External Hemorrhoids: Causes, Symptoms, and Treatments
Just the term hemorrhoid can make most people squirm. And while hemorrhoids are a very common gastrointestinal issue, they can be uncomfortable and painful, not to mention irritating, embarrassing, and disruptive to the daily functioning of our lives.
Hemorrhoids are simply enlarged veins in the lower rectum, most often caused by straining during bowel movements. Rectal bleeding, irritation, itching, and pain are some of the most common complaints with hemorrhoids. The good news is that internal hemorrhoids, external hemorrhoids, or any combination of the two, are typically very treatable. Many people think they are limited to only the most extreme options—living with hemorrhoids, or undergoing surgery called a hemorrhoidectomy. But most hemorrhoids will go away on their own, and relief is available through a number of doctor-prescribed or over-the-counter treatment options. Even something as simple as a sitz bath can help.
It’s a good idea for anyone who thinks they may have hemorrhoids to talk with a doctor. A gastroenterologist can review your symptoms, perform a physical exam, and help you make a treatment plan, while ruling out other more severe conditions.
What Exactly is a Hemorrhoid Anyway?
A hemmorhoid is a swollen blood vessel in the anal or rectal area. The veins often swell due to constipation and pushing too hard during bowel movements.
There are two basic types of hemorrhoids, also commonly called piles: internal hemorrhoids and external hemorrhoids. Just as the name suggests, internal hemorrhoids are inside the rectum. They are typically painless and are not visible but may cause some bleeding. They can sometimes be pushed through the anus creating a protruding hemorrhoid, which can be painful. External hemorrhoids can be seen from the outside. They occur under the skin around the anus and are typically more painful and irritating than internal hemorrhoids. Blood clots can also form inside hemorrhoids creating what is called a thrombosed external hemorrhoid.
Symptoms of External Hemorrhoids
One of the first symptoms people may notice with external hemorrhoids is bright red blood in their stool. The bright red blood is typically seen in the toilet or on toilet paper after a bowel movement. Any amount of bleeding can feel scary, but this rectal bleeding is often painless and doesn’t typically involve a large amount of blood. Dark blood or blood that appears to be formed in the stool should be reported to your doctor.
A bulge or small lumps of tissue can often be felt around the anus with external hemorrhoids. You may also experience painful bowel movements, itching, and irritation. In some cases hemorrhoids can also cause leakage of feces making it difficult to wipe or clean the area. While all of these symptoms are uncomfortable, hemorrhoids are very treatable and are not usually medically concerning.
What Causes External Hemorrhoids?
The main cause of external hemorrhoids is constipation (hard or irregular stools). Too much straining can make hemorrhoids you already have worse and increase the risk of new hemorrhoids. Other types of straining such as lifting heavy objects or sitting for long periods of time can contribute.
Who is at Risk for Hemorrhoids?
Hemorrhoids are one of the most common gastrointestinal illnesses. They affect both males and females of all races, in all age groups. But there are some factors that can put you at higher risk including:
- Genetics—A family history of hemorrhoids puts you at higher risk. Doctors will often ask whether family members suffer from hemorrhoids in order to identify a genetic tendency.
- Aging—The risk of hemorrhoids increases with age. While children and young adults do experience hemorrhoids, they are most common in adults 45-65 years old.
- Obesity—Body weight can contribute to the risk of hemorrhoids since heavier weight can cause additional strain on the body and contribute to a more sedentary lifestyle.
- Nutrition—A poor diet that lacks fiber often leads to constipation and straining during bowel movements.
- Pregnancy—The weight of carrying a baby during pregnancy can put increased pressure on the pelvic area. Thankfully, these will often resolve completely after delivery of the baby.
Can I Prevent Hemorrhoids?
Benjamin Franklin’s phrase, “An ounce of prevention is worth a pound of cure,” was made in reference to fire prevention, but the same wisdom applies to health and specifically to hemorrhoids. Making proactive lifestyle choices can help prevent hemorrhoids from occurring or recurring.
Most important? Eat a high-fiber diet. Consuming lots of fruits, vegetables, and other high-fiber foods including nuts, seeds, and whole grains will help produce normal bowel movements. Drinking plenty of water (6-8 glasses a day) is central to a high-fiber diet. Hydration works together with the fiber to help keep you regular. And don’t forget to exercise! Keeping the body moving helps keep everything inside the body moving as well.
Two more tips for prevention: First, when you feel the urge to go, go! Allowing bowel movements to happen regularly will help prevent constipation. Second, limit the time you spend sitting on the toilet to reduce pressure on the rectal area.
How to Treat External Hemorrhoids
The best ways to treat external hemorrhoids are through conservative measures like adopting the lifestyle changes mentioned above. You may also find over-the-counter or prescribed stool softeners and laxatives helpful.
Other treatment options are all about reducing the discomfort of the symptoms. Applying ice packs or cold compresses to the area can help with swelling and relieve irritation. A sitz bath provides relief by soaking the rectal area in warm water for 15 minutes three or four times per day. You can use your bathtub filled with two-to-three inches of warm water, or a shallow plastic basin available at drug stores, specifically designed for this. The basin fits over the toilet and allows you to soak only the rectal area.Remember, don’t add anything to the warm water unless directed by a doctor. A sitz bath is an excellent first treatment option because it is non-invasive and can bring immediate, frequent relief.
Over-the-counter pain relievers such as Ibuprofen and Tylenol can also be used to reduce pain. Ointments, pads, or suppositories that contain medications can also temporarily relieve itching and pain. While you can self-administer many of these treatments, please note that creams with hydrocortisone shouldn’t be used for more than a week. If your symptoms haven’t improved, you should stop using the cream and talk with your doctor about other treatment options.
If your symptoms don’t respond to lifestyle changes and initial treatment, your doctor may recommend other options. External and internal hemorrhoids can be removed through surgery called a hemorrhoidectomy. A less invasive procedure, offered at GI Associates, is available for internal hemorrhoids, called hemorrhoidal banding or rubber band ligation. Rubber band ligation involves a doctor placing rubber bands or small rings around the hemorrhoids. With a restricted blood supply, the hemorrhoids will shrink and fall off, usually within a few days. While some patients report a feeling of tightness, rubber band ligation is painless and has a high success rate, making it an excellent option for treating internal hemorrhoids.
When to Call Your Doctor
It’s always a good idea for anyone with hemorrhoids to consult with his or her doctor. However, you should call your gastroenterologist right away if you experience a lot of blood in the stool, dark tar-colored stool, or excessive pain. While most cases of hemorrhoids are not medically concerning, some of the same symptoms can point to more serious conditions including anal fissure, anal cancer, colorectal cancer, perianal abscess, and inflammatory bowel disease. A GI doctor will help you access your symptoms and make an accurate diagnosis. If you are experiencing the symptoms of external hemorrhoids, request an appointment at GI Associates and Endoscopy Center today. As the largest gastroenterology group in Mississippi, we have three convenient locations to serve you. Our doctors can provide options and help you decide on a treatment plan.