Hemorrhoids are often caused by straining while having a bowel movement. People may push too hard, sit on the toilet for too long, or have a stool that is hard and difficult to pass.
If an external hemorrhoid does not go away in 1 to 2 weeks, a doctor may prescribe stool softeners to make passing the stool easier. However, if a person is in severe pain, a doctor may recommend surgical removal of the hemorrhoid.
Causes and risk factors
Constipation can cause external hemorrhoids that may become painful.
In addition to straining, other causes and risk factors for hemorrhoids include:
- lifting heavy objects or weights
- a low-fiber diet
- standing or sitting for long periods of time
- ascites, which is a buildup of fluid that places extra pressure on the stomach and intestines
External hemorrhoids are different from other hemorrhoid types, mostly due to their location.
Internal hemorrhoids, for example, are inside the rectum. Usually, they are 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 out of 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.
What are the symptoms?
External hemorrhoids are often itchy and may be painful.
People can often feel them if they touch the area around the anus. External hemorrhoids are typically slightly less pink than the surrounding skin.
Blood in the stool
People with external hemorrhoids may also notice some blood when they pass stool. The blood is typically on the stool's outer surface and 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 their doctor.
Blood clots in the hemorrhoid
External hemorrhoids can be very painful if they become thrombosed. Thrombosed hemorrhoids are usually purple-blue.
A thrombosed hemorrhoid occurs when the veins that cause the bulge in the hemorrhoid develop a blood clot. As a result, blood is unable to flow to the hemorrhoid, and the effect can be extremely painful.
The body will often absorb the blood clot, therefore 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.
A doctor can diagnose external hemorrhoids during a physical examination.
A doctor can diagnose external hemorrhoids by assessing symptoms as well as conducting a physical exam.
Anyone who suspects they have external hemorrhoids should see a doctor.
This is important because some of the symptoms, such as bleeding, can be due to other more severe conditions, including:
What are the treatment options?
Treatments include home remedies and surgery.
Examples of home remedies people can use to treat hemorrhoids include:
- taking warm baths
- gently cleaning the anus 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
Removing a painful thrombosed external hemorrhoid within 72 hours after it develops can provide more rapid pain relief than other treatments, according to a study in the journal American Family Physician.
A doctor can perform surgery with local anesthesia.
Surgery is only effective if the procedure takes place within 72 hours of the symptoms developing. After this time, surgery is not typically helpful, and symptoms will eventually improve on their own.
Treatments during pregnancy
Pregnant women can try many of the home remedies listed above to treat their external hemorrhoids and ease the pain. However, they must always check with their doctor before using any topical application on external hemorrhoids to ensure it will not interfere with the pregnancy.
Eating more dietary fiber can help prevent constipation and hemorrhoids.
The main way to prevent external hemorrhoids from developing involves avoiding 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, including eating fresh fruits, vegetables, whole-grain bread, and cereals.
- Drinking plenty of water each day, so that every time a person urinates the urine is pale yellow.
- Engaging in regular physical activity, which promotes natural movement of the bowels.
- Using the bathroom when needed and not delaying for an unnecessary amount of time.
- Reducing the amount of time spent sitting on the toilet.
People who have recurring problems with constipation and hemorrhoids should talk to their doctor about treatment options.
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 see their doctor for recommended treatments.