Do external hemorrhoids require surgery?

Written by Yu Xu Chao
Colorectal Surgery
Updated on April 10, 2025
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If external hemorrhoids do not cause any discomfort to the patient, then it is possible to delay surgical treatment in this situation. This is because the treatment of external hemorrhoids is primarily based on their clinical symptoms to choose different treatment methods.

If it is simply a case of redundant skin hemorrhoids, where the patient only experiences a slight foreign body sensation in the anus, surgical intervention is not necessary. The patient only needs to maintain smooth bowel movements, perform more anal lifting exercises, avoid prolonged sitting and squatting, and take a warm saltwater sitz bath after defecation to prevent exacerbation of the external hemorrhoids.

However, if the external hemorrhoid node develops inflammatory edema or thrombosis, causing anal swelling and pain, and the patient is unable to walk normally, it is then recommended to promptly visit the proctology department of a hospital to undergo external hemorrhoidectomy, to prevent worsening of the inflammatory edema or thrombosis, leading to significant anal swelling and pain.

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Written by Yu Xu Chao
Colorectal Surgery
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How to relieve the pain of external hemorrhoids?

When there is pain in an external hemorrhoidal tag, it is often due to inflammatory edema or the formation of a thrombus, leading to pain. In such cases, it is advisable to first use an anal cleansing agent or a potassium permanganate solution for a sitz bath after defecation. The duration of the sitz bath should be controlled between five to ten minutes, which can effectively reduce swelling and relieve pain. After the sitz bath, applying external remedies such as Yellow Ointment or Musk Hemorrhoids Cream can also help reduce swelling and alleviate pain. For particularly severe pain, directly using diclofenac sodium suppositories inserted into the anus can provide anti-inflammatory and analgesic effects. Additionally, for external hemorrhoids with inflammatory edema, it is also necessary to combine this with oral diosmin tablets to relieve discomfort. However, if the external hemorrhoidal tag remains swollen for a long period or if the thrombus does not resolve, it is advisable to consider early surgical excision of the external hemorrhoids, followed by diligent postoperative dressing changes.

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Written by Yang Dong
Colorectal Surgery Department
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Symptoms of thrombosed external hemorrhoids

Thrombotic external hemorrhoids are a type of external hemorrhoids. They are caused by the rupture of blood vessels in external hemorrhoids, leading to blood spillage, which in turn causes pain and inflammation. The symptoms manifest as a sudden hard lump near the anus. If visible, subcutaneous purple bruises can be seen, and pressing on it causes pain. Generally, surgical treatment is required.

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Written by Chen Tian Jing
Colorectal Surgery
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Is a mixed hemorrhoidal thrombosis external hemorrhoid serious?

When thrombotic external hemorrhoids are combined with mixed hemorrhoids, the situation is generally not severe. However, if it is in the acute phase, it needs to be dealt with as soon as possible. During the acute phase of thrombotic external hemorrhoids, there is severe pain in the local area of the anus, accompanied by swelling. The patient feels restless and the pain is unbearable, and thrombectomy surgery needs to be performed as soon as possible. If mixed hemorrhoids with thrombosis do not affect the patient's life, methods such as using anal plugs, hemorrhoid suppositories, or applying hemorrhoid cream to the anus can be used. Additionally, attention should be paid to not strain too much during bowel movements, as excessive straining can cause more severe congestion and swelling in the hemorrhoidal nucleus in the local area of the anus, thereby aggravating the condition of thrombotic external hemorrhoids.

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Written by Yu Xu Chao
Colorectal Surgery
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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.

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Written by Yu Xu Chao
Colorectal Surgery
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Can external hemorrhoids heal by themselves?

External hemorrhoids can be classified into cutaneous flap hemorrhoids, varicose vein hemorrhoids, thrombotic hemorrhoids, and inflammatory hemorrhoids. These are mostly caused by poor defecation habits of the patient, such as prolonged defecation time or excessive straining during bowel movements, which then lead to the growth of excess skin flaps, varicose veins, or rupture of venous blood vessels, resulting in various types of external hemorrhoids. Therefore, these types of hemorrhoids cannot heal on their own and require treatment with medication or surgery. For cutaneous flap hemorrhoids, if the patient does not experience significant discomfort, specific treatment is generally not necessary, just attention to hygiene around the anal area is needed. However, for inflammatory or thrombotic hemorrhoids, since they can cause anal pain and a feeling of prolapse, it is advisable to opt for surgical stripping of the hemorrhoids as soon as possible. Post-surgery, treatments such as anal washes, red oil gauze strips, and golden ointment should be used for dressing changes, while also maintaining cleanliness of the anal region.