Do external hemorrhoids without any symptoms need treatment?

Written by Yu Xu Chao
Colorectal Surgery
Updated on March 18, 2025
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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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Written by Chen Tian Jing
Colorectal Surgery
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How to eliminate the flesh balls of external hemorrhoids

External hemorrhoids primarily manifest as local skin tags or connective tissue protrusions, which may also be due to transient congestion and edema caused by acute episodes. If the hemorrhoids are skin tag-type or connective tissue-type and do not present any clinical symptoms or affect the patient's normal life, excessive treatment is generally not required. It is only necessary to maintain good dietary and defecation habits to prevent the condition from worsening. If the external hemorrhoids involve congestion, edema, or pain caused by thrombosis, complete removal can only be achieved through surgical excision. Merely using topical medications, applying heat, or using hemorrhoid creams can only reduce the size of the masses or alleviate symptoms, but cannot completely remove the masses.

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Written by Chen Tian Jing
Colorectal Surgery
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Can thrombotic external hemorrhoids be lanced?

Thrombosed external hemorrhoids, as the most common clinical symptom of external hemorrhoids, exhibit significant local pain during acute attacks and are accompanied by a feeling of constriction. If during an acute attack, dark red hemorrhoidal prolapse occurs around the anal area and cannot be absorbed or retracted, a professional doctor can use specialized techniques to crush the local hemorrhoid node or surgically excise it. However, it is not advisable for patients to burst it themselves because if done without proper sterilization and hygiene, it can easily lead to local infection, thereby exacerbating the condition or complicating future surgical treatments. Therefore, if thrombosed external hemorrhoids are detected, it is crucial to seek prompt and active treatment at a hospital.

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Written by Yang Dong
Colorectal Surgery Department
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The difference between rectal prolapse and external hemorrhoids.

Rectal prolapse is the protrusion of the rectal mucosa, which manifests as an eversion of the mucosa presenting as pink-colored, cylindrical protrusions. These can usually be manually repositioned back into the anus, appearing smooth once repositioned. In contrast, external hemorrhoids are mostly caused by varicosities and are the same color as the skin. They cannot be completely repositioned manually, which distinguishes them from rectal prolapse.

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Written by Chen Tian Jing
Colorectal Surgery
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What is inside a thrombotic external hemorrhoid?

Thrombotic external hemorrhoids are a common clinical presentation of external hemorrhoids. During an episode, blood clots generally form within the hemorrhoidal nucleus, which means that thrombotic external hemorrhoids mainly consist of blood clot particles. Because the blood clots are wrapped inside the hemorrhoidal nucleus, the pressure inside the nucleus increases, leading to congestion and edema. Patients experience significant pain and a feeling of fullness. Severe symptoms may also affect the patient's ability to sit or walk normally. Therefore, it is crucial to treat thrombotic external hemorrhoids early in their development. For early-stage mild thrombotic external hemorrhoids, local treatments such as hot compresses with hemorrhoidal medication or manual pressure can be employed to promote the absorption of the blood clots. Oral medications that reduce swelling, relieve pain, and stop bleeding can also be used for symptomatic relief. If thrombotic external hemorrhoids recur frequently or if conservative medication fails, surgical excision and stripping of the thrombotic external hemorrhoids can also be considered.

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Written by Yu Xu Chao
Colorectal Surgery
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How to eliminate the flesh lump of external hemorrhoids

External hemorrhoids mainly consist of varicose external hemorrhoids, inflammatory external hemorrhoids, and thrombotic external hemorrhoids. If the patient wants to completely remove them, in such cases, only external hemorrhoidectomy or external hemorrhoid stripping surgery can be performed. After the surgery, anal cleansers, red oil gauze strips, and golden ointment are used for dressing changes to promote wound healing. If the patient is unwilling to undergo surgery and opts for conservative treatment with medications alone, the external hemorrhoidal mass will not be completely eliminated but will only shrink slightly and improve clinical symptoms. To completely eliminate the external hemorrhoidal mass, surgical treatment is necessary. Moreover, after surgery, patients should develop good defecation habits, such as not spending too much time on defecation, not straining excessively, and performing more pelvic floor exercises after defecation to strengthen the anal sphincter muscles to help prevent recurrence of external hemorrhoids.