External hemorrhoids are a common condition that affects millions of people worldwide. They are varicose veins in the area of ​​the anus and rectum, which can cause significant discomfort and pain. Symptoms range from mild pain and itching to bleeding and severe inflammation.

In this article, we will look in detail at the various symptoms of external hemorrhoids, the causes of their occurrence, as well as treatment and prevention options.


1. Pain and discomfort


Pain is one of the most common symptoms of external hemorrhoids. The pain is usually felt in the area of ​​the anus and can be of different intensity - from mild to severe. It is often aggravated during bowel movements or when sitting for long periods of time.


Types of pain

Pain in external hemorrhoids can be divided into several types:

  • Sharp pain: It comes on suddenly and can be very intense. It is often associated with thrombosed hemorrhoids, where a blood clot forms inside the hemorrhoid, causing severe pain and swelling;
  • Dull pain: This type of pain is longer lasting and moderate in intensity. It can be persistent and worsen with pressure on the affected area, such as sitting or physical activity.


How to deal with pain:

  • Local anesthetics: Ointments and creams;
  • Hot sitz baths;
  • Pain relievers: ibuprofen or paracetamol.


2. Itching and irritation


Itching and irritation are two of the most common and unpleasant symptoms of external hemorrhoids. They can range from mild to very intense, often causing significant discomfort and inconvenience.


Reasons for the appearance of itching


Itching in external hemorrhoids can be the result of several factors:

  • Skin irritation;
  • Mucus discharge: In some cases, hemorrhoids can cause a slight discharge of mucus from the anus, leading to irritation and itching;
  • Poor hygiene: Poor hygiene can lead to the accumulation of fecal particles around the anus, while excessive hygiene can remove the protective layer of the skin and cause further irritation.


How to deal with itching:

  • Ointments: Using creams and ointments with hydrocortisone or other soothing ingredients can reduce inflammation and itching;
  • Warm baths several times a day;
  • Maintain good hygiene: Gently cleaning the anal area with a soft cloth and warm, soap-free water can prevent further irritation. Avoid aggressive cleaning agents that can worsen the condition.


How to deal with itching


3. Bleeding


Bleeding is one of the main symptoms of external hemorrhoids and can cause significant stress and anxiety. Although often not serious, bleeding should always be discussed with a medical professional to rule out other potentially serious causes.


Bleeding from external hemorrhoids is usually visible and appears as bright red blood:

  • On the toilet paper: After a bowel movement, blood is often seen on the toilet paper;
  • In the toilet bowl: Blood can also appear in the toilet bowl, especially if the bleeding is more intense.


Causes of bleeding


Trauma during defecation

Excessive straining and friction during bowel movements can tear the tender veins and tissues of the hemorrhoids, causing bleeding.


Chronic constipation

Constipation increases the pressure on the veins in the anus and rectum.


Irritation and inflammation

Inflamed and irritated hemorrhoids are more prone to bleeding with minimal pressure or trauma.


4. Lumps and nodules


Lumps and nodules are common symptoms of external hemorrhoids and can cause significant discomfort and distress. They are caused by enlarged and inflamed veins in the anal area that form bulging nodules or lumps around the anus.


Bumps and nodules in external hemorrhoids have several characteristic features:

  • Appearance: They are often visible and can be felt as soft or hard lumps around the anus. Their color can vary from normal skin color to darker shades, depending on the degree of inflammation and the presence of thrombosis;
  • Sizes: The size of bumps and nodules can vary from small and barely noticeable to large and significantly bulging;
  • Tenderness: These nodules may be tender to the touch, causing pain when sitting, walking or during bowel movements.


Reasons for their appearance:

  • Increased pressure: The increased pressure in the anal veins, which can be the result of constipation, prolonged sitting or heavy physical activity, which leads to the expansion of the veins and the formation of bumps;
  • Thrombosis: In some cases, a blood clot (thrombus) can form in the nodes, making them hard and extremely painful. This condition is known as thrombosed hemorrhoids.


5. Feeling of fullness


The sensation of fullness is often described as a feeling of pressure or heaviness in the anus and rectum, which may be accompanied by an urge to have frequent bowel movements.


It can be due to several factors:

  • Varicose veins: Varicose and inflamed veins in the anus and rectum can cause a feeling of pressure and fullness. This is due to the increased volume and swelling of the veins, which takes up additional space in the anal area;
  • Inflammation and swelling;
  • Thrombosed hemorrhoids: In the presence of a thrombosed hemorrhoid, where there is a blood clot, the feeling of fullness can be even more pronounced and accompanied by pain and discomfort.




Constant feeling of something in the anus

This feeling can be continuous and not relieved even after a bowel movement.


Desire for frequent bowel movements

The feeling of fullness can create a false urge to have frequent bowel movements, leading to futile attempts and additional discomfort.


Discomfort when sitting

This symptom may be aggravated by prolonged sitting due to increased pressure on the anus.


Discomfort when sitting


6. Irritation and inflammation


These symptoms are usually the result of increased pressure in the anal veins and the inflammatory process that occurs in the tissues around the anus.


Causes of irritation and inflammation


Physical friction

Prolonged sitting or walking can cause hemorrhoids to rub against clothing, leading to irritation and inflammation.


Using harsh or perfumed products

Using rough toilet paper or perfumed products can irritate the sensitive skin around the anus.



In rare cases, inflammation can be caused by bacterial infections that lead to additional irritation and swelling.




  • Redness and swelling: The skin around the anus may be red and swollen due to inflammation;
  • Burning and itching: Burning and itching sensations often occur, which can be very unpleasant and difficult to ignore;
  • Skin sensitivity: The skin around the anus can be extremely sensitive and painful to the touch.


7. Complications


Complications of external hemorrhoids are rare, but when they occur, they can cause serious health problems and significantly impair quality of life. The most common complication is thrombosis.


Thrombotic hemorrhoids


Thrombosed hemorrhoids are the most common complication. They develop when a blood clot (thrombus) forms in the external hemorrhoid, causing:

  • Severe pain: The pain of thrombosed hemorrhoids is intense and sharp, often described as throbbing. It can be aggravated when sitting, walking and defecating;
  • Hard nodules: The formation of a thrombus leads to the appearance of hard, painful nodules around the anus that are clearly visible;
  • Blue-violet color: The affected area often changes color to blue-violet due to impaired blood supply and accumulation of blood in the hemorrhoid.




Although rare, infection is a possible complication of external hemorrhoids. Inflammation and irritation can cause a disruption of the skin barrier and create the conditions for bacterial infection, which leads to:

  • Redness and swelling;
  • Purulent formations: In severe cases, pus and discharge may appear from the affected area;
  • Fever: Local infection may cause a slight increase in body temperature.




Ulceration (sore formation) of hemorrhoids is another potential complication. It can occur with prolonged and severe inflammation.

  • Bleeding: Ulcers are prone to bleeding, which can be prolonged and significant;
  • Pain: The formation of ulcers causes severe pain and further irritation of the skin and tissues around the anus.




Prolonged and profuse bleeding from external hemorrhoids can lead to anemia. This risk is higher in individuals who already have other predisposing factors for low hemoglobin.


Symptoms of anemia include:

  • Weakness and fatigue: Reduced hemoglobin levels lead to an insufficient supply of oxygen to the body, causing general weakness and fatigue;
  • Pallor: The skin may become pale due to low levels of red blood cells.




Prolapsed hemorrhoids, although more common with internal hemorrhoids, can also occur with external hemorrhoids. It represents the protrusion of the hemorrhoids outside the anus, which leads to:

  • Bulging nodules: Hemorrhoids are seen and felt as bulging nodules outside the anus;
  • Retention and pain: Prolapsed hemorrhoids can cause significant pain and discomfort.


8. Treatment


Treatment of the symptoms of external hemorrhoids is aimed at relieving pain, reducing inflammation and preventing complications. Approaches can range from conservative methods to more invasive procedures, depending on the severity of symptoms and the individual patient's condition.


Conservative treatment


Conservative treatment is the first line of therapy for most cases of external hemorrhoids and includes:

  • Dietary changes: Increase fiber intake by eating fruits, vegetables, whole grains, and legumes. This helps to soften stools and reduce straining during bowel movements;
  • Hydration: Drinking enough water to prevent constipation and maintain regular bowel function;
  • Warm baths: Short sitz baths with warm water several times a day can relieve pain and inflammation.


Medication treatment


Drug treatment includes the use of various topical and oral drugs:

  • Local anesthetics: Creams and ointments containing lidocaine or other anesthetic ingredients;
  • Anti-inflammatory agents: Topical corticosteroids such as hydrocortisone;
  • Phlebotonics: Oral medications such as diosmin and hesperidin that strengthen vein walls and improve venous tone.


Minimally invasive procedures


In more severe cases or when conservative treatment is not effective, minimally invasive procedures may be required:

  • Rubber band ligation: A procedure in which a small rubber band is placed around the base of the hemorrhoid to cut off its blood supply. This causes the hemorrhoid to dry up and fall off;
  • Sclerotherapy: Injection of a sclerosing solution into the hemorrhoid, which causes it to shrink and form a scar;
  • Infrared Coagulation: Using infrared light to coagulate and shrink hemorrhoidal tissue.


Surgical treatment


In the most severe cases, when other methods are not successful, surgical treatment is recommended:

  • Hemorrhoidectomy: Surgical removal of hemorrhoids that is effective for large or complicated hemorrhoids. The procedure may be associated with a longer recovery period;
  • Hemorrhoidopexy: A procedure to lift prolapsed hemorrhoids and fix their position using a special instrument.


9. Prevention


Although some factors such as genetic predisposition cannot be controlled, there are a number of measures that can help reduce the risk of developing external hemorrhoids.


A healthy diet


High fiber intake

Eating foods rich in fiber, such as fruits, vegetables, whole grains, and legumes, helps soften stools and make them easier to pass through the intestines.


Proper hydration

Drinking enough water is important to prevent constipation, which is one of the main risk factors for developing hemorrhoids.


Regular physical activity


Regular physical activity


Exercises to strengthen the abdominal muscles

Exercises such as yoga and pilates can strengthen the abdominal muscles and improve digestion.


Aerobic exercises

Regular aerobic exercise such as walking, running and swimming improves blood circulation and supports bowel function.


Maintaining a healthy weight


Maintaining a healthy weight can reduce pressure on the veins in the anus and rectum, thereby reducing the risk of developing hemorrhoids.


Avoiding prolonged sitting and standing


Prolonged sitting and standing can increase the pressure on the veins in the anus.

  • Take frequent breaks: Take regular breaks if your job requires prolonged sitting. Get up and move around at least every hour;
  • Use of ergonomic furniture: Use ergonomic chairs and pillows that support correct posture and reduce pressure on the anus.


Proper hygiene


Proper hygiene of the anal area is important to prevent irritation and inflammation.

  • Gentle cleaning: Use soft toilet paper or wet wipes without alcohol and perfumes to clean after bowel movements;
  • Avoiding aggressive products: Avoid using aggressive soaps and products that can irritate the skin.


Regular bowel movements


Do not postpone bowel movements

Try to go to the bathroom as soon as you feel the need. Retention can lead to the accumulation of harder stools and increased pressure on the veins.


Avoid overexertion

Do not strain excessively during bowel movements as this can increase the pressure on the veins.


Medical examinations


Regular medical examinations and consultations with a doctor are important for the early detection and treatment of hemorrhoids.


Periodic reviews

See a doctor for periodic checkups, especially if you have risk factors or symptoms of hemorrhoids.


Early treatment

Timely treatment of initial symptoms can prevent the development of more serious problems.


10. When to seek medical attention


If you experience severe pain, prolonged bleeding, or other serious symptoms, it is important to seek medical attention. A doctor can assess your condition and recommend appropriate treatment.


External hemorrhoids are a common but treatable condition that can cause significant discomfort. Recognizing symptoms, such as pain, itching, bleeding and inflammation, is key to timely and effective treatment.

Preventive measures, such as maintaining a healthy diet, regular physical activity and proper hygiene, play an important role in reducing the risk of developing hemorrhoids.



1. Мedicinenet: Hemorrhoids (Piles): What are the symptoms of hemorrhoids? (25.05.2024)
2. Healthline: Causes of Hemorrhoids and Tips for Prevention (25.05.2024)
3. Mayo Clinic: Hemorrhoids: Symptoms  (25.05.2024)