What are External Haemorrhoids? 

External haemorrhoids are a common condition affecting the general population. In India, haemorrhoids are known to affect nearly 40 million people, the true incidence remains unknown because of a tendency to self-medicate and not seek proper consultation. Haemorrhoids are swollen and enlarged veins in the anal region, that can be internal or external haemorrhoids.  After the age of 45-65, both sexes have an equal risk of haemorrhoids. The number of deaths reported with haemorrhoids is low but it can have a high impact on quality of life.¹ 

Symptoms¹ 

Following are the signs noticed by the doctor in people with external haemorrhoids:

• A painful mass present on the skin near the rectal region which is increasing in size over time
• External skin tags or skin outgrowth

Following are the symptoms that you may experience if you have an external haemorrhoid:

• Pain and bleeding during bowel movements
• Itching, burning and pain sensations near the rectum and anal region
• Reduced appetite²

Consulting a proctologist is a must as sometimes removing external hemorrhoids can lead to very large amounts of bleeding which is dangerous.

Dr. M.G. Kartheeka, MBBS, MD

Causes

If you have any of the above complaints, you should seek an expert opinion.

Increased intra-abdominal pressure due to chronic constipation may exert pressure on the tissues present in the anal canal, resulting in swelling and enlargement of the veins.²

Risk factors: ²

1. Dietary factors:

• Spicy food
• Low-fibre diet
• Alcohol consumption

2. Diseased conditions:

• Inflammatory bowel disease
• Rectal surgery due to residual hemorrhoidal tissue left after the surgery
• Diarrhea
• Constipation
• Obesity

3. Others: 

• Age 
• Family history
• Pregnancy

External hemorrhoids may develop an inflammation and may recur if left untreated or treated improperly, consultation with a physician is very crucial in such scenarios.

Dr. Ashish Bajaj, M.B.B.S., M.D.

Complications^3,5

• Thrombosed haemorrhoids: Sometimes, there may be a formation of a blood clot inside the hemorrhoid; this is referred to as a thrombosed hemorrhoid. 
• Skin tags or outgrowths of skin near the rectal region.
• Anemia due to excessive blood loss associated with hemorrhoids.
• Infection when external haemorrhoids may get infected. 

Also Read: How to Stop Itchy Anus at Night: Effective, Research-Backed Solutions

Diagnosis¹

Your doctor will take a detailed history and thorough physical examination to confirm piles. Physical examination may help reveal a tender, purplish nodule, skin tags which are suggestive of an external haemorrhoid. To rule out other causes of bleeding, your doctor may  do a digital rectal examination.

Your physician will observe you in a prone-jack knife position. This will require you to sleep in a prone position i.e. sleep on your stomach with your head and legs lowered while your hips will be elevated for examining the rectal region.

Read More: 8 Best Home Remedies For Piles

Treatment

Treatment of external haemorrhoids includes conservative management which includes dietary and lifestyle modifications, behavioral changes and local treatments. The basic goal is to avoid constipation and thus straining and pressure associated with stools. Following are the general recommendations:

1. Dietary recommendations⁴ 

• Avoid eating fried food, salty food, caffeinated beverages, and chocolates
• Increase the intake of fibre; add high-fibre foods to your diet like fruits, vegetables, lentils, etc. 
• Drink plenty of fluids (at least 6 glasses of water or any non-caffeinated drink)³
• Reduce the consumption of fatty foods
• Eat at regular time intervals daily say every 3-4 hours

2. Exercise

Moderate exercises like yoga, brisk walking, swimming for 20-30 minutes a day to help improve bowel function and keep your bowel smooth. Avoid sitting immediately after having food.  

3. Anal hygiene ^4,5

• Wash the anal region with water every time after passing stools without soaps.
• Avoid sitting for a long duration on toilet seat, remove any reading material from the toilets, refrain from taking your cell phones in washrooms.³

4. Local treatment at home for external haemorrhoids^3,5

• Placing an ice pack for a few minutes near the anal region may help reduce swelling and pain.
• Sitz bath: after each bowel movement, a 20-minute warm water bath for the hips and buttocks. Dry the anal region afterwards gently and avoid rubbing hard.

5. Medications³

• Painkillers will be given to you for symptomatic relief from pain. Painkillers should only be taken after consultation from a doctor. Many ayurvedic, homeopathic medicines for are available in the market, but you should not self-medicate and always consult your doctor before taking these medicines.
• Painkillers should ideally be taken with food to avoid stomach upset.
• Avoid the use of narcotic painkillers as they may cause constipation and hard stools.
• Many over-the-counter medications like creams, ointments, wipes, lotions are available which can be topically applied for a soothing effect for pain.

If conservative management does not help for treatment of haemorrhoids, non-operative procedures may be recommended by your doctor. If still the symptoms do not resolve, surgical excision of the haemorrhoids may be needed.

Although many medicines are available over-the-counter in medical stores, you should not self-medicate, it is not safe to treat external haemorrhoids at home. You should avoid external haemorrhoids cure at home and consult your doctor for proper management of haemorrhoids.

Read More: What is the Cost of Piles Surgery in India?

Conclusion

 External hemorrhoids are a type of hemorrhoid that develops outside the anus, usually under the skin around the anal opening. They occur when the veins in the anal area become swollen and inflamed, causing bleeding, pain, and itching.  It is best to consult a doctor for proper treatment of piles and avoid self-medication.

Frequently Asked Questions (FAQs):

References:

1. Sun Z, Migaly J. Review of hemorrhoid disease: presentation and management. Clinics in colon and rectal surgery. 2016 Mar; 29(01):022-9. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755769/
2. Das KD, Ghosh S, Das AK, Ghosh A, Mondal R, Banerjee T, Ali SS, Ali SS, Koley M, Saha S. Treatment of hemorrhoidsith individualized homeopathy: An open observational pilot study. Journal of intercultural ethnopharmacology. 2016 Sep; 5(4):335. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5061475/ 
3. Zuber TJ. Hemorrhoidectomy for thrombosed external hemorrhoids. American Family Physician. 2002 Apr 15; 65(8):1629. Available at: https://www.aafp.org/pubs/afp/issues/2002/0415/p1641.html 
4. Lawrence A, McLaren ER. External hemorrhoid. Available at: https://www.ncbi.nlm.nih.gov/books/NBK500009/
5. Hemorrhoids (Internal & external): Pictures, symptoms, causes, treatment (no date) WebMD. WebMD. Available at: https://www.webmd.com/digestive-disorders/understanding-hemorrhoids-basics 

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