Uncomplicated External Hemorrhoids
Everyone has a normal hemorrhoidal tissue in their rectum and anus. It’s only when your hemorrhoidal veins enlarge and become varicose veins that they’re considered abnormal or diseased. Internal hemorrhoids form above the dentate line, while external hemorrhoids form below the dentate line. They are covered proximally by anoderm and distally by skin, both of which are sensitive to pain and temperature.
External hemorrhoids usually affect the cleansing after the bowel movement and cause the skin irritation and itching. The patients may feel the lumps near or around the anus.
Small and asymptomatic external hemorrhoids don’t need any treatment, however most patients will have an intermittent flare up. Eventually patients may need surgery (external hemorrhoidectomy) if you have large external hemorrhoids and/or persistent symptomatic external hemorrhoids.
Anal skin tags are flaps of skin or flesh found around the anus. The tags are usually flesh colored and hang in the opening of the anus by a stalk or stem that supplies the blood to the tag. Anal skin tags are usually associated with hemorrhoids or other anorectal problems.
Causes of anal tags include:
Anal tags can easily be removed in our office using local anesthetic and a radiofrequency device. The procedure only takes less than 10 minutes and you are able to drive yourself home afterwards.
External Thrombosed hemorrhoids
External hemorrhoids develop below the dentate line and outside the anal verge. Thrombosed external hemorrhoids occur if varicose veins rupture and blood clots develop. It is often accompanied by swelling with a bluish-purplish discoloration and severe pain. It is not clear why healthy people suddenly develop clots in external hemorrhoids.
The treatments for external hemorrhoids are different from those for internal hemorrhoids. One treatment option is to allow clots in the external hemorrhoids to be slowly absorbed by the body over several weeks. The symptoms may improve in some patients with conservative nonsurgical treatment – the anal care we coined includes stool softeners, increased dietary fiber, increased fluid intake, warm Sitz baths, and analgesia.
For most patients, surgical excision is often more effective and efficient in treating thrombosed external hemorrhoids. Surgical excision is an office-based procedure performed under local anesthesia. This safe office procedure offers low complication and recurrence rates and high levels of patient satisfaction.
One procedure creates an incision (cut) over the clot, allowing the doctor to squeeze out the clot. Unfortunately, this quick and easy procedure frequently results in blood clots reforming and continuing pain. A more extensive procedure (full hemorrhoidectomy) removes the clot and the blood vessels in the hemorrhoid. This procedure is longer and may require sutures (stitches) to close the wound, but can yield better results. Local anesthesia (numbing medicine) is used for both procedures.
The patient will be instructed to do anal care measures, including warm Sitz baths three times a day for 15-30 minutes at a time. Acetaminophen or ibuprofen should be used for pain control. The patient should remain well hydrated and take a stool softener to keep stool soft.
Common complications of thrombosed external hemorrhoid excision include pain, bleeding, infection and delayed healing. A perianal skin tag could develop in some patients. Stricture and incontinence are extremely rare complications.