Clinical Characteristics of External Hemorrhoids

Written by Deng Heng
Colorectal Surgery
Updated on January 02, 2025
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External hemorrhoids refer to hemorrhoids located below the dentate line, which are classified into four main types, each with distinct clinical manifestations. Connective tissue external hemorrhoids and varicose vein-type external hemorrhoids primarily present with a mild sensation of a foreign body in the anus. Inflammatory external hemorrhoids are characterized by redness, swelling, protrusion, burning, or itching of the anal skin or skin tags. Thrombosed external hemorrhoids often occur after intense exercise or straining during bowel movements, suddenly presenting as a round or oval lump under the skin at the edge of the anus. This lump contains a venous thrombus and is accompanied by anal pain.

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How are thrombosed external hemorrhoids formed?

The formation of thrombosed external hemorrhoids is mainly related to local congestion pressure in the anal area and excessive filling of submucosal blood vessels, especially after the patient abstains from spicy and irritating food, excessive defecation, and excessive fatigue. This condition becomes more prominent. Once thrombosed external hemorrhoids form, they are generally accompanied by the formation of skin tags and internal hemorrhoids in the anal area, and the external hemorrhoids enclose a blood clot. When the blood clot becomes congested or swollen, the patient will experience significant pain or distension. Once thrombosed external hemorrhoids have formed, it is crucial to treat them early to avoid necrosis caused by prolonged and repeated congestion and edema. Treatment options include using local medications for hot compresses or application to alleviate symptoms, or performing surgery to excise and remove the blood clots.

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Do external hemorrhoids without any symptoms need treatment?

External hemorrhoids can be categorized into skin tag-like external hemorrhoids, varicose vein-like external hemorrhoids, and thrombosed external hemorrhoids. Most patients with skin tag-like external hemorrhoids do not have any sensations, and in such cases, treatment is not necessary. Patients only need to pay attention to the hygiene around the anal area. After each bowel movement, they should wash the anal area with clean water. They should also frequently change their underwear, and their diet should be light and easily digestible to avoid diarrhea or constipation. During bowel movements, it's important to ensure the process is smooth to avoid lengthy bathroom visits or excessive straining, which can prevent the exacerbation of skin tag-like external hemorrhoids, hence no treatment would be needed. However, for varicose vein-like external hemorrhoids or thrombosed external hemorrhoids, patients may experience a foreign body sensation or pain around the anus. In such cases, conservative treatment with medications can be considered initially. If conservative treatment is ineffective, surgical intervention may be required.

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Can external hemorrhoids be eliminated?

External hemorrhoids can certainly be removed. Clinically, surgical treatment can be used to remove external hemorrhoidal masses. Hemorrhoidectomy is a common surgical option and can be performed under local infiltration anesthesia, spinal anesthesia, or general anesthesia. After surgery, it is crucial for patients to adhere to changing dressings to avoid infections, inflammation, or edema at the wound site. Dietary precautions should be taken as well; spicy, irritating, and dry foods should be avoided as much as possible. If patients prefer not to undergo surgery, medications can be considered for treating external hemorrhoids, though they can only reduce the size of the hemorrhoidal masses, not eliminate them entirely. Common treatments include anal washes and sitz baths, topical application of golden ointment, and when necessary, oral administration of Diosmin can help reduce swelling. Additionally, patients should regularly perform pelvic floor exercises and avoid prolonged or excessive straining during bowel movements.

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How long does surgery for thrombotic external hemorrhoids take?

Thrombotic external hemorrhoid surgery primarily involves the excision of thrombotic external hemorrhoids. If it's simply an excision of external hemorrhoids, the surgery generally takes about half an hour. The recovery time post-surgery requires two to three weeks, mainly depending on the severity of the patient's condition and individual tissue healing rates, which can vary. After the excision surgery for thrombotic external hemorrhoids, a local wound is left, necessitating daily disinfection and dressing changes. When necessary, hemorrhoid ointment or muscle-generating Yuhong ointment may also be applied to promote healing and treatment.

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How to deal with external hemorrhoids bleeding?

If external hemorrhoids bleed without apparent reason, it may be due to the rupture of thrombosed external hemorrhoids, leading to bleeding. Firstly, it is necessary to disinfect and clean the local wound to avoid accumulation of blood or contaminants and feces, which may cause infection of the wound. If the bleeding does not stop, topical hemostatic drugs or oral hemostatic drugs should be used for symptomatic treatment. If external hemorrhoids bleed and are accompanied by severe prolapse of internal hemorrhoids, it is recommended that the patient undergo surgical treatment to remove and ligate both external and internal hemorrhoids at the same time. This can further prevent exacerbation of bleeding and fundamentally treat hemorrhoids. Patients with bleeding external hemorrhoids must have a light diet and avoid irritating foods such as chili peppers and seafood. (The use of medications should be under the guidance of a doctor.)