What are the other Names for this Condition? (Also known as/Synonyms)

• EH (External Hemorrhoids)

What is External Hemorrhoids? (Definition/Background Information)

• External Hemorrhoids (EH) are swollen blood vessels around the anus, situated beneath the skin. They can be caused by increased pressure in the lower rectum, often due to chronic straining during bowel movements, obesity, or pregnancy
• The signs and symptoms of External Hemorrhoids include pain, itching, and swelling around the anal area. Occasionally, they may cause bleeding during bowel movements
• The treatment options for External Hemorrhoids include over-the-counter creams, warm baths, and lifestyle changes such as increased fiber intake to ease bowel movements. Medical procedures, such as rubber band ligation or surgical removal, may be considered in more severe cases
• Prevention strategies involve maintaining a high-fiber diet, staying well-hydrated, avoiding prolonged sitting, and practicing good bathroom habits. The prognosis for External Hemorrhoids is generally good with proper management, but recurrent symptoms may be observed, emphasizing the importance of preventive measures and lifestyle modifications

There are various types of hemorrhoids, and these include:

• Internal Hemorrhoids: These are present far inside the rectum and are not typically visible from the outside. They rarely cause pain but can cause bleeding
• External Hemorrhoids: These are present underneath the anal skin and can lead to thrombosis or blood clot in the veins, which appears as a hard lump around the anus
• Mixed Hemorrhoids: These result from vascular issues in the lower rectum, causing lumps due to pathological dilation. They exhibit features of both internal and external hemorrhoids

Who gets External Hemorrhoids? (Age and Sex Distribution)

• Individuals between the age group of 20 and 50 are susceptible to External Hemorrhoids
• The condition may be noted in both males and females
• Worldwide, individuals belonging to any racial or ethnic group may be affected

What are the Risk Factors for External Hemorrhoids? (Predisposing Factors)

The risk factors associated with External Hemorrhoids include:

• Straining during bowel movements
• Undesirable bowel habits such as sitting in the toilet for long hours
• Pregnancy
• Aging
• Chronic constipation
• Diarrhea
• Anal intercourse
• Cirrhosis
• Obesity or excess body weight
• A diet high in fat and low in fiber

It is important to note that having a risk factor does not mean one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of External Hemorrhoids? (Etiology)

The lower portions of the anus or rectum consist of a cushion of veins and supporting connective tissue. During bowel movements, when one strains to move the stools, i.e., such as due to chronic constipation, excess pressure builds up in the anal canal. The connective tissue in the anal canal may become weak due to age and constant pressure buildup, which may cause the anal veins to bulge out. This results in External Hemorrhoids.

Some of the other causes of this condition include:

• Sitting for long hours on the toilet seat
• Pregnancy
• Diarrhea
• Anal intercourse
• Cirrhosis
• Obesity or excess body weight
• High fat and low fiber diet

What are the Signs and Symptoms of External Hemorrhoids?

The common signs and symptoms exhibited by External Hemorrhoids include:

• Anal veins that swell or bulge out
• Extreme pain in the anus area
• Bleeding
• Anal itching
• Burning sensation
• Painful bowel movements
• Irritation and discomfort
• Thrombosed External Hemorrhoids - painful swelling and formation of a hard lump around the anus caused by clotting of the anal veins

External Hemorrhoids are located at the lowermost portion of the anus and rectum.

How is External Hemorrhoids Diagnosed?

The procedure for diagnosing External Hemorrhoids may include:

• A thorough follow-up of the medical history of the patient
• A complete physical examination to check for all the signs and symptoms exhibited by the patient. The physician may perform an anal exam to diagnose and assess the degree of hemorrhoids
• The physician may use a proctoscope for a complete rectal examination
• Sigmoidoscopy and colonoscopy procedures may be undertaken to rule out other rectal conditions

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of External Hemorrhoids?

The following are the possible complications that can result from External Hemorrhoids:

• Severe pain in the anal area with formation of a lump
• Bleeding due to chronic irritation and breakdown of skin
• Prolonged discomfort if treatment is delayed

How is External Hemorrhoids Treated?

The treatment options for External Hemorrhoids may include:

• Use of hemorrhoid creams that contain anesthetics to reduce pain and irritation, such as:
  • Benzocaine
  • Benzyl alcohol
  • Lidocaine
• Pharmaceutical ointments containing vasoconstrictors to reduce swelling and prevent blood clots. They also contain anesthetics, which will help in reducing pain and itching
• Sitz bath and ice cubes may be used to reduce the size of the hemorrhoids and bleeding
• If the hemorrhoids have increased in severity, then the patient may need surgery. In such cases, the following procedures may be considered:
  • Hemorrhoidectomy
  • Hemorrhoid laser treatment
  • Hemorrhoid banding procedure
  • Sclerotherapy

How can External Hemorrhoids be Prevented?

The following measures may be adopted to minimize the formation of External Hemorrhoids:

• Making the stool soft so it passes out quickly without too much strain and stress
• Emptying the bowel immediately when the urge occurs
• Regular exercises and walking
• Increasing fiber content in the diet will help reduce constipation and, in turn, prevent hemorrhoids

What is the Prognosis of External Hemorrhoids? (Outcomes/Resolutions)

• Most individuals with External Hemorrhoids show spontaneous resolutions or benefit from conservative medical therapy
• The recurrence rate is higher when non-surgical treatment measures are adopted than surgical options

Additional and Relevant Useful Information for External Hemorrhoids:

The following DoveMed website link is a helpful resource for additional information:

https://www.dovemed.com/health-topics/focused-health-topics/hemorrhoidectomy-surgical-treatment-hemorrhoids