The difference between internal and external hemorrhoids

Written by Yu Xu Chao
Colorectal Surgery
Updated on November 26, 2024
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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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What medicine is used for thrombotic external hemorrhoids?

Thrombosed external hemorrhoids generally result from the formation of blood clots inside the local external hemorrhoids, causing acute symptoms. During an episode of thrombosed external hemorrhoids, patients experience localized pain or a feeling of constriction, and the formation of dark red or purplish external hemorrhoids can be visibly seen at the anus, which are very painful to the touch. Treatment for thrombosed external hemorrhoids primarily involves topical medications or surgery. If the symptoms are mild, one may choose to apply hemorrhoid cream or use diluted saline solution to compress and reduce swelling. Surgery can also be opted to excise and remove the affected external hemorrhoids. Thrombosed external hemorrhoids generally occur in individuals who strain excessively during defecation or after extreme fatigue. Therefore, if accompanied by dry stools, it is necessary to use stool softeners to help lubricate and ease bowel movements for treatment.

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Written by Deng Heng
Colorectal Surgery
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Will external hemorrhoids affect sexual life?

External hemorrhoids generally do not affect sexual life. External hemorrhoids mainly refer to hemorrhoids that grow below the dentate line, primarily divided into connective tissue external hemorrhoids, varicose external hemorrhoids, inflammatory external hemorrhoids, and thrombosed external hemorrhoids. The main clinical manifestations of the first three types of external hemorrhoids are a foreign body sensation in the anus and moisture at the anus, so they do not affect sexual life. Only thrombosed external hemorrhoids can cause anal pain, which might affect sexual life if the pain is very severe.

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Written by Chen Tian Jing
Colorectal Surgery
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What are the effects of external hemorrhoid fumigation and washing liquid?

Shrink hemorrhoids, eliminate swelling. For the treatment of external hemorrhoids, one can choose Chinese herbal washes to fumigate the affected area, apply hot compresses, or take sitz baths. Their primary efficacy is to shrink the local external hemorrhoidal nodules and reduce swelling through the effects of the medication, or to enable the self-absorption of thrombosis and varicose veins within the local nodules. Beyond local fumigation agents, the treatment of external hemorrhoids can also include applying ointments or using suppositories. It is also necessary to maintain good bowel habits to avoid further irritation and enlargement from stool. If repeated treatment for external hemorrhoids is ineffective, or if the local symptoms are severe, surgery may be considered to remove the external hemorrhoids completely.

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Written by Yu Xu Chao
Colorectal Surgery
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Can external hemorrhoids be punctured?

External hemorrhoids should not be punctured because they are located at the anus, which is at the end of the digestive tract and often contaminated by feces and excretions. If punctured, it can easily lead to local infection, causing pain and increased secretion, and worsening necrosis of the external hemorrhoids. Therefore, external hemorrhoids should be treated as soon as possible with hemorrhoidectomy, rather than being punctured by oneself. After surgical treatment, it is also necessary to use anal cleansers, red oil gauze, and golden ointment for dressing changes to promote the healing of the wound. Moreover, patients should maintain smooth bowel movements to avoid hard and dry stools or frequent diarrhea. In terms of diet, it is advisable to consume foods rich in roughage to ensure smooth bowel movements and to avoid fishy seafood and similar foods.

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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.