1. What are external hemorrhoids?


External hemorrhoids are dilated blood vessels that form under the skin around the anus. These hemorrhoids are located outside the rectum and are different from internal hemorrhoids, which form inside the rectum. The main function of the veins in the anus is to help control stool. When these veins become enlarged and swollen, they form external hemorrhoids, which can cause discomfort and pain.

Physiologically, external hemorrhoids are covered with sensitive skin that can easily be irritated or injured. This skin covering makes external hemorrhoids more painful compared to internal hemorrhoids, which are covered by a mucous membrane that is less sensitive to pain.


2. Causes of external hemorrhoids


The causes of external hemorrhoids can be diverse and are often related to increased pressure in the blood vessels of the anus and rectum. These factors can lead to swelling and dilation of the veins, leading to the formation of hemorrhoids.


Here are some of the main reasons:


Constipation and straining during bowel movements

            Constipation is one of the leading causes of external hemorrhoids. When a person has difficulty having a bowel movement, they often strain more, which increases the pressure on the veins in the anus. This can lead to their expansion and the formation of hemorrhoids. Prolonged straining during bowel movements can also worsen existing hemorrhoids.


Prolonged sitting

Sitting for a long time, especially in the same position, can also contribute to the development of external hemorrhoids. This is a common problem in people who work in an office environment or lead a sedentary lifestyle. Prolonged sitting increases the pressure on the veins in the anus, which can cause or worsen hemorrhoids.


Pregnancy and birth

During pregnancy, the growing uterus puts pressure on the veins in the rectal area, which can lead to the formation of hemorrhoids. Hormonal changes during pregnancy can weaken the walls of the veins, making them more vulnerable to dilation. During childbirth, the pressure and strain of straining can also cause or worsen hemorrhoids.






Excess weight can put extra pressure on the veins in the rectal area. This is especially true for people with abdominal obesity, where the pressure on the veins is greater. Being overweight is a risk factor for the development of hemorrhoids and can complicate their treatment.


Insufficient fiber intake

A diet low in fiber can lead to constipation, which, as already mentioned, is one of the main causes of external hemorrhoids. Fiber helps soften stools and make them easier to pass through the intestines. A lack of fiber in the diet can lead to harder stools and the need to strain harder to pass a bowel movement.


Heavy physical activity

Strenuous physical activity, especially heavy lifting, can increase pressure in the abdominal and rectal areas. This extra strain on the veins can lead to hemorrhoids. It is important for people involved in heavy physical work or sports to take precautions and avoid overexertion.



Genetic factors also play a role in the development of hemorrhoids. If there are cases of hemorrhoids in your family, the probability that you too will face this problem is more. Hereditary factors can affect the strength of venous walls and their resistance to expansion.


3. Symptoms


Symptoms of external hemorrhoids can vary depending on the severity of the condition and the individual characteristics of the patient. These symptoms can be mildly unpleasant or very painful, significantly affecting the quality of life.


Here are some of the main symptoms:


Pain and discomfort

Pain is one of the most characteristic symptoms of external hemorrhoids. It can be acute and intense, especially in thrombosed hemorrhoids, when a blood clot forms in the hemorrhoidal vein. The pain may increase when sitting, moving or having a bowel movement.


Itching and irritation

Itching around the anus is a common symptom of external hemorrhoids. It is caused by skin irritation and can be very unpleasant. Constant friction and moisture in this area can worsen the itching and cause further irritation and inflammation.



It is usually seen during bowel movements, when hard stool passes through the anus and injures the varicose veins. Bleeding can be light, with small drops of blood on the toilet paper, or more profuse, with larger amounts of blood in the toilet bowl.


Swelling and edema

It is due to the dilation of the veins and the accumulation of fluid in the tissues around the anus. The swelling may be soft or firm, depending on the presence of a thrombus in the hemorrhoidal vein.


Hard nodules

Sometimes external hemorrhoids can form hard nodules around the anus. These nodules are the result of blood pooling in varicose veins and can be very painful. On palpation, these nodules are felt as hard lumps under the skin.


Inflammation and redness

Redness and swelling are the result of tissue irritation and inflammation. This condition can be accompanied by a burning sensation and increased sensitivity of the skin.


Difficulty in passing stools


Difficulty in passing stools


People with external hemorrhoids often have difficulty having a bowel movement. Pain and discomfort can make walking as needed uncomfortable and even painful. This can lead to avoidance of bowel movements and worsening constipation, further complicating the condition.


4. Diagnostics


Diagnosing external hemorrhoids is a key process for proper treatment and management of the condition. An accurate diagnosis can help distinguish hemorrhoids from other conditions with similar symptoms, such as anal fissures, abscesses, or even anal cancer.

The diagnostic process usually involves several steps:


1. Clinical examination

The first step in the diagnosis of external hemorrhoids is the clinical examination. The doctor conducts a visual inspection of the anal area to detect visible hemorrhoids. External hemorrhoids are often visible as bumps or nodules around the anus. The doctor may also palpate to determine the size and tenderness of the hemorrhoids.


2. Anoscopy

Anoscopy is a minimally invasive procedure in which the doctor uses a special instrument called an anoscope to look inside the anus and the lower part of the rectum. This procedure helps to better visualize the hemorrhoids and assess their condition. Anoscopy is useful not only for diagnosing internal hemorrhoids, but also for differentiating other possible causes of anal bleeding.


3. Proctoscopy

A proctoscopy is similar to an anoscopy, but uses a longer instrument called a proctoscope that allows viewing of more of the rectum. This procedure is useful for detecting higher-lying hemorrhoids and other diseases of the rectum. Proctoscopy is performed on an outpatient basis and usually does not require anesthesia.


4. Sigmoidoscopy

Sigmoidoscopy is a procedure that allows examination of the lower part of the large intestine (sigmoid colon) and rectum. It is performed using a flexible instrument called a sigmoidoscope. This procedure can help detect inflammation, polyps, or tumors that may be causing symptoms similar to hemorrhoids. Sigmoidoscopy is particularly useful when more serious bowel diseases are suspected.


5. Laboratory tests


Laboratory researches


In some cases, the doctor may order laboratory tests to rule out other diseases. A blood test can help detect anemia that can result from chronic bleeding. A stool test can be used to detect the presence of blood in the stool, which may be a sign of hemorrhoids or other bowel conditions.


5. Treatment


Treatment for external hemorrhoids is varied and depends on the severity of the symptoms, the extent of the hemorrhoids, and the general health of the patient. It is important to start with the correct diagnosis in order to determine the most appropriate method of treatment. External hemorrhoids can be treated with both conservative methods and surgical interventions.


Conservative treatment


Conservative treatment is the first line of therapy for many patients with external hemorrhoids. It includes various non-invasive methods that aim to relieve symptoms and prevent the condition from worsening.


Lifestyle changes:

  • Increased fiber intake: Consuming more fiber can help soften stools and make bowel movements easier. This reduces the strain on the veins in the anus and rectum. Fiber-rich foods include fruits, vegetables, whole grains, and legumes;
  • Increased fluid intake: Drinking enough water helps maintain hydration and prevents constipation;
  • Avoiding prolonged sitting: Regular breaks and changes in position can reduce pressure on the anus.


Local treatments

  • Creams and Ointments: Topical anesthetics and anti-inflammatory creams can help relieve pain and itching. Examples include hydrocortisone creams and products containing lidocaine;
  • Warm baths: Sitting in warm water several times a day can ease discomfort and reduce swelling.


Oral medications

  • Pain relievers: Taking pain relievers such as ibuprofen or acetaminophen can help reduce pain and inflammation;
  • Flavonoids: Some patients find relief with supplements containing flavonoids, which have venotonic and anti-inflammatory properties.


Minimally invasive procedures


When conservative treatment is not effective enough, minimally invasive procedures can be applied. They are usually outpatient and offer quick relief of symptoms.


Rubber band ligation

This procedure involves placing a small rubber band around the base of the hemorrhoid. The tape cuts off the blood supply to the hemorrhoid, causing it to dry up and fall off within a few days. Ligation is an effective method of treating internal hemorrhoids, but it can also be used for external hemorrhoids that are located near the rectum.



Sclerotherapy involves injecting a sclerosing agent into the hemorrhoid, which causes the veins to shrink and sclerose. This procedure is quick and effective for treating small to medium-sized hemorrhoids.


Infrared coagulation

Infrared coagulation uses infrared rays to coagulate hemorrhoidal tissue. This procedure is minimally invasive and offers quick relief.


Surgical treatment


In the case of severe or complicated hemorrhoids, surgical methods may be most effective. These procedures are usually applied when other methods have failed.




Removal of hemorrhoids


Hemorrhoidectomy is a surgical procedure to remove hemorrhoids. It is performed under general or local anesthesia and involves excision of the hemorrhoidal tissue. This procedure is effective for treating large and stubborn hemorrhoids, but requires a longer recovery period.


Stapler hemorrhoidopexy

Stapler hemorrhoidopexy uses a surgical stapler to remove some of the hemorrhoidal tissue and lift the rest of the hemorrhoids. This procedure is less painful than a traditional hemorrhoidectomy and has a shorter recovery period.


6. Myths and facts about external hemorrhoids


There are many myths and misconceptions about external hemorrhoids. Separating the myths from the facts is important for the proper understanding and management of this condition. Here are some of the most common myths and the realities associated with them.


Myth: Only the elderly suffer from hemorrhoids

Fact: Hemorrhoids can affect people of all ages

Although hemorrhoids are more common in the elderly, they can affect people of all ages, including young adults and even children. Risk factors such as constipation, poor eating habits and a sedentary lifestyle can cause hemorrhoids regardless of age.


Myth: External hemorrhoids always bleed

Fact: Not all external hemorrhoids bleed

Bleeding is a common symptom of hemorrhoids, but not all external hemorrhoids bleed. Some hemorrhoids cause only pain, swelling, and discomfort with no visible bleeding. Bleeding usually occurs in more serious cases or when hemorrhoids are injured.


Myth: Hemorrhoids always require surgical treatment

Fact: Many hemorrhoids can be treated with conservative methods

Not all hemorrhoids require surgery. Many cases can be successfully treated with lifestyle changes, dietary changes, topical treatments and minimally invasive procedures. Surgical treatment is only necessary in severe or complicated cases.


Myth: Sitting on cold surfaces causes hemorrhoids

Fact: There is no evidence that cold surfaces cause hemorrhoids

Sitting on cold surfaces has not been proven to cause hemorrhoids. The main causes of hemorrhoids are related to increased pressure in the rectal area, constipation, pregnancy and hereditary factors. Cold surfaces may cause temporary discomfort, but they do not lead to hemorrhoids.


Myth: All anus pain is caused by hemorrhoids

Fact: Pain in the anus can be caused by a variety of conditions

Pain in the anus is not always the result of hemorrhoids. Other conditions such as anal fissures, abscesses, infections and even anal cancer can cause similar symptoms. Therefore, it is important to consult a doctor for an accurate diagnosis and appropriate treatment.


Myth: Exercise makes hemorrhoids worse

Fact: Moderate exercise is helpful in preventing and managing hemorrhoids

Moderate exercise, such as walking, yoga, and swimming, can help improve circulation and prevent constipation, which reduces the risk of hemorrhoids. Strenuous exercise, especially weight lifting, can worsen the condition if not performed correctly.


Myth: Dietary changes alone are enough to treat hemorrhoids

Fact: Dietary changes are important, but other methods are often needed

Dietary changes, such as increasing fiber and fluid intake, are an important part of hemorrhoid prevention and treatment. However, in many cases, other methods, such as topical treatments, minimally invasive procedures or even surgery, are needed to effectively manage the condition.


7. When to seek medical attention


Although external hemorrhoids can often be treated with home remedies and lifestyle changes, there are situations in which it is necessary to seek medical attention. Early referral to a doctor can prevent complications and ensure faster and more effective treatment.


Here are some of the cases in which you should seek medical help:


Severe and prolonged pain

If you experience severe and persistent pain in the anal area that is not relieved by home remedies or over-the-counter medications, you should consult a doctor. Severe pain may be a sign of a thrombosed external hemorrhoid that requires medical intervention.


Excessive bleeding

Bleeding from the anus is a common symptom of hemorrhoids, but if the bleeding is excessive or prolonged, it is important to seek medical attention. Excessive bleeding can lead to anemia and be a sign of other serious conditions, such as anal fissures or colon cancer.


Difficult bowel movement

If you have difficulty passing a bowel movement or feel like your bowels are incomplete, this could be a sign of a more serious problem. A doctor can perform the necessary tests to determine the cause and suggest appropriate treatment.


Swelling and inflammation

Swelling and inflammation around the anus that does not improve with home treatments requires medical evaluation. Inflammation may be a sign of an infection or abscess that requires antibiotic treatment or surgery.


Changes in stool color or consistency

Changes in stool color or consistency, such as black or very dark stools, can be a sign of internal bleeding. This requires immediate medical evaluation to rule out serious conditions such as ulcers or cancer.


Recurrent hemorrhoids

If your hemorrhoids recur frequently despite lifestyle changes and home remedies, a doctor's consultation is necessary. The doctor may suggest additional tests and more effective treatment methods, such as minimally invasive procedures or surgery.


Worsening of symptoms

If your hemorrhoid symptoms are getting worse instead of getting better, it's important to seek medical attention. Worsening symptoms may be a sign of complications that require more aggressive treatment.


Family history of colorectal cancer

If you have a family history of colorectal cancer, you should be more attentive to the symptoms and seek medical help at the first sign of problems. Early detection and treatment of potentially serious conditions is essential.


8. Conclusion


External hemorrhoids are a common and unpleasant problem. They can be managed with proper treatment and lifestyle changes. If you have symptoms, consult a doctor for the best treatment. Maintain a healthy lifestyle to prevent future problems.



1. Mayo Clinic: Hemorrhoids - Symptoms and causes (26 май 2024)
2. Mayo Clinic: Hemorrhoids - Diagnosis and treatment (26 май 2024)
3. Mayo Clinic: Hemorrhoids during pregnancy (26 май 2024)