Hemorrhoidal tissue can be found within the anal canal as well as the perianal area. This type of tissue consists of blood vessels located just under the skin outside the anus. When significant pressure is exerted on this area, it can cause the veins both within the anus and in the lower rectum to swell; these swollen veins in this area are known as hemorrhoids. External hemorrhoids specifically are hemorrhoids that develop under the skin around the anus, and can result in blood clots that are localized to the area.
Symptoms of External Hemorrhoids
Some symptoms of external hemorrhoids might include itching or general irritation around the anal region, pain or discomfort, bleeding, itching, and swelling around the anus. It is important to note that rectal bleeding can occur with other diseases including cancer and should not immediately be assumed to be a symptom of hemorrhoids. Also, similar symptoms can be caused by skin tags, anal fissures, anal fistulas, perianal infections, and other rare pathologies. When any of these symptoms persist, they should be evaluated by a specialist.
Causes of External Hemorrhoids
Hemorrhoids can develop from increased pressure in the pelvis and lower rectum due to a number of causes. In general, the veins around the anus tend to stretch under pressure and may swell as a result of this repeated stretching.
Common causes of external hemorrhoids include straining during bowel movements, experiencing chronic diarrhea or constipation, sitting on the toilet for extended periods of time, having anal intercourse, and having a diet that is low in fiber. Being pregnant, overweight, or engaging in the regular heavy lifting of objects can also contribute to the development of external hemorrhoids.
Diagnosis of External Hemorrhoids
While external hemorrhoids can be visible to the naked eye, a medical history and physical examination may also assist in the diagnostic process. External hemorrhoids can be diagnosed by checking the area around the anus.
During a physical exam, a doctor may check the area around the anus for any unusual growths, swelling, leakage of stool or mucus, or general skin irritation. A doctor may also check for an anal skin tag, which is extra skin left behind when an external hemorrhoid or other inflammatory process resolves.
The presence of anal fissures, which are small tears in the anus that may cause itching or bleeding, can also aid in diagnosing external hemorrhoids. The entire colon may be examined if it is suspected that signs and symptoms point in the direction of a digestive system disease such as Crohn’s, or if there are risk factors present for colorectal cancer.
Prevention of External Hemorrhoids
The most effective method of preventing hemorrhoids is to keep stools bulky and soft so that they can pass easily throughout the digestive system. Maintaining a diet plentiful in high fiber foods, including more fruits, vegetables, and whole grains, can soften stool as well as increase its bulk, which will help to avoid the straining that can result in hemorrhoids. Fiber supplements can help to improve overall symptoms as well as bleeding as a result of hemorrhoids. Staying hydrated is also the key to hemorrhoid prevention as hydration helps to keep stools soft.
Maintaining healthy bowel habits can also help prevent hemorrhoids. Straining for long periods of time in an effort to pass a stool causes greater pressure in the veins in the lower rectum and can result in external hemorrhoids. In addition, the urge to pass a bowel movement should never be ignored. If the urge to use the bathroom is ignored and the urge goes away, the stool can dry out and become more difficult to pass.
Lifestyle adjustments can also help to prevent hemorrhoids. Regular exercise can help prevent constipation by keeping the digestive system moving and reducing pressure on the veins, which can occur with long periods of sitting or standing.
Exercise can also help lose weight if excess weight is a contributing cause of external hemorrhoids. In general, it is recommended to avoid long periods of sitting, particularly on the toilet. The habit of reading in the privacy of the commode causes the hemorrhoids to lose their supportive structure over time. Since the toilet seat fails to support the anal region, our upper body weight becomes focused on the hemorrhoid cushions for the duration of the reading.
Treatment of External Hemorrhoids
There are several non-invasive methods of treating external hemorrhoids. Eating foods with high fiber content can aid the digestive system tremendously and result in less overall force applied to the lower half of the body when passing a stool. Furthermore, taking a stool softener or fiber supplements such as psyllium or methylcellulose can aid in the passing of stool. Staying hydrated, avoiding straining during bowel movements, not using excessive amounts of toilet paper, and avoiding sitting on the toilet for extended periods of time will also aid in the treatment of external hemorrhoids. Taking over-the-counter pain relief medications such as aspirin or ibuprofen can ease pain associated with external hemorrhoids. Sitting in a sitz bath, which is a warm, shallow bath that cleanses the space between the rectum and the vulva or scrotum, can also aid in quelling hemorrhoid symptoms.
Using over-the-counter creams or suppositories can also address the symptoms of external hemorrhoids, but it is important to note that medical intervention should be sought after one week of using over-the-counter products with little or no improvement. Treating external hemorrhoids at home can be relatively simple provided that there is no excessive pain, itching, or swelling.
The medical professionals at RS Surgical provide comprehensive treatment for external hemorrhoids, with the method and cost of treatment depending on the size, number, and location of anal tags and origin of the externally visible hemorrhoids. Often a significant portion of hemorrhoids noted externally include chronically prolapsed internal hemorrhoidal tissue. These can be treated with a variety of methods. One treatment approach known as rubber band ligation involves a doctor placing a rubber band around the base of the hemorrhoid, which cuts off blood supply to the hemorrhoid. The banded portion of the hemorrhoid will shrivel and fall off in a matter of days, with scar tissue forming over the remaining portion of the hemorrhoid. If symptoms of external hemorrhoids reoccur, the rubber band ligation process can be repeated as necessary, though most patients find that diet and lifestyle changes coupled with an initial ligation is enough to ease their hemorrhoid symptoms.
Another treatment method known as infrared photocoagulation can be used to treat the hemorrhoid. In this procedure, the doctor will use a tool that directs infrared light at a hemorrhoid. Heat generated by the light will result in scar tissue, subsequently cutting off the blood supply to the hemorrhoid and shrinking the hemorrhoid. In addition to these treatment methods, RS Surgical offers excision of external hemorrhoids and anal skin tags where appropriate.
While controlling external hemorrhoids with medication can address any symptoms, long-term relief and resolution can sometimes require treatment from an experienced proctologist. In-office procedures for hemorrhoid removal can provide better long-term results than medical management alone.