FAQs About External Hemorrhoids: What Are They? How Do You Treat Them?

Medically Reviewed By Cynthia Taylor Chavoustie, MPAS, PA-C
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Anyone can experience external hemorrhoids. External hemorrhoids are bulging blood vessels located on the outside of your anus. External hemorrhoids are usually the result of straining due to bowel movements or pregnancy.

Increasing your hydration, exercising regularly, and eating a diet high in fiber helps reduce your chance of developing external hemorrhoids.

This article will explain who might get external hemorrhoids, what can cause them, and how to treat them.

What are external hemorrhoids?

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External hemorrhoids are inflamed veins located on the outside of your anus that become swollen and irritated. Sometimes, they can become thrombosed external hemorrhoids.

Thrombosed external hemorrhoids are hemorrhoids that develop a blood clot. This is not a life-threatening blood clot but it is often very painful.

There are four grades of hemorrhoids:

  • Grade 1: These are slightly enlarged hemorrhoids, but you cannot see them from outside the anus.
  • Grade 2: These hemorrhoids are large and sometimes appear outside the anus during certain activities. They may appear when passing bowel movements or during physical activity. They then return inside the anus on their own.
  • Grade 3: These hemorrhoids temporarily appear outside the anus in similar situations to grade 2. However, they do not go back in on their own. You can gently push these back inside the anus yourself.
  • Grade 4: This type of hemorrhoid is always visible from the outside of the anus. You cannot push this type back inside.

Who gets external hemorrhoids?

External hemorrhoids are a common health condition found in the general population. They affect males and females equally. Pregnant people are more likely to develop the condition due to straining during labor.

Age seems to play a role in this condition. Almost half of all adults aged 50 or older experience hemorrhoids. People under age 20 rarely develop external hemorrhoids. Hemorrhoids are the most common cause of rectal bleeding.

Where are external hemorrhoids located? 

There are two types of hemorrhoids: internal and external. Internal hemorrhoids are inside your anal cavity. The swollen vessels lie along the lining of your cavity and alongside the bottom of your rectum. Sometimes, the affected blood vessels can hang below your anal opening. This type of hemorrhoid is called a prolapsed internal hemorrhoid. This is a more serious condition than other internal hemorrhoids.

External hemorrhoids are on the outside of the anus. These hemorrhoids are under the skin surrounding the anal cavity. If you were to touch the area, you may be able to feel them.

Can you push external hemorrhoids back in?

You cannot push in external hemorrhoids that are always outside the anus. It may be possible to push in hemorrhoids that only appear outside the anus temporarily. Examples include those that occur during bowel movements or physical activity.

What symptoms occur with external hemorrhoids?

There are a few symptoms associated with external hemorrhoids.

These symptoms include:

  • at least one lump near your anus
  • anal pain that is worse when seated
  • anal itching
  • bright red blood in your stool

Are external hemorrhoids painful?

External hemorrhoids can be uncomfortable. They can also become irritated when you rub the area or strain. This can cause an increase in pain and itching.

If you feel a sudden increase in pain, it may be an indication of an external thrombosed hemorrhoid.

When should you contact a doctor for external hemorrhoids? 

Sometimes, symptoms associated with thrombosed external hemorrhoids can be extremely painful and require urgent medical intervention. For occasional and mild discomfort, home remedies or a non-emergency medical visit can help relieve symptoms.

Seek medical attention as soon as you start experiencing severe rectal pain. If a procedure is necessary, it is most effective within the first 3 days of symptoms.

Learn more about when to contact a doctor for hemorrhoids.

What causes external hemorrhoids?

A host of factors, including straining, can cause external hemorrhoids. Straining can happen during a difficult bowel movement, during labor, or when you are moving heavy objects. Straining causes an increase in pressure in your abdomen. An increase in abdominal pressure will enlarge the blood vessels around your anal cavity.

A low fiber diet and dehydration can cause constipation. Diarrhea, along with chronic constipation, can also cause external hemorrhoids. Having consistently hard stools means you may be straining to produce a bowel movement.

External hemorrhoids can also develop due to obesity and a sedentary lifestyle.

Learn about some more causes of constipation.

How do you treat external hemorrhoids?

There are several different treatment options your doctor may recommend. A combination of medication and lifestyle changes can help you manage your external hemorrhoids. Your doctor may recommend hemorrhoid creams or medication to help make your bowel movements easier.

Nonsteroidal anti-inflammatory medication, such as ibuprofen, may help ease your discomfort.

Surgical removal

Surgical removal is not always the first-line treatment for external hemorrhoids. External hemorrhoid surgery, or hemorrhoidectomy, will help by removing any blood clots or swollen tissue. However, hemorrhoids may reoccur if you do not make other changes, such as to dietary and stooling habits.

Hemorrhoids have a high risk of returning if you do not address the underlying cause. Your doctor may recommend surgery if other treatments have been ineffective.

Home remedies

You may choose to treat your external hemorrhoids at home following the treatment plan your physician recommends. This may include over-the-counter stool softeners. You can also increase the amount of water you drink and your daily fiber intake. Examples of some high-fiber foods include whole grains, chickpeas, and lentils.

You can also take a sitz bath to reduce symptoms. By soaking your rectum in warm water several times a day, you can help heal the area.

Can external hemorrhoids go away on their own?

External hemorrhoids can resolve on their own within a few days. External hemorrhoid removal is usually not necessary unless the symptoms are persistent and severe.

How are external hemorrhoids diagnosed?

Your primary care physician can diagnose external hemorrhoids during a visit to their office. They will listen to your list of symptoms to determine if you may have external hemorrhoids.

A visual examination of the anus will help your doctor provide an accurate diagnosis. During this private assessment, your doctor will position you so the area is visible.

Your doctor may perform a digital exam with a gloved hand to feel the area. You may feel some pressure and slight discomfort during the short digital exam, but it is usually not painful. Your doctor will use lubrication to make you as comfortable as possible.

Sometimes, your doctor may recommend an anoscopy. During an anoscopy, your doctor will insert a small tube in your anus to help visualize the area better. This lubricated tube is 2 inches long and will give your doctor a better view of your anatomy.

How can you prevent external hemorrhoids?

You can prevent external hemorrhoids by reducing the amount of time you spend straining. You can increase the amount of water you drink daily, along with the fiber in your diet. This will help you pass stools easier.

When lifting heavy objects, you should always breathe deeply. Holding your breath can increase your abdominal pressure, which increases your chance of developing external hemorrhoids.

You should monitor your breathing pattern during labor and if you are straining during a difficult bowel movement.

Increasing your physical activity level and managing your weight can also decrease your risk of developing external hemorrhoids. This can help tighten the muscles around your pelvis and reduce the amount of time you spend sitting.

Summary

External hemorrhoids are swollen blood vessels located under the skin surrounding the outside of your anus. They can be itchy and cause bleeding during bowel movements. They can develop after increased abdominal pressure due to straining, prolonged sitting, or alterations in your regular bowel movements.

External hemorrhoids usually resolve on their own. However, you can consult your doctor for creams and medications to help prevent them from coming back. Increasing your fiber intake, fluid intake, and daily exercise can also reduce your chances of developing external hemorrhoids.

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Medical Reviewer: Cynthia Taylor Chavoustie, MPAS, PA-C
Last Review Date: 2022 Jul 25
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