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External hemorrhoids
Do external hemorrhoids without any symptoms need treatment?
External hemorrhoids can be categorized into skin tag-like external hemorrhoids, varicose vein-like external hemorrhoids, and thrombosed external hemorrhoids. Most patients with skin tag-like external hemorrhoids do not have any sensations, and in such cases, treatment is not necessary. Patients only need to pay attention to the hygiene around the anal area. After each bowel movement, they should wash the anal area with clean water. They should also frequently change their underwear, and their diet should be light and easily digestible to avoid diarrhea or constipation. During bowel movements, it's important to ensure the process is smooth to avoid lengthy bathroom visits or excessive straining, which can prevent the exacerbation of skin tag-like external hemorrhoids, hence no treatment would be needed. However, for varicose vein-like external hemorrhoids or thrombosed external hemorrhoids, patients may experience a foreign body sensation or pain around the anus. In such cases, conservative treatment with medications can be considered initially. If conservative treatment is ineffective, surgical intervention may be required.
What causes external hemorrhoids to itch?
External hemorrhoids are hypertrophic skin tags at the anal margin and surrounding skin, or dilation of the subcutaneous venous plexus leading to blood stasis and thrombus formation, resulting in protruding lesions. According to their characteristics, they can be divided into connective tissue external hemorrhoids, thrombotic external hemorrhoids, varicose external hemorrhoids, and inflammatory external hemorrhoids. In particular, inflammatory external hemorrhoids can cause the surrounding skin to become moist. This moisture can lead to the formation of eczema and pruritic diseases in the surrounding skin, causing skin lesions. One of the main features after skin lesions is itching around the skin surrounding the external hemorrhoids.
Thrombotic external hemorrhoids clinical characteristics
The clinical features of thrombosed external hemorrhoids primarily include acute episodes of localized swelling and pain in the anal area, with thrombosis forming in the local hemorrhoidal tissue. This condition is primarily due to dry stools and excessive straining during bowel movements, leading to congestion and edema in the local hemorrhoidal tissue and subsequent disruption of local blood circulation, resulting in thrombosis. After an attack, the anal hemorrhoidal tissue may display dark red or purplish clots, enclosed by the local skin and mucous membrane. Treatment options include the application of topical medications and hot compresses to promote absorption of the hemorrhoids, as well as local surgical excision. It is important to note that if rupture or bleeding occurs, considering the possibility of local thrombus rupture, it is essential to perform proper local cleaning and disinfection and to promptly proceed with surgical excision to prevent infection.
Does the surgical removal of external hemorrhoids hurt?
Surgical removal of external hemorrhoids generally does not cause significant pain because anesthesia is required for the procedure. There are options for anesthesia, including local infiltration anesthesia, spinal anesthesia, or general anesthesia via intravenous injection, ensuring the patient does not experience notable pain during the surgery. However, post-surgery sensitivity is higher because the external hemorrhoids are innervated by perineal nerves. Therefore, it is crucial to use pain relief medication appropriately when changing dressings to alleviate discomfort. Additionally, it is essential to prevent infection, inflammation, or swelling of the wound to reduce postoperative pain. Patients should also manage their bowel movements to avoid dry, hard stools; smooth bowel movements can somewhat relieve postoperative pain. If the pain is particularly severe, the use of diclofenac sodium suppositories for anal insertion can help reduce inflammation and pain. (Please follow medical advice regarding medication use.)
Can external hemorrhoids be eliminated?
External hemorrhoids can certainly be removed. Clinically, surgical treatment can be used to remove external hemorrhoidal masses. Hemorrhoidectomy is a common surgical option and can be performed under local infiltration anesthesia, spinal anesthesia, or general anesthesia. After surgery, it is crucial for patients to adhere to changing dressings to avoid infections, inflammation, or edema at the wound site. Dietary precautions should be taken as well; spicy, irritating, and dry foods should be avoided as much as possible. If patients prefer not to undergo surgery, medications can be considered for treating external hemorrhoids, though they can only reduce the size of the hemorrhoidal masses, not eliminate them entirely. Common treatments include anal washes and sitz baths, topical application of golden ointment, and when necessary, oral administration of Diosmin can help reduce swelling. Additionally, patients should regularly perform pelvic floor exercises and avoid prolonged or excessive straining during bowel movements.
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.
What does an external hemorrhoid look like?
External hemorrhoids are hypertrophic protrusions of the skin around the anal margin, forming skin tags, or expansions of the subcutaneous venous plexus, where blood flow stagnates and thromboses form, or other raised lesion-like abnormalities appear. Based on histopathological characteristics, external hemorrhoids can be categorized into four main types: connective tissue-type, thrombotic-type, varicose-type, and inflammatory external hemorrhoids. Connective tissue-type external hemorrhoids primarily consist of hypertrophic protrusions of the anal margin skin tags, also known as skin tag external hemorrhoids. Varicose-type external hemorrhoids, also known as venous cluster-type external hemorrhoids, occur when the venous plexus below the dentate line expands and twists, forming venous clusters. Inflammatory external hemorrhoids are a condition where pre-existing skin tag external hemorrhoids develop inflammatory changes. Thrombotic-type external hemorrhoids are a type of anal disease that occurs due to bleeding from the hemorrhoidal veins or the formation of thromboses in the skin around the anus.
Can external hemorrhoids be eliminated?
External hemorrhoids are generally divided into skin tag-type external hemorrhoids, thrombotic external hemorrhoids, and inflammatory edematous external hemorrhoids; each type presents different clinical symptoms. If the condition is skin tag-type external hemorrhoids or connective tissue-type external hemorrhoids, the patient generally does not feel obvious symptoms, but these will not resolve on their own and require surgical removal. If skin tag-type or connective tissue-type external hemorrhoids do not affect the patient's normal life, it is possible to avoid excessive intervention and treatment. However, if it is thrombotic external hemorrhoids or inflammatory edematous external hemorrhoids, since there is significant pain during flare-ups that affects the patient’s normal life, surgical removal and treatment should be performed as soon as possible.
Can external hemorrhoids be treated with anti-inflammatory drugs?
Some types of external hemorrhoids can be treated with anti-inflammatory drugs. External hemorrhoids refer to hemorrhoids that are located below the dentate line. They can be divided into four categories: connective tissue external hemorrhoids, varicose vein type external hemorrhoids, thrombotic external hemorrhoids, and inflammatory external hemorrhoids. The first three types of external hemorrhoids do not require anti-inflammatory drugs. Only inflammatory external hemorrhoids, which are caused by inflammatory hyperplasia around the anus, can be treated with anti-inflammatory drugs during inflammation to reduce the size of the pathological tissues. (Please use medication under the guidance of a doctor.)
How long does it take to recover after external hemorrhoidectomy?
External hemorrhoids are mainly classified into inflammatory external hemorrhoids, thrombotic external hemorrhoids, connective tissue external hemorrhoids, and varicose vein external hemorrhoids. Regardless of the type, the primary treatment method is surgical removal. After the hemorrhoids are excised, the perianal area generally does not bleed when passing stools for the first two to three days, and the patient can usually go home in about 7 days. For complete recovery to the pre-condition state, it is estimated to take between 20 days to a month.