Hemorrhoids are divided into several degrees.

Written by Yu Xu Chao
Colorectal Surgery
Updated on May 20, 2025
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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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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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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.

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What are the effects of external hemorrhoid fumigation and washing liquid?

Shrink hemorrhoids, eliminate swelling. For the treatment of external hemorrhoids, one can choose Chinese herbal washes to fumigate the affected area, apply hot compresses, or take sitz baths. Their primary efficacy is to shrink the local external hemorrhoidal nodules and reduce swelling through the effects of the medication, or to enable the self-absorption of thrombosis and varicose veins within the local nodules. Beyond local fumigation agents, the treatment of external hemorrhoids can also include applying ointments or using suppositories. It is also necessary to maintain good bowel habits to avoid further irritation and enlargement from stool. If repeated treatment for external hemorrhoids is ineffective, or if the local symptoms are severe, surgery may be considered to remove the external hemorrhoids completely.

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Colorectal Surgery
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What should I do about thrombosed external hemorrhoids?

Thrombotic external hemorrhoids often occur due to intense exercise, straining during bowel movements, eating spicy and stimulating foods, or after fatigue. The onset of thrombotic external hemorrhoids is quite sudden, presenting as a round or oval lump under the skin at the edge of the anus during defecation, with the lump being a subcutaneous blood clot formed from subcutaneous bleeding. The treatment method for thrombotic external hemorrhoids is determined by the amount of subcutaneous bleeding. If the diameter of the thrombus is less than 0.5 centimeters, conservative treatment can be chosen, which includes eating more vegetables and fruits to keep bowel movements smooth and applying hemorrhoid creams and suppositories. If the thrombotic external hemorrhoids do not respond to conservative treatment and the thrombus cannot be absorbed and resolved, a thrombotic external hemorrhoid excision procedure may be adopted.

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Is a mixed hemorrhoidal thrombosis external hemorrhoid serious?

When thrombotic external hemorrhoids are combined with mixed hemorrhoids, the situation is generally not severe. However, if it is in the acute phase, it needs to be dealt with as soon as possible. During the acute phase of thrombotic external hemorrhoids, there is severe pain in the local area of the anus, accompanied by swelling. The patient feels restless and the pain is unbearable, and thrombectomy surgery needs to be performed as soon as possible. If mixed hemorrhoids with thrombosis do not affect the patient's life, methods such as using anal plugs, hemorrhoid suppositories, or applying hemorrhoid cream to the anus can be used. Additionally, attention should be paid to not strain too much during bowel movements, as excessive straining can cause more severe congestion and swelling in the hemorrhoidal nucleus in the local area of the anus, thereby aggravating the condition of thrombotic external hemorrhoids.