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 Yu Xu Chao
Colorectal Surgery
1min 11sec home-news-image

How to relieve the pain of external hemorrhoids?

When there is pain in an external hemorrhoidal tag, it is often due to inflammatory edema or the formation of a thrombus, leading to pain. In such cases, it is advisable to first use an anal cleansing agent or a potassium permanganate solution for a sitz bath after defecation. The duration of the sitz bath should be controlled between five to ten minutes, which can effectively reduce swelling and relieve pain. After the sitz bath, applying external remedies such as Yellow Ointment or Musk Hemorrhoids Cream can also help reduce swelling and alleviate pain. For particularly severe pain, directly using diclofenac sodium suppositories inserted into the anus can provide anti-inflammatory and analgesic effects. Additionally, for external hemorrhoids with inflammatory edema, it is also necessary to combine this with oral diosmin tablets to relieve discomfort. However, if the external hemorrhoidal tag remains swollen for a long period or if the thrombus does not resolve, it is advisable to consider early surgical excision of the external hemorrhoids, followed by diligent postoperative dressing changes.

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Written by Yu Xu Chao
Colorectal Surgery
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Hemorrhoids are divided into several degrees.

In clinical practice, external hemorrhoids are not classified by degrees but mainly into skin tag hemorrhoids, varicose vein hemorrhoids, inflammatory hemorrhoids, and thrombosed hemorrhoids. Skin tag hemorrhoids and varicose vein hemorrhoids typically cause sensations of foreign bodies in the anus and feelings of anal prolapse, etc., and conservative medication treatment is generally chosen for these. However, thrombosed hemorrhoids or inflammatory hemorrhoids can cause significant anal swelling and pain, severely impacting the patient's normal life. For these two types of external hemorrhoids, it is recommended to promptly undergo hemorrhoidectomy, followed by medication treatment to promote healing of the surgical site. Because the surgical site for hemorrhoid operations is located at the anus, it is susceptible to contamination from feces and other secretions, which can easily lead to local infections, bleeding, and swelling. Therefore, it is essential to persist in changing dressings and to maintain smooth bowel movements.

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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.

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Written by Chen Tian Jing
Colorectal Surgery
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Thrombosed external hemorrhoid characteristics

Thrombosed external hemorrhoids are a clinical type of external hemorrhoids. The main characteristics of the hemorrhoid nucleus in thrombosed external hemorrhoids are that the hemorrhoid nucleus is stuck at the anus and cannot retract, accompanied by swelling and enlargement. As the hemorrhoid nucleus contains thrombosis, its color is mostly purplish red or dark red, and patients will experience severe local pain and a sensation of distension. Thrombosed external hemorrhoids generally belong to the acute phase of external hemorrhoids, often occurring when the stool is dry or the intestinal heat is severe. For the treatment of thrombosed external hemorrhoids, one can choose Chinese herbal solution for hot compresses to promote the absorption of the thrombus, or directly perform a surgical excision. (This answer is for reference only. For medication, please consult a professional physician and do not medicate blindly.)

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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.