Do external hemorrhoids without any symptoms need treatment?

Written by Yu Xu Chao
Colorectal Surgery
Updated on March 18, 2025
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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.

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Written by Yu Xu Chao
Colorectal Surgery
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The difference between internal and external hemorrhoids

Internal hemorrhoids are located above the dentate line in the anal canal, at the end of the rectum, and are innervated by the autonomic nervous system. Clinically, they are mainly characterized by intermittent, painless rectal bleeding. The blood is bright red, often dripping or spraying after defecation. If internal hemorrhoids worsen, they can prolapse and even become strangulated and edematous, causing anal swelling and pain. External hemorrhoids, on the other hand, are located below the dentate line in the anal canal, and are innervated by the spinal nerves, making them more sensitive to pain. Clinically, they are categorized into skin tag-type external hemorrhoids, varicose vein-type external hemorrhoids, inflammatory external hemorrhoids, and thrombotic external hemorrhoids. Skin tag-type and varicose vein-type external hemorrhoids primarily cause a sensation of a foreign body and itching in the anus, while inflammatory or thrombotic external hemorrhoids can lead to an increase in perianal secretions and anal swelling and pain, necessitating prompt surgical removal of the external hemorrhoids.

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Written by Chen Tian Jing
Colorectal Surgery
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How long does surgery for thrombotic external hemorrhoids take?

Thrombotic external hemorrhoid surgery primarily involves the excision of thrombotic external hemorrhoids. If it's simply an excision of external hemorrhoids, the surgery generally takes about half an hour. The recovery time post-surgery requires two to three weeks, mainly depending on the severity of the patient's condition and individual tissue healing rates, which can vary. After the excision surgery for thrombotic external hemorrhoids, a local wound is left, necessitating daily disinfection and dressing changes. When necessary, hemorrhoid ointment or muscle-generating Yuhong ointment may also be applied to promote healing and treatment.

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Written by Chen Tian Jing
Colorectal Surgery
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How to deal with external hemorrhoids bleeding?

If external hemorrhoids bleed without apparent reason, it may be due to the rupture of thrombosed external hemorrhoids, leading to bleeding. Firstly, it is necessary to disinfect and clean the local wound to avoid accumulation of blood or contaminants and feces, which may cause infection of the wound. If the bleeding does not stop, topical hemostatic drugs or oral hemostatic drugs should be used for symptomatic treatment. If external hemorrhoids bleed and are accompanied by severe prolapse of internal hemorrhoids, it is recommended that the patient undergo surgical treatment to remove and ligate both external and internal hemorrhoids at the same time. This can further prevent exacerbation of bleeding and fundamentally treat hemorrhoids. Patients with bleeding external hemorrhoids must have a light diet and avoid irritating foods such as chili peppers and seafood. (The use of medications should be under the guidance of a doctor.)

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Written by Yu Xu Chao
Colorectal Surgery
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How to eliminate external hemorrhoids with a fleshy lump?

External hemorrhoids involving a flesh mass are considered organic lesions. Complete removal typically requires hemorrhoid surgery, such as excision of external hemorrhoids or debridement surgery. Postoperative care includes changing dressings using products like anal washes, red oil gauze strips, and golden ointment. It is also important for patients to develop good bowel habits post-surgery, maintain smooth bowel movements, and avoid prolonged or excessive straining to facilitate recovery and prevent recurrence of external hemorrhoids. If treated solely with conservative medication, the flesh mass of external hemorrhoids can only be reduced, not completely eliminated. Inappropriate diet or abnormal bowel movements can lead to an increase in the size of external hemorrhoids, potentially causing inflammatory edema or thrombosis, which can result in significant anal discomfort and severely impact the patient’s normal life. Therefore, the treatment approach for external hemorrhoid flesh mass should be based on the severity of the condition.

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Colorectal Surgery
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Thrombosed external hemorrhoid characteristics

Thrombosed external hemorrhoids are a clinical type of external hemorrhoids. The main characteristics of the hemorrhoid nucleus in thrombosed external hemorrhoids are that the hemorrhoid nucleus is stuck at the anus and cannot retract, accompanied by swelling and enlargement. As the hemorrhoid nucleus contains thrombosis, its color is mostly purplish red or dark red, and patients will experience severe local pain and a sensation of distension. Thrombosed external hemorrhoids generally belong to the acute phase of external hemorrhoids, often occurring when the stool is dry or the intestinal heat is severe. For the treatment of thrombosed external hemorrhoids, one can choose Chinese herbal solution for hot compresses to promote the absorption of the thrombus, or directly perform a surgical excision. (This answer is for reference only. For medication, please consult a professional physician and do not medicate blindly.)