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 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 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 Chen Tian Jing
Colorectal Surgery
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What fruits should be eaten for thrombotic external hemorrhoids?

During the acute phase of thrombosed external hemorrhoids, patients experience varying degrees of pain in the anal region, occasionally accompanied by a feeling of bloating. Therefore, the diet should primarily consist of light, liquid, and easy-to-digest foods. If consuming fruits, it is best to eat soft, cool-natured fruits such as dragon fruit and bananas, avoiding hard or tropical fruits that may cause dry stools, which can exacerbate the symptoms of thrombosed external hemorrhoids. During the acute phase of thrombosed external hemorrhoids, in addition to dietary considerations, it is also necessary to use topical hemorrhoid cream locally or undergo surgery to excise and strip the local thrombosis for significant symptom relief, to prevent the condition from worsening, which could lead to increased thrombosis or necrosis.

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Written by Deng Heng
Colorectal Surgery
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Can external hemorrhoids be treated without surgery?

Some external hemorrhoids do not require surgical treatment, as they come in three types. The first type, connective tissue external hemorrhoids, mainly presents as a mild foreign body sensation, generally painless, thus surgery is not necessary. Varicose vein type external hemorrhoids typically cause a feeling of heaviness and discomfort around the anus, and if symptoms are not severe, surgery is not required either. Only thrombosed external hemorrhoids, which usually involve severe pain, may resolve significantly on their own within two to three days if the lump is not large. Surgery is only needed for large, thrombosed external hemorrhoids.

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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.