What is External Hemorrhoid?
Hemorrhoids are a common health issue that can cause symptoms from mild discomfort to severe pain, and may even have substantial impact on a person’s mental and social well-being.
Hemorrhoids have a high amount of blood vessels and can swell up and slip out of place. The symptoms can range from a slight itch and bleeding to intense pain. Unfortunately, due to the awkward nature of the location, many individuals avoid seeking treatment because they feel embarrassed.
Doctors usually start with simple treatments, which a primary care doctor can kick-start. Educating the patient about the condition is extremely important. If the hemorrhoids persist or are severe, a specialist in colon and rectum diseases (colorectal surgeon) can take over. These specialists have a range of treatment methods at their disposal, from minimally invasive procedures to full surgical removal of the hemorrhoids.
What Causes External Hemorrhoid?
Pathologic hemorrhoids, or abnormal hemorrhoids, occur due to an increased pressure within the network of blood vessels in the rectal area, also known as the hemorrhoid plexus. This usually happens when there is increased pressure within the abdomen. This could be due to multiple reasons such as continuously pushing hard during bowel movements or due to pregnancy and childbirth. In fact, having a history of passing hard stools frequently can lead to hemorrhoid disease.
There are several risk factors related to developing hemorrhoids which include:
- A family history of hemorrhoids
- Chronically loose stools
- A sedentary, or inactive, lifestyle
- Obesity
- Belonging to a higher socioeconomic status
- Injuries to the spinal cord
- Previous rectal surgery
- Engaging in anal sex
- Having an inflammatory bowel disease
Risk Factors and Frequency for External Hemorrhoid
Hemorrhoid disease is a widespread issue that affects the anal and rectal areas and is a leading cause of rectal bleeding. This condition affects millions of people in the United States, with both men and women having equal chances of suffering from it. Though it’s seldom seen in people under 20, it typically manifests most frequently between the ages of 45 and 65. Pregnancy can also increase the risk of developing hemorrhoid disease, with about 35% of pregnant women potentially experiencing this condition.
Signs and Symptoms of External Hemorrhoid
Hemorrhoids are a common condition marked by discomforting symptoms such as pain, itching, burning sensation, swelling, and rectal bleeding. Those suffering from hemorrhoids often notice bright red blood in the toilet. Hemorrhoids are, in fact, the leading cause of rectal bleeding.
Physical observations associated with this condition commonly include:
- Presence of skin tags
- Fistulas or fissures
- Prolapsed or clotted hemorrhoid
- Blood observed during examination
Testing for External Hemorrhoid
Your doctor may ask you to lie on your stomach or on your left side during your physical exam. The goal is to get a clear view of your backside. By doing this, your doctor will be able to check for conditions like hemorrhoids, tears in the skin around the anus (anal fissure), a rectal prolapse (part of the rectum coming out through the anus), and abnormal connections between two body parts (fistulas).
Your doctor will then carry out a digital exam. This simply means they will wear a glove, apply a lubricating jelly to their finger, and then gently insert the finger into your rectum. This can help your doctor feel for any abnormalities.
Your doctor may also decide to use an instrument called an anoscope. This device helps them see further into your rectum. They might ask you to bear down as if you are trying to pass stool. This action can help to mimic the kind of pressure your abdomen experiences when you are defecating, making it easier for your doctor to identify any issues.
If a physical exam isn’t enough, or if you are uncomfortable with the examination in the clinic, your doctor might suggest performing the exam in an operating room under anesthesia. This is often done in more complex cases or when colorectal surgeons are involved.
Treatment Options for External Hemorrhoid
Treating symptomatic hemorrhoids, or swollen veins in the rectum or anus, typically begins with non-medical treatments. These include changes to diet like increasing fiber intake, using stool softeners, and drinking more water. It’s important to note that fiber should be paired with enough water to make sure stool is not just larger, but softer. Medications like polyethylene glycol, which increase water content to soften stool, and docusate, which helps water and fat mix into the stool, are also often used. These changes help lessen straining and pressure when using the restroom. This helps reduce congestion and allows the hemorrhoids to return to a normal, non-irritated state.
If these non-invasive measures don’t help, there are minor procedures available for treating first, second, and some third-degree internal hemorrhoids. These include rubber band ligation, a procedure where bands are placed around the hemorrhoids to cut off their blood supply; sclerotherapy, where a chemical solution is injected into the hemorrhoid to shrink it; and infrared photocoagulation, which uses heat to cause scar tissue to cut off the hemorrhoid’s blood supply.
If the disease is persistent or severe, a surgical procedure called a hemorrhoidectomy can be performed. This surgery, which removes the hemorrhoids, can sometimes be done on the same day for healthy patients. After the procedure, pain is usually managed with medications, warm sitz baths, and over-the-counter pain relievers.
Thrombosed external hemorrhoids, which are blood clots in an external hemorrhoid, can be removed under local anesthetic. After the procedure, the area should be covered in a pressure dressing and the patient is then recommended to take sitz baths.
Other recommendations to manage hemorrhoids include:
* Drinking plenty of fluids
* Using stool softeners
* Eating a high-fiber diet
* Staying physically active
* Keeping the anal area clean
* Using painkillers for any discomfort
A crucial part of managing hemorrhoids is avoiding constipation.
What else can External Hemorrhoid be?
When a doctor is evaluating the possibility of hemorrhoids, they also need to think about other health conditions that could affect the rectal area. Some of the health problems they might consider include:
- Anal fissures, which are small tears in the lining of the lower rectum that can cause pain and bleeding, especially during bowel movements.
- Anorectal abscesses, which are painful, swollen pockets filled with pus in the anal or rectal area. They can sometimes be felt as a lump and could lead to a severe, life-threatening infection called sepsis.
- Anal prolapse, which happens when the inner lining of the rectum collapses and sticks out of the anus. It can cause pain during bowel movements and the feeling of a lump.
- Proctitis, which is inflammation of the inner lining of the rectum. It can be caused by sexual activity, and symptoms can include pain, bleeding, and even changes in skin appearance. Possible causes include Chlamydia trachomatis, Neisseria gonorrhoeae, and Herpes simplex.
- Cancer, although rare, could cause rectal bleeding and this should not be overlooked.
If the rectal bleeding is caused by hemorrhoids in a young, otherwise healthy individual, then a full colon inspection might be delayed, but close monitoring would be necessary. On the other hand, patients who have a family history of cancer or are over the age of 49 should be scheduled for a routine colonoscopy.
What to expect with External Hemorrhoid
Mild hemorrhoids often heal on their own or with minor treatment. However, they can return, become infected, form a clot (thrombosed), or even cause a lack of control of bowel movements (incontinence). Minor treatment results in more than a 50% chance of hemorrhoids returning; however, after surgery, the chance of them returning decreases to between 5% and 10%.
It’s important to note that after surgery, patients often experience significant pain, and men commonly have difficulty passing urine (retention of urine).
Possible Complications When Diagnosed with External Hemorrhoid
The most frequent issue people face after hemorrhoid removal surgery is trouble urinating, which affects around 30% to 50% of people who undergo this procedure. The pain after surgery is usually serious and often needs strong painkillers, in addition to anti-inflammatory drugs. Patients may also experience bleeding, infection, or a loss of control over their bowel movements.
Consequences of Hemorrhoidectomy:
- Trouble urinating
- Significant post-operative pain
- Bleeding
- Infection
- Loss of bowel control
Recovery from External Hemorrhoid
After the surgical removal of hemorrhoids, patients often experience a high level of pain. This is usually managed with painkillers, non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxers, and warm sitz baths. However, if the pain continues or gets worse, and is accompanied by a fever, it could mean you have an infection that’s killing the surrounding soft tissue.
Preventing External Hemorrhoid
The first step in treating uncomfortable hemorrhoids is usually through simple lifestyle changes. This includes eating more dietary fiber, taking stool softeners, and drinking more water. These changes in routine can help reduce straining during bowel movements, easing the pressure that comes with it. This can reduce swelling and let the swollen veins in the rectum (known as hemorrhoids) heal and get back to normal.
Adding more fiber to your diet can help with hemorrhoids, but it’s very important that you also drink more water. This makes sure that your stools are not just bigger but also softer. Polyethylene glycol is a type of laxative that works by increasing the water in your stools, making them softer. Docusate, on the other hand, is a type of stool softener that works by increasing the amount of water and fats in your stools, making them even softer.
