The difference between internal and external hemorrhoids

Written by Yu Xu Chao
Colorectal Surgery
Updated on November 26, 2024
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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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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.

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Written by Deng Heng
Colorectal Surgery
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How to treat thrombotic external hemorrhoids?

The treatment of thrombosed external hemorrhoids generally falls into two categories: first, conservative treatment; second, surgical treatment. Small lumps can be treated conservatively, and after 2-3 days, the thrombus can be absorbed, the pain can be significantly reduced, and self-healing is possible. However, larger lumps may erode on the surface, causing bleeding and severe pain that can impede walking and cause discomfort while sitting or lying down. In such cases, thrombectomy may be necessary.

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Written by Chen Tian Jing
Colorectal Surgery
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How to treat thrombosed external hemorrhoids

The treatment of thrombosed external hemorrhoids generally includes conservative medication or surgical treatment. Thrombosed external hemorrhoids are a clinical type of external hemorrhoids. They usually present in the acute phase with significant local pain and thrombus encapsulation within the hemorrhoid. Due to congestion and edema in the hemorrhoid, excessive pressure builds up inside, causing severe pain for the patient. Conservative medication treatment primarily involves sitz baths with hemorrhoidal wash solutions and hot compresses to promote thrombus absorption, as well as applying hemorrhoidal creams, or orally taking anti-swelling, pain-relieving, and thrombus-absorbing medications. If these methods repeatedly fail, surgery can be opted to strip and remove the local thrombus.

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Written by Yu Xu Chao
Colorectal Surgery
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Do external hemorrhoids require surgery?

If external hemorrhoids do not cause any discomfort to the patient, then it is possible to delay surgical treatment in this situation. This is because the treatment of external hemorrhoids is primarily based on their clinical symptoms to choose different treatment methods. If it is simply a case of redundant skin hemorrhoids, where the patient only experiences a slight foreign body sensation in the anus, surgical intervention is not necessary. The patient only needs to maintain smooth bowel movements, perform more anal lifting exercises, avoid prolonged sitting and squatting, and take a warm saltwater sitz bath after defecation to prevent exacerbation of the external hemorrhoids. However, if the external hemorrhoid node develops inflammatory edema or thrombosis, causing anal swelling and pain, and the patient is unable to walk normally, it is then recommended to promptly visit the proctology department of a hospital to undergo external hemorrhoidectomy, to prevent worsening of the inflammatory edema or thrombosis, leading to significant anal swelling and pain.

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Written by Yu Xu Chao
Colorectal Surgery
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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.