External Hemorrhoid

External hemorrhoids are swollen veins located around the anus and lower rectum. Unlike internal hemorrhoids, which develop inside the rectum, external hemorrhoids form under the skin around the anal opening and can be painful or uncomfortable, especially during bowel movements. External hemorrhoids can be thrombosed (symptomatic) or non-thrombosed.

1. Non-Thrombosed External Hemorrhoids
• Usually cause intermittent swelling, pressure, or discomfort around the anus.
• Often triggered by straining or constipation.
• Generally managed without surgery using:
• High-fiber diet
• Fiber supplements
• Topical creams for relief
• Surgical removal is rarely necessary.

2. Thrombosed (Symptomatic) External Hemorrhoids
• Present as a bluish, painful lump just outside the anus.
• Often occurs spontaneously or after excessive straining.
• The skin in this area is tightly attached, so when a blood clot forms, pressure rises quickly, causing constant, sometimes severe pain.
• Occasionally, the skin over the clot may break down, allowing blood to leak.
• Pain usually peaks 48–72 hours after onset and improves after 4–5 days.

Causes of External Hemorrhoids

Several factors can contribute to the development of external hemorrhoids, including: Straining during bowel movements – often due to constipation. Chronic diarrhea – frequent bowel movements irritate the anal veins. Pregnancy – increased pressure on pelvic veins can cause swelling. Obesity – excess weight puts pressure on rectal veins. Prolonged sitting – reduces blood flow around the anal area. Aging – tissues supporting veins weaken over time.

Treatment of Thrombosed External Hemorrhoids

Non-Operative Measures (for mild/moderate pain or improving symptoms):

• Warm sitz baths
• Pain-relieving creams or medications
• Fiber therapy and hydration

• Excision of the thrombosed hemorrhoid under local anesthesia
• The procedure involves removing the blood clot and sometimes a small portion of overlying skin
• Usually performed in the office with minimal recovery time