External hemorrhoids are hemorrhoids that affect veins outside the anus. These hemorrhoids can cause bleeding, cracking, and itching. Home remedies can treat most external hemorrhoids.

Hemorrhoids, also called piles, often result from straining while having a bowel movement. A person may push too hard, sit on the toilet for too long, or have a stool that is hard and difficult to pass.

Most external hemorrhoids will not cause additional issues, but they can become more painful if they develop a clot, known as a thrombus. If a person is in severe pain, a doctor may recommend the surgical removal of hemorrhoids.

In this article, we detail what external hemorrhoids are, the common causes, and how a person can get rid of them.

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External hemorrhoids usually do not require a specific treatment unless they develop a clot and become painful. Most will go away on their own within a few days. Those that persist may cause discomfort, itching, and some pain. Home remedies can be effective in easing these symptoms.

People can try various home remedies to treat hemorrhoids, such as:

  • taking warm baths
  • cleaning the anus gently after a bowel movement, often by using moistened wipes or cotton pads
  • applying cloth-covered ice packs to reduce swelling
  • taking over-the-counter (OTC) pain relievers, such as ibuprofen or acetaminophen, to relieve pain and discomfort
  • applying ointments, such as creams with witch hazel or hydrocortisone, that relieve itching

Doctors can sometimes treat external hemorrhoids that develop a clot through surgery.

Surgical removal

There are two types of surgery for external hemorrhoids.

The first involves making a small cut in a thrombosed external hemorrhoid and draining blood from the clot. A doctor can perform this surgery under local anesthesia. This procedure does not remove the hemorrhoid itself. However, if a doctor can perform this procedure within 48 hours of a hemorrhoid developing, it can provide more rapid pain relief than other treatments.

After this time, surgery is not typically helpful, and the symptoms will eventually improve on their own.

The second form of surgery is a hemorrhoidectomy. This procedure fully removes the hemorrhoid and requires general anesthesia.

Learn more about hemorrhoid surgery.

Treatments during pregnancy

Many of the home remedies above are suitable to use during pregnancy to treat external hemorrhoids and ease pain. However, a pregnant person must always check with a doctor before using any topical application on external hemorrhoids to ensure that it will not interfere with the pregnancy.

External hemorrhoids protrude below the anus, and a person may be able to feel them. On the other hand, internal hemorrhoids are not visible from the outside. A digital rectal exam may be necessary to assess internal hemorrhoids.

External hemorrhoids are often itchy and irritating, and they can also cause pain and discomfort. However, not everyone experiences symptoms. In fact, in an older study from 2021, more than half of those with hemorrhoids reported no symptoms.

People with external hemorrhoids can often feel a tender lump if they touch the area around the anus.

Blood in the stool

People with external hemorrhoids may also notice some blood when they pass stool, which is typically on the stool’s outer surface. The blood tends to be bright red because it usually comes directly out of the hemorrhoid rather than anywhere else in the gastrointestinal tract.

Blood from hemorrhoids should be minimal. Anyone with external hemorrhoids who notices a significant amount of blood should contact a doctor.

Blood clots in the hemorrhoid

External hemorrhoids can be very painful if they become thrombosed. Thrombosed hemorrhoids usually appear purple-blue on light skin and grey, black, or dark brown on dark skin.

Learn more about thrombosed hemorrhoids.

A thrombosed hemorrhoid occurs when the veins that cause the bulge in the hemorrhoid develop a blood clot. As a result, blood cannot flow to the hemorrhoid, and the effect can be excruciating.

The body will often absorb the blood clot in time, reducing the symptoms and easing the pain.

When the blood clot passes or the body reabsorbs it, an external hemorrhoid may sometimes leave behind a perianal skin tag. A doctor may recommend surgical removal if this skin tag regularly catches stool and is difficult to keep clean.

In addition to straining, other possible causes of hemorrhoids include:

  • lifting heavy objects or weights
  • a low fiber diet
  • obesity
  • standing or sitting for extended periods
  • pregnancy
  • ascites, which is a buildup of fluid that places extra pressure on the stomach and intestines

Hemorrhoids are one of the most common medical conditions, and the likelihood of developing them increases with age. The reason for this is that the tissues lining the anus and sphincter become thinner and less able to withstand pressure from pushing and straining.

External hemorrhoids are different than other hemorrhoid types, mostly due to their location. Internal hemorrhoids, for example, are inside the rectum. They are usually painless but may bleed.

Prolapsed hemorrhoids are internal hemorrhoids that sometimes bulge outside of the anus. It is possible to push these hemorrhoids back inside, but they may go back in without intervention.

External hemorrhoids protrude from the anus. They tend to cause more pain than internal hemorrhoids because the outside of the anus is more sensitive than the inside.

People may have multiple hemorrhoid types at the same time.

A doctor can diagnose external hemorrhoids by assessing the person’s symptoms and conducting a physical exam.

Anyone who suspects that they have external hemorrhoids should see a doctor. Some of the symptoms, such as bleeding, can be due to other more severe conditions, including:

The primary way to prevent external hemorrhoids from developing is to avoid constipation and the development of hard, dry stools that are difficult to pass.

Tips to prevent external hemorrhoids include:

  • increasing the amount of dietary fiber in the diet to 25–30 grams by eating plenty of fresh fruits, vegetables, whole grain bread, and cereals
  • drinking enough water each day so that every time a person urinates, the urine is pale yellow
  • engaging in regular physical activity, which promotes the natural movement of the bowels
  • using the bathroom when necessary and not delaying for an unnecessary amount of time
  • spending the shortest possible time sitting on the toilet

People who have recurring problems with constipation and hemorrhoids should talk with a doctor about the treatment options.

Below, we provide answers to some of the questions people often ask about external hemorrhoids.

Are external hemorrhoids painful?

External hemorrhoids can be painful. They are usually most painful immediately following a bowel movement or after straining or lifting.

They may be especially painful if they develop a blood clot, which is known as a thrombosed hemorrhoid. If medical professionals can lance and drain the clot within 2 days of development, the pain will ease immediately. If not, the clot will likely dissolve on its own, and the pain will ease in time.

Are external hemorrhoids dangerous?

External hemorrhoids are rarely dangerous. They can develop a blood clot that may burst, but although this will cause several minutes of bleeding, it will usually end independently. If it does not, a person should seek emergency medical treatment.

Anyone who experiences regular rectal bleeding should avoid assuming that it is from a hemorrhoid. Rectal bleeding can signify other issues, including colorectal cancer or anal cancer. A person should discuss regular rectal bleeding and any other symptoms with a doctor.

Do external hemorrhoids go away on their own?

Yes, most external hemorrhoids will go away on their own within weeks, even without treatment. However, external hemorrhoids can recur, which means that a person may deal with them regularly if they do not take steps to prevent them.

Can you push an external hemorrhoid back in?

No, external hemorrhoids develop outside the anus, so a person cannot push them back in.

External hemorrhoids will usually go away on their own.

Taking steps to reduce the incidence of constipation and avoiding straining with bowel movements can help a person reduce the likelihood of developing any types of hemorrhoids.

Anyone who experiences extremely painful external hemorrhoids should consult a doctor about the treatment options.