Swollen varicose veins lying in the anus region just below the mucous membranes are termed as external hemorrhoids. These are very uncomfortable and painful compared to internal hemorrhoids as the top layer of the skin ruptures causing severe pain and bleeding. In few cases, blood clots form within the hemorrhoid tissue due to increased flow of blood in to the swollen tissue forming thrombosed hemorrhoids. These are very painful and irritating.
Why do external hemorrhoids develop?
Various factors aggravate the formation of hemorrhoids. Increased straining to pass the stools, sitting quite a long time on toilet seat, poor intake of fiber or long hours of sitting or standing exert pressure on veins associated with the anus and rectum causing them to stretch and swell. Increased stretching of the swollen veins causes hemorrhoids. Other medical conditions such as obesity and cirrhosis also aggravate this disease.
Symptoms of external hemorrhoids
- Can be sensed as a bulge near the anus region.
- Formation of painful anal lumps due to formation of blood clots within the swollen veins.
- Formation of skin tags that complicate the cleaning process of anus region.
- Traces of blood may be observed in stools or on toilet paper.
- Persistent urge to defecate even after passing the stools.
- Intense pain and itching of the anus region due to mucus leaking from the swollen tissue.
All individuals suffering with these hemorrhoids may not show these symptoms.
Diagnosis and Treatment of external hemorrhoids
External hemorrhoids can be diagnosed by simple physical examination and by knowing the history of the symptoms. Digital examination of the rectum reveals signs of bleeding. Other tests such as colonoscopy and sigmoidoscopy are done to identify other reasons of rectal bleeding such as colon cancer or polyps.
Small sized hemorrhoids can often be managed by following natural measures such as relieving constipation by softening the stools. Stool softeners, fiber supplements, increased intake of water and fiber rich diet help to soften the stools.
- Regular practice of exercises helps to improve bowel movements and reduces straining.
- Pain can be relieved temporarily by using topical hemorrhoid creams containing analgesics or anesthetics. However, use the creams only for a short duration as suggested by the physician.
- Vasoconstrictors can be used to shrink the blood vessels.
- Use of small ice pack on the anal region helps to reduce the inflammation as well as pain.
- If the other measures do not work then, medical procedures such as sclerotherapy, rubber band ligation and coagulation techniques are used to shrink the swollen tissue.
- If the pain worsens within 48-72 hours then it is an indication for presence of thrombosed hemorrhoid. Very large thrombosed external hemorrhoids are often removed surgically. Hemorrhoidectomy (surgical removal of hemorrhoids) can be done either by conventional method or by stapled hemorrhoidectomy. In either case, post operative pain is severe and also results in other complications. Retention of urine, hemorrhage, anal fissures, anal infections and leaking of stools are some of the complications of hemorrhoidectomy. However, pain is less and recovery time is fast in case of stapled hemorrhoidectomy.
For quick relief from pain avoid activities such as straining at stools, standing or sitting for a long time to avoid pressure on anal veins. Itching can be reduced by keeping the area dry.
How to prevent external hemorrhoids?
External hemorrhoids can be prevented by following certain measures.
- Increasing the intake of fiber to about 20-30 grams per day.
- Drinking adequet amount of water every day based on age and climate.
- Doing simple exercises such as brisk walking to improve bowel functioning.
- Never backup stools. Empty the bowels whenever you feel the urge to defecate.