Is the pain and swelling of hemorrhoids external or internal?

Written by Yu Xu Chao
Colorectal Surgery
Updated on June 04, 2025
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This situation might involve both internal and external hemorrhoids, which is referred to as mixed hemorrhoids. Internal hemorrhoids might also prolapse, leading to inflammatory edema and causing anal swelling and pain. External hemorrhoids can also present with inflammatory edema and thrombosis, leading to anal swelling and pain. Hence, in clinical practice, this situation is often considered as mixed hemorrhoids. Mixed hemorrhoids mainly occur at the same point in the anal canal, both above and below the dentate line, and symptoms of both internal and external hemorrhoids are present. Clinically, if the patient is unwilling to undergo surgery, conservative treatment with medication can be considered initially, such as oral administration of Diosmin tablets, followed by the use of an anal wash or a sitz bath with potassium permanganate solution after defecation, and then application of Dihuang ointment externally to alleviate discomfort. However, if the inflammatory edema does not subside and anal swelling and pain are significant, it is advised to consider surgical intervention early to prevent necrosis due to prolapsed hemorrhoids. (Please follow medical advice when using medications.)

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Written by Deng Heng
Colorectal Surgery
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External hemorrhoids are located.

External hemorrhoids are formed by the inferior rectal venous plexus, located below the dentate line, and are covered by the skin of the anal canal. The most common type is thrombosed external hemorrhoids, which form when a blood clot develops in the subcutaneous venous plexus of the anal canal. Connective tissue external hemorrhoids and inflammatory external hemorrhoids are also relatively common, both located below the dentate line, around the anal margin and inside the anal canal. Generally speaking, hemorrhoids below the dentate line are called external hemorrhoids, and those above the dentate line are called internal hemorrhoids.

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Written by Deng Heng
Colorectal Surgery
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Can external hemorrhoids be treated without surgery?

Some external hemorrhoids do not require surgical treatment, as they come in three types. The first type, connective tissue external hemorrhoids, mainly presents as a mild foreign body sensation, generally painless, thus surgery is not necessary. Varicose vein type external hemorrhoids typically cause a feeling of heaviness and discomfort around the anus, and if symptoms are not severe, surgery is not required either. Only thrombosed external hemorrhoids, which usually involve severe pain, may resolve significantly on their own within two to three days if the lump is not large. Surgery is only needed for large, thrombosed external hemorrhoids.

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Written by Deng Heng
Colorectal Surgery
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How long does it take for a thrombosed external hemorrhoid to subside?

Thrombotic external hemorrhoids are a type of external hemorrhoids. Generally, after 2-3 days, the thrombus begins to be absorbed and the pain significantly reduces and can be healed. However, in cases with a large thrombotic lump, significant pain can occur and in severe cases, it can hinder walking. The patient may be restless whether sitting or lying down, the surface may re-ulcerate, causing bleeding, and the thrombus can naturally expel itself. At this time, the lump will be eliminated.

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Written by Chen Tian Jing
Colorectal Surgery
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Thrombotic external hemorrhoids clinical characteristics

The clinical features of thrombosed external hemorrhoids primarily include acute episodes of localized swelling and pain in the anal area, with thrombosis forming in the local hemorrhoidal tissue. This condition is primarily due to dry stools and excessive straining during bowel movements, leading to congestion and edema in the local hemorrhoidal tissue and subsequent disruption of local blood circulation, resulting in thrombosis. After an attack, the anal hemorrhoidal tissue may display dark red or purplish clots, enclosed by the local skin and mucous membrane. Treatment options include the application of topical medications and hot compresses to promote absorption of the hemorrhoids, as well as local surgical excision. It is important to note that if rupture or bleeding occurs, considering the possibility of local thrombus rupture, it is essential to perform proper local cleaning and disinfection and to promptly proceed with surgical excision to prevent infection.

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

If a patient experiences an acute episode of thrombosed external hemorrhoids, the local pressure on the external hemorrhoids is generally high, and there are thromboses wrapped in the hemorrhoid nucleus. However, it is not advisable for patients to burst it on their own, as under unhygienic conditions, doing so could easily lead to local infection of the hemorrhoids, further exacerbating the condition. The treatment of thrombosed external hemorrhoids requires the professional management of a proctologist. Generally speaking, for mild symptoms, local use of Chinese herbal wash solutions or hemorrhoid creams can be chosen to press on the area, which helps promote the absorption of local thromboses. Alternatively, a professional proctologist can use specialized techniques to crush and press the local thromboses. If the thromboses are large or the local symptoms are severe, causing significant pain and severely affecting normal life, surgical excision might also be considered.