What External Hemorrhoids Look Like and How to Get Rid of Them
Medically reviewed by Robert Burakoff, MD
Hemorrhoids, also known as piles, are swollen or inflamed veins in your rectum or anus. They develop from increased pressure on the skin in and around the anal area. Hemorrhoids can be internal or external. External hemorrhoids can be the most painful. They form under the skin around your anus. They can cause anal itching and swelling when the skin around them is irritated.
Most external hemorrhoids resolve on their own, with or without treatment. Home treatments can often relieve symptoms. If blood clots form in external hemorrhoids, surgery may be needed to remove them.
This article describes the causes, symptoms, and diagnosis of external hemorrhoids. It also explains treatments, when medical care is needed, and ways to prevent them.
Ijubaphoto / Getty Images
What Do External Hemorrhoids Look Like?
External hemorrhoids look like swollen, bluish-colored lumps near the opening of your anus. Unlike internal hemorrhoids which are invisible from the outside of your body, you can usually see or feel external hemorrhoids.
External hemorrhoids are flat and soft. They are covered with a layer of skin or mucus. External hemorrhoids can become uncomfortable as the overlying skin becomes irritated and deteriorates.
If a thrombosis (blood clot) forms in a hemorrhoid, it can appear blue, purple, black, gray, or dark brown, depending on your skin color.
What Are the Symptoms of External Hemorrhoids?
External hemorrhoids are usually not problematic. However, they can be very painful if a blood clot forms. Common symptoms of external hemorrhoids include:
Painless, bright red blood from your rectum
Anal itching
Anal aching or pain, especially when sitting
One or more tender or hard lumps near your anus
Blood in the Stool
External hemorrhoids can sometimes bleed. The bleeding can result in bright red blood in your stool, on toilet tissue, or in the toilet bowl as the blood drips. This may occur after a bowel movement.
Blood Clots in the Hemorrhoid
An external hemorrhoid with a blood clot inside it is called a thrombosed hemorrhoid. The extra pressure of the blood clot on the surrounding tissue can cause constant and severe pain.
Learn More: Hemorrhoids: Signs, Symptoms, and Complications
What Causes External Hemorrhoids?
While the exact causes of external hemorrhoids are unknown, these growths are linked with physical features and behaviors that weaken and produce too much pressure on the veins around your anus. This interferes with blood flow to and from the anal area, causing the blood to pool and enlarge the blood vessels there. Over time, the swollen and inflamed veins appear as external hemorrhoids.
Straining during a bowel movement is a common cause of extra pressure on the anal area that leads to external hemorrhoids. Physical changes, such as the extra pressure exerted on the veins around the anus during pregnancy, can also contribute to external hemorrhoids. Hemorrhoids increase with age because the connective tissue that supports and holds them in place can weaken over time.
There is also evidence that some people may be predisposed to hemorrhoids. Research indicates that people with hemorrhoids are likely to have an anal canal that tends to be tighter than average, even without straining. The extra straining that occurs during a bowel movement increases the pressure in the anal canal.
Who Is at Risk of External Hemorrhoids?
While it is difficult to predict who will develop external hemorrhoids, certain habits and physical characteristics can exert extra pressure on your rectum and anus. This can cause swelling in the area and increase your potential for hemorrhoids.
The following risk factors can increase your chances of having external hemorrhoids:
Straining during bowel movements
Frequent lifting of heavy objects
Chronic constipation or diarrhea
Smoking
Aging
Genetics that predispose you to developing hemorrhoids
Anal sex
Activities in which you stand or sit for long periods
Pregnancy or childbirth
Sitting on the toilet for long periods
Learn More: Are Hemorrhoids Contagious?
How Are External Hemorrhoids Diagnosed?
External hemorrhoids are diagnosed by a healthcare provider based on your medical history and a physical examination. During a physical exam, your healthcare provider will check your anal area for signs of external hemorrhoids and the following problems that often accompany them:
Lumps or swelling
Prolapsed internal hemorrhoids (internal hemorrhoids that have fallen through the anal opening)
Leakage of bowel movements or mucus
Skin irritation
Anal skin tags (extra skin that remains after a blood clot in an external hemorrhoid dissolves)
Anal fissures (small anal tears that cause pain, itching, or bleeding)
Based on the results of your physical examination, your healthcare provider may perform one or more of the following diagnostic procedures to identify issues such as tumors, inflammation, and internal hemorrhoids:
Digital rectal exam: With this exam, your healthcare provider uses a gloved, lubricated finger to perform a manual examination of your anal canal and rectum. The exam checks for muscle tone and signs of internal hemorrhoids, bleeding, lumps, or masses.
Anoscopy: This examination involves the use of an anoscope (a hollow tube with a light at the end) to examine the lining of your lower rectum and anus.
Sigmoidoscopy: This internal examination uses a sigmoidoscope (a tubelike instrument with a light and lens) to closely examine the lining of your anus, rectum, and lower colon.
Colonoscopy: A colonoscopy involves the use of a colonoscope (a flexible tube with a camera on the end) to examine your anus and entire colon closely. It is performed while you are under sedation to rule out colon cancer.
Learn More: How Hemorrhoids Are Diagnosed
How to Get Rid of External Hemorrhoids at Home
Most external hemorrhoids go away on their own after a few days. If not, you can relieve pain at home with simple conservative measures. These treatments typically relieve pain within one to two weeks.
The following strategies can treat hemorrhoids at home:
Shorten bathroom trips: Limit toilet use to one to two minutes when possible to avoid straining.
Consume more fiber and drink more water: Get 25–30 grams of fiber daily from fiber-rich foods (fresh fruits, leafy vegetables, and whole-grain breads) or fiber supplements to help stools pass easier and reduce the need for straining.
Use a stool softener: Stool softeners increase the water your stool absorbs, making them easier to pass without straining.
Use over-the-counter topical hemorrhoid treatments: Topical hemorrhoid creams containing a local anesthetic like lidocaine can temporarily soothe pain. Witch hazel wipes and creams that contain hydrocortisone can also soothe inflammation.
Use nonsteroidal anti-inflammatory drugs (NSAIDs) or other over-the-counter pain relievers to relieve pain: Pain relievers that include Tylenol (acetaminophen), and NSAIDs like Advil, Motrin (ibuprofen), or Aleve (naproxen) can help relieve the throbbing pain of external hemorrhoids.
Take a sitz bath: A sitz bath is a warm water bath for soaking the area between your genitals and anus (perineum). Soaking in this way can relieve irritation and spasms of the anal sphincter muscle. For best results, soak for about 20 minutes after each bowel movement plus two or three times daily. Add Epsom salts or baking soda to the water for better results.
Apply ice packs: Apply ice to the irritated area for five to 10 minutes. Use a towel between your skin and the ice pack to prevent skin damage.
Practice regular physical exercise: Moderate aerobic exercise, such as brisk walking 20 to 30 minutes daily, can stimulate bowel function and reduce constipation.
Maintain proper hygiene in the perineal area: Fill a squirt bottle (peri bottle) with warm water and use it to cleanse the perineal area after urinating or a bowel movement. This cleanses the area gently and thoroughly.
Learn More: Hemorrhoid Treatments: Home Remedies, OTC Medicine, and More
Other External Hemorrhoids Treatment Options
Medical treatment for external hemorrhoids is limited to specific cases. Treating external hemorrhoids is reserved for cases in which the external hemorrhoids are very large, thrombosed (filled with blood clots), and/or causing intense pain.
Surgical Removal
When medical treatment is justified, external hemorrhoids are removed with a surgical procedure called a hemorrhoidectomy. This involves using a laser, scalpel, or electricity through a device to remove the affected area or the entire hemorrhoid, depending on the technique used.
The two approaches to hemorrhoidectomy are:
An excisional hemorrhoidectomy is the conventional operative approach. It involves surgically removing the entire external hemorrhoids. This procedure is performed in an operating room, often under intravenous (IV) sedation, spinal block, or general anesthesia.
An incisional hemorrhoidectomy involves making a cut over the skin of the external hemorrhoid and removing the clot and the overlying skin of the thrombosed hemorrhoid. This in-office procedure is performed after the injection of local anesthesia to numb the affected area.
Treatments During Pregnancy
Medical treatment for external hemorrhoids during pregnancy and in the immediate postpartum period is not routinely administered. Surgical removal of external hemorrhoids via hemorrhoidectomy during this time is reserved for cases that involve severe complications.
Learn More: Do Hemorrhoids Go Away on Their Own?
Ways to Prevent External Hemorrhoids
You can help prevent hemorrhoids by taking the following steps to ensure healthy bowel habits and avoid constipation:
Maintain a high-fiber diet: Limit the amount of low-fiber and processed foods you consume.
Avoid heavy lifting when possible: Straining when you lift heavy objects exerts extra pressure on your rectal ad anal veins.
Limit the time you spend on the toilet: Don't delay going to the bathroom. Try to spend no more than 10 to 15 minutes on the toilet when having a bowel movement. Avoid straining or forcing if possible.
Reduce distractions when sitting on the toilet: Avoid losing track of time by looking at your phone or reading on the toilet.
Avoid laxatives, except bulk-forming laxatives with psyllium: Other types of laxatives can cause diarrhea, which can worsen hemorrhoids.
Learn More: Coping With Hemorrhoids
When to Contact a Healthcare Provider
Contact a healthcare provider about your external hemorrhoids if you have the following symptoms:
Rectal bleeding
Worsening or new symptoms
Symptoms that do not improve after one week of home treatments
Weight or appetite loss or other changes that affect your entire body
The following symptoms indicate a possible medical emergency. Seek immediate medical care if you have any of the following symptoms with external hemorrhoids:
Severe pain in your anal area
Rectal bleeding that won't stop
Severe abdominal pain
Diarrhea
Fever
Dizziness or fainting, especially during bleeding
Learn More: How to Treat Bleeding Hemorrhoids
Summary
External hemorrhoids occur as a result of extra pressure on the veins in your anal area. Straining with bowel movements or sitting for long periods on the toilet can increase your risk. These growths are more common with pregnancy, obesity, and aging.
Most external hemorrhoids resolve on their own even without treatment. Home treatments can help relieve symptoms of itching, swelling, and pain. Lifestyle changes like eating more fiber can reduce your risk and prevent them from recurring.
Contact your healthcare provider if you have external hemorrhoids that do not improve after a week of home treatments. Seek prompt medical treatment if you also have a lot of bleeding, intense pain, dizziness, and/or other signs of severe illness with external hemorrhoids.
Read the original article on Verywell Health.
