External Hemorrhoids

Written by Elly Dock
Medically Reviewed by George Krucik, MD

What Are External Hemorrhoids?

Hemorrhoids occur when the veins of the rectum or anus become inflamed because of too much straining in the area. Depending on where your hemorrhoids are located, they are considered “internal” or “external.” External hemorrhoids are usually found beneath the skin that surrounds the anus.

Recognizing the Symptoms of External Hemorrhoids

There are a range of symptoms that can affect a person with hemorrhoids. Symptoms tend to vary depending on the severity of your hemorrhoids. Some of the symptoms that you may have include the following:

  • itching around the anus or rectal area
  • pain around the anus
  • lumps near or around the anus
  • blood in the stool

You may notice bleeding when using the bathroom, such as seeing blood on toilet paper or in the toilet. Lumps around the anus may feel as if they are swollen. These symptoms may also occur because of other conditions. If you think that you may have hemorrhoids, you should schedule an exam with your doctor.

What Are the Causes of External Hemorrhoids?

Hemorrhoids may be caused by a few different factors. The most common cause of hemorrhoids is repeated straining while having a bowel movement. Straining gets in the way of blood flow into and out of the area, which results in pooling of blood and enlargement of the vessels in that area. For the same reason, a severe case of constipation or diarrhea can also cause hemorrhoids. Additionally, pregnant women may be at increased risk of hemorrhoids because of the pressure that the uterus places on these veins.

Who Is at Risk for External Hemorrhoids?

If your parents have had hemorrhoids in the past, you may be more likely to have them as well. Hemorrhoids may also be caused by other factors, such as pregnancy or aging. Your doctor might be able to determine the main factors that are causing you to experience hemorrhoids. Anything that causes you to strain during bowel movements can lead to external hemorrhoids.

How Are External Hemorrhoids Diagnosed?

Because many of the symptoms of external hemorrhoids can also be caused by other conditions, it is necessary to have an in-depth exam to find out if your symptoms are from hemorrhoids or another condition. Your doctor may use a series of tests to confirm the presence of external hemorrhoids near the anus. These tests may include:

  • proctoscopy
  • digital rectum exam
  • colonoscopy
  • sigmoidoscopy
  • anoscopy

Your doctor may begin with a physical exam to find out if you have any swollen veins that may be causing external hemorrhoids. In cases of external hemorrhoids, your doctor may be able to see the hemorrhoids during this physical exam. Procedures such as a colonoscopy, anoscopy, sigmoidoscopy, or proctoscopy will allow your doctor to examine any possible abnormalities. If your doctor suspects that you have internal hemorrhoids instead of external hemorrhoids, he or she may use an anoscopy to examine the inside of the anus.

Find an internist or a general surgeon near you.

Treating External Hemorrhoids

Hemorrhoids can be treated in a few ways, depending on how severe or bothersome they may be. Your doctor may ask if you have any preference for certain types of medications or treatments; this can help him or her find the option that is the best choice for you. Some general treatments that your doctor might suggest include ice packs to reduce swelling, suppositories, or hemorrhoid creams.

These options can offer relief to individuals who have minimal hemorrhoids. If you have a more severe case of hemorrhoids, your doctor may suggest treating your hemorrhoids with a surgical procedure. Surgical treatments include:

  • removal of hemorrhoids (hemorrhoidectomy)
  • burning hemorrhoid tissue (infrared photo, laser, or electrical coagulation)
  • reduction of the hemorrhoids (sclerotherapy or rubber band ligation)

What Is the Long-Term Outlook for External Hemorrhoids?

Hemorrhoids are a fairly common condition and are usually not severe. Many people recover well from their hemorrhoids with proper treatment and do not have continued symptoms in the future. In severe cases of external hemorrhoids, surgical methods may be necessary for treatment. People who have severe external hemorrhoids may only notice a reduction in hemorrhoids as a result of these types of treatment.

How Can I Prevent External Hemorrhoids From Developing?

The main factor for preventing external hemorrhoids is to avoid straining during bowel movements. If you have severe constipation, you may want to try using aids such as laxatives or include more fiber in your diet to help ease your bowel movements. Stool softeners are another popular over-the-counter option that can help you if you are dealing with temporary constipation due to pregnancy or other factors. If these options do not help, you may want to talk with your doctor about other options to reduce strain.

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