Uncomplicated External Hemorrhoids
While internal hemorrhoids develop above the dentate line inside the rectum, external hemorrhoids form below the dentate line and are visible outside the opening of the rectum. Some patients who suffer from external hemorrhoids may feel lumps near or around the anus. These cases are especially irritating during and after bowel movements, which can cause further anal itching and swelling.
External hemorrhoids are prone to intermittent flare-ups and can become large or persistent enough that they require surgical excision (external hemorrhoidectomy). Small and asymptomatic external hemorrhoids, however, don’t usually need any treatment.
Anal tags are excess, flesh-colored skin folds that appear around the anal opening, attached via a stalk or stem that supplies blood to the tag. Anal tags can be associated with a variety of anorectal issues and can cause discomfort, itching and discharge.
Causes of anal tags include:
While anal tags can be very irritating, they can easily be removed with a simple radio frequency device. This 10-minute procedure is performed in an office using local anesthesia and requires zero downtime.
Thrombosed External Hemorrhoids
When an external hemorrhoid escalates into a thrombosed external hemorrhoid, this indicates that somewhere in the anal skin, varicose veins ruptured and caused blood clots to develop. This, in turn, causes swelling with a bluish-purplish discoloration and severe pain.
A simple treatment method for less severe external hemorrhoids is to allow the hemorrhoidal blood clots to slowly absorb into the body over several weeks. This process is then paired with home remedies such as sitz baths, stool softeners, and increased fiber and fluid intake.
For more severe cases, surgical excision is often more effective and efficient, especially for thrombosed external hemorrhoids. Performed under local anesthesia, surgical excision is a safe, office-based procedure with low complication and recurrence rates and high levels of patient satisfaction.
There are two primary surgical methods that can be used. The first, which is quicker and seemingly more efficient, creates an incision over the clot and allows your doctor to squeeze out the clot’s contents. However, this method often results in blood clot recurrence and continued pain, which often brings patients right back to the office for further treatment.
A more extensive procedure, called a full hemorrhoidectomy, removes the entire clot and the hemorrhoidal blood vessels. This method takes longer and may require stitches, but it can yield better long-term results.
Both methods are performed under local anesthesia.
Acetaminophen or ibuprofen can be taken for pain. Warm sitz baths should be done three times daily, 15-30 minutes per session, while stool should be kept soft by drinking lots of water and taking stool softeners.
Common complications associated with thrombosed external hemorrhoid treatment include pain, bleeding, infection and delayed healing. Some patients may also develop an anal skin tag (see above). Extremely rare complications include anal stricture (narrowing of the anal passage) and incontinence (inability to control urination and defecation).