How to deal with occasional bleeding from external hemorrhoids?

Written by Yu Xu Chao
Colorectal Surgery
Updated on April 16, 2025
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Occasional bleeding from external hemorrhoids is mainly due to damage to the hemorrhoids, which leads to bleeding, usually accompanied by pain and a foreign body sensation in the anus. In such cases, if the bleeding is not severe and the pain is mild, it means the damage to the external hemorrhoids is not serious. For these cases, one can choose to use an anal cleansing agent for sitz baths to achieve anti-inflammatory and antibacterial effects, and then apply hemorrhoid cream and other medications externally to promote healing of the sores. At the same time, patients should wear loose, breathable cotton underwear to avoid frequent friction on the external hemorrhoids, which can worsen the damage. If the damage to the external hemorrhoids is severe, or if there is swelling or thrombosis, it is advised to go to the hospital's anorectal surgery department as soon as possible to undergo a hemorrhoidectomy. After the surgery, patients must persist in changing dressings to promote wound healing.

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Written by Yu Xu Chao
Colorectal Surgery
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Can external hemorrhoids heal by themselves?

External hemorrhoids can be classified into cutaneous flap hemorrhoids, varicose vein hemorrhoids, thrombotic hemorrhoids, and inflammatory hemorrhoids. These are mostly caused by poor defecation habits of the patient, such as prolonged defecation time or excessive straining during bowel movements, which then lead to the growth of excess skin flaps, varicose veins, or rupture of venous blood vessels, resulting in various types of external hemorrhoids. Therefore, these types of hemorrhoids cannot heal on their own and require treatment with medication or surgery. For cutaneous flap hemorrhoids, if the patient does not experience significant discomfort, specific treatment is generally not necessary, just attention to hygiene around the anal area is needed. However, for inflammatory or thrombotic hemorrhoids, since they can cause anal pain and a feeling of prolapse, it is advisable to opt for surgical stripping of the hemorrhoids as soon as possible. Post-surgery, treatments such as anal washes, red oil gauze strips, and golden ointment should be used for dressing changes, while also maintaining cleanliness of the anal region.

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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 Yu Xu Chao
Colorectal Surgery
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How to eliminate external hemorrhoids without a core?

Conservative medication treatment for external hemorrhoidal nodules can only reduce their size, but cannot completely eliminate them. For instance, if an external hemorrhoidal nodule develops inflammatory edema, one can take oral Diltiazem tablets, combined with anal wash or potassium permanganate solution for local sitz baths, and apply Golden Ointment externally, which can achieve good anti-swelling effects. However, if the external hemorrhoidal nodule is significantly enlarged, or even forms a thrombus causing pain and swelling in the anus, simply using medication cannot effectively improve the symptoms. In such cases, surgical intervention is required to eliminate the nodule, such as external hemorrhoidectomy. Post-surgery, dressing changes such as Mupirocin ointment, red oil gauze strips, Golden Ointment, and other medications are recommended. Furthermore, the patient should maintain good bowel habits, avoiding prolonged toilet time or excessive straining.

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Written by Yu Xu Chao
Colorectal Surgery
1min 9sec home-news-image

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.

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Written by Chen Tian Jing
Colorectal Surgery
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Can thrombotic external hemorrhoids go away?

Thrombotic external hemorrhoids mainly refer to the formation of blood clots within the external hemorrhoids located around the anus. During the acute phase of thrombotic external hemorrhoids, there is generally severe pain and a feeling of distension in the anal region. If not treated with medication, thrombotic external hemorrhoids are difficult to resolve on their own. Options include applying hemorrhoid cream or using traditional Chinese medicine solutions for fumigation and hot compresses to promote the absorption and dissipation of the blood clots in the external hemorrhoids. If conservative medication does not yield good results, surgery can be considered to strip and remove the blood clots from the external hemorrhoids. Failure to use medications can potentially lead to a worsening of the thrombotic external hemorrhoids, or an increase in blood clots leading to necrosis and delaying treatment of the disease.