essential, avoiding prolonged defecation and excessive straining. After defecation, it is advisable to perform more anal lift exercises to strengthen the anal sphincter muscles.

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Written by Deng Heng
Colorectal Surgery
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Is internal hemorrhoids more uncomfortable or external hemorrhoids?

"Whether internal hemorrhoids or external hemorrhoids are more uncomfortable, overall, internal hemorrhoids tend to be more discomforting. This is because internal hemorrhoids have three main clinical manifestations: rectal bleeding, prolapse of the hemorrhoidal nucleus outside the anus, and pain. Rectal bleeding can lead to systemic anemia, prolapse of the hemorrhoidal nucleus can cause anal itching and anal eczema, and the pain is also very distressing. On the other hand, the main clinical manifestations of external hemorrhoids are a foreign body sensation in the anus and moisture in the anus, and only thrombosed external hemorrhoids cause anal pain."

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Colorectal Surgery
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What causes external hemorrhoids to itch?

External hemorrhoids are hypertrophic skin tags at the anal margin and surrounding skin, or dilation of the subcutaneous venous plexus leading to blood stasis and thrombus formation, resulting in protruding lesions. According to their characteristics, they can be divided into connective tissue external hemorrhoids, thrombotic external hemorrhoids, varicose external hemorrhoids, and inflammatory external hemorrhoids. In particular, inflammatory external hemorrhoids can cause the surrounding skin to become moist. This moisture can lead to the formation of eczema and pruritic diseases in the surrounding skin, causing skin lesions. One of the main features after skin lesions is itching around the skin surrounding the external hemorrhoids.

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Written by Yu Xu Chao
Colorectal Surgery
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The difference between internal and external hemorrhoids

Internal hemorrhoids are located above the dentate line in the anal canal, at the end of the rectum, and are innervated by the autonomic nervous system. Clinically, they are mainly characterized by intermittent, painless rectal bleeding. The blood is bright red, often dripping or spraying after defecation. If internal hemorrhoids worsen, they can prolapse and even become strangulated and edematous, causing anal swelling and pain. External hemorrhoids, on the other hand, are located below the dentate line in the anal canal, and are innervated by the spinal nerves, making them more sensitive to pain. Clinically, they are categorized into skin tag-type external hemorrhoids, varicose vein-type external hemorrhoids, inflammatory external hemorrhoids, and thrombotic external hemorrhoids. Skin tag-type and varicose vein-type external hemorrhoids primarily cause a sensation of a foreign body and itching in the anus, while inflammatory or thrombotic external hemorrhoids can lead to an increase in perianal secretions and anal swelling and pain, necessitating prompt surgical removal of the external hemorrhoids.