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External Hemroids aka External Hemorrhoids / External Piles
External Hemroids covers external hemroids causes, external hemroids treatment and external hemroids symptoms, as well as home remedies, surgery, and creams and medications for controlling or eliminating external hemroids
Initial Reaction to Finding External Hemroids and What to do:
External hemroids can be one of the most annoying and embarrassing medical conditions in existence. Some people react with "yuck, yuck, yuck!" when they first see or feel their external hemroids. Most, I believe, become concerned, which is further exasperated as, apart from a doctor, who else can they show these external hemroids to, to get a diagnosis and help?
Also, if you use our hemroid photo page, you may be able to compare your alleged hemroids to the ones in the photos, which may help with any self diagnosis you may attempt - currently we have many such hemroid pictures - external hemroids, prolapsed internal hemroids, thrombosed external hemroids, and many others.
Photo / Picture of External Hemroid
If you don't mind the graphic nature of such, then click --> hemroid pictures to see quite a variety of external hemroids pictures, as well as pictures of other hemroid types.
The above two pictures of external hemroids give a good idea of what external hemroids can look like.
The picture below is of an external hemroid that has thrombosed. Although it is difficult to see the size of the external hemroid, it is about as large as a pea, and the doctor said, because of the thrombosed external hemroid being small, to just leave the hemroid alone and see if it becomes worse or settles down over the next few days, which it eventually did - the external hemroid was quite painful, which is quite common for thrombosed hemroids to be.
Definition of External Hemroids - What are external hemroids? - and how are External hemroids different to internal and prolapsed hemroids?
External hemroids are specifically defined as lumps or masses of tissue containing enlarged blood vessels that lie just outside of the anal canal. External hemroids start below the dentate line of the anal canal, where the transition between internal mucus membrane and external skin occurs and only occurs in the anal region.
A lump of blood and inflamed tissue on the upper leg would be referred to variously as a hematoma, myotoma, etc. Varicose veins are the closest related condition to external hemroids, I think. An external hemroid, specifically, is an enlarged vein that comes from the stretchable veins around the anal region, and only occurs because those veins are so stretchable for sphincter muscle control purposes.
Internal hemroids occur above this line inside of the anal canal, and usually do not hurt as there are not nearly so many sensitive nerves above this transition, but external hemroids usually hurt quite a lot as they occur right on or around a sensitive nerve band. Sometimes an internal hemroid can originate above the dentate line, but protrude below it even to the point of extruding outside the body. This condition is referred to specifically as a prolapsed hemroid, and is not covered in this article.
External Hemroids Symptoms:
External hemroids exist in an area of our body that is extremely sensitive and densely packed with nerves.
The external hemroid symptoms are very similar to those of hemroids in general. External hemroids can be quite unsightly while being irritating as well. When external hemroids get enlarged and inflamed, the external hemroids cause painful swelling along the anal rim. The external hemroids itch, they burn, they're extremely sensitive to the touch and external hemroids can really make life more miserable than their internal counterparts, as there are very few nerves above the dentate line in the anal canal. Internal hemorrhoids can go for some time without being noticed, but external hemroids / hemorrhoids generally make their presence known with a proverbial neon sign.
External hemroids symptoms can also (rarely) include bright red blood on toilet paper, stool, or in the toilet bowl.
These external hemroid symptoms are also common for internal hemroids that have prolapsed.
Getting back to external hemroids, when external hemroids are inflamed and the swelling is bright red, it means that the tissue of and around the external hemroid has become irritated.
If there is a dark red, bluish, blackish or purplish tinge the external hemroid has probably developed a thrombosis, or blood clot in simpler terms - A blood clot in an external hemroid can also produce symptoms of pronounced burning, itching, and can hurt like crazy. At that point it has turned into an thrombosed external hemroid and should be looked at by a doctor to prevent dangerous side effects, but the treatments for external hemroids are similar whether thrombosed or not.
External hemroids will always swell at or around the anal rim, external hemroids never protrude from inside the body. Again, that is a prolapsed internal hemroid and needs to be looked at by a doctor ASAP.
Bleeding External Hemroids:
Any rectal bleeding, no matter how slight, should always be looked at by a doctor, as the causes of rectal bleeding can include external hemroids, anal fissures, polyps, warts, fistulas, ulcers, and colorectal cancer.
Nearly all of those conditions need to be treated by a doctor immediately and cannot be dealt with at home.
External Hemroids Treatment:
Ever asked the questions: How to treat external hemroids? How to get rid of external hemroids?
However, unless the external hemroid has thrombosed or is bleeding, external hemroids are normally quite easy to treat at home. Most of the creams and ointments on the market are specifically targeted at the treatment of external hemroids - those with internal or prolapsed hemroids are not so lucky.
Of the above, for cost effectiveness, and only for external hemroids, I would suggest that the Heal Hemorrhoids topical essential oils and the Neo Healar topical Cream, are both premium, first class choices. If your external hemroid has thrombosed - has a blood clot (normally the external hemroid is dark blue or purple, with much pain) - I have no suggestion except to see a doctor for assessment, as I can't be sure how any of these products would interact with a blood clot. If you have internal hemroids, or you don't know if you have internal or external hemroids, then the pills are suggested as being the most beneficial and safest option.
Avoid the Cause of External Hemroids:
The best way to treat external hemroids is to not cause the external hemroids in the first place.
External hemroids are caused by excessive abdominal pressure on the veins that naturally swell in our anus to provide excretion control. This pressure most often comes from either pregnancy or constipation. If the cause is pregnancy, preventing it may not be the desired course of action for completely different reasons, and hemroids are certainly not the most important factor in that decision. However, pregnancy-induced external hemroids usually vanish after childbirth with no further recurrence. In addition, the regimen to prevent and treat constipation-induced external hemroids also helps the pregnancy-induced external hemroids.
However, with external hemroids that are not pregnancy related, nor constipation related, the cause is often found in examining your physical life style for things that may damage the veins in that area of your body. Two main causes in this group being:
Improper procedure when doing anal intercourse can cause external hemroids - please see our page on hemroids and achieving safer anal sex.
The second is I believe to be exercise - When I have been doing the photo proofs of various hemroid treatments, I have found that in three cases the treatment worked much slower than expected, and in one case the hemroid sufferer kept improving then appeared to be retraumatising the hemroid. When I looked at these two cases much more indepthly, I found that the three were engaged in very solid exercise - one did heaps of contact sports and lots of running, while the other was shovelling snow and weight lifting, while the 3rd was into doing squats. So if you are into real solid exercise type stuff, you may need to stop until the external hemroid is healed. Lets face it, the options are that you get rid of the external hemroid now, or you risk needing an external hemorrhoidectomy further down the way, which will put a real damper on your physical routine for two to three months, as opposed to around two to three weeks now.
Prevent and Cure External Hemroids:
1... To prevent and cure external hemroids, first eat a balanced diet with plenty of fresh fruits, whole grains, and beans for fiber. To stay healthy, your intestinal tract needs about 96 grams of fiber per day to allow it to function properly.
To avoid excessive gas, introduce these foods slowly and one at a time, until you are eating a healthy and balanced diet. Also remember to drink enough water, at least eight glasses a day.
Avoid excessive consumption of coffee, tea, and soft drinks, as the caffeine in these drinks actually serves to dehydrate you which can only worsen a constipation problem, and hence make external hemroids more likely to develop and or act up.
2... Also, a regimen of light and regular exercise serves to remind your body to keep working even when you're resting. The intestinal tract performs a muscle movement called "peristaltic motion" which is how it transports food during digestion. This peristalsis is aided by the action of walking or running. Walking briskly twenty minutes a day three times a week is more than sufficient to help your intestines do their job, and help prevent and get rid of external hemroids.
3... Setting a schedule for bowel movements by sitting on the toilet at a certain time of day can train your intestinal tract to evacuate regularly. When trying this, do not strain and do not sit forever if nothing happens, just try again tomorrow.
4... Also, never resist the bowel movement urge when it comes up, go immediately and again, don't strain. Following these lifestyle guidelines prevents both external hemroids and a huge host of other health problems.
If external hemroids are already a problem, any treatment regimen that doesn't include these lifestyle guidelines will be almost useless.
Fiber Supplements and Laxatives as External Hemroids Treatments:
If it is impossible to get enough dietary fiber through regular, whole foods, taking a fiber supplement like Metamucil can help significantly with external hemroids and can be used frequently. Fiber supplements are not laxatives, but instead are a dietary supplement.
Never put yourself on a regular schedule of laxatives without a doctor's supervision, as overuse of laxatives can lead to dehydration, malnutrition, and serious intestinal dysfunction, and make your external hemroids worse.
It's one thing to take an over the counter laxative for a one-time constipation problem brought about by a singular event, like eating poorly while camping, but laxatives are not a regular maintenance item for anybody who doesn't have a specific medical condition.
External Hemroids Treatment for the Itch
Another point to keep in mind is that anal itching that is referred to as pruritis ani, the most common cause of which is external aggravation. This doesn't refer to your annoying relative's visit, but irritation caused by too vigorous cleansing or by harsh soaps or dyes.
While we commonly think of that area as filthy and in need of a good scrubbing, the truth is that our rectum and anus are naturally designed to be self-cleaning.
We have several oil-producing glands in that area that serve to slough off dirt and kill bacteria and, when we scrub too much we strip those oils out of our skin. Dry skin always itches, and when we clean this area too much our natural antibacterial defenses are stripped away, so it's a lot easier to get an infection.
Inflamed external hemroids can also start the cycle of itching, scratching, and inflammation, which is why gentle and immediate treatment is important.
The upshot of all of this is don't clean this area any more than you do anywhere else, don't use alcohol based wipes or harsh soaps on it, and if it's itching with no lump or mass, see your doctor to find the real cause to help get you back to your natural balance.
External Hemroid Treatment for Relief : Home Remedies:
For external hemroid relief, take warm, plain water sitz baths for 15 to 20 minutes two to three times per day. Taking them in the morning and evening works for just about any work schedule. Never use additional chemicals or cleansers in these sitz baths, as any chemical additions can only serve to further inflame the area. Carefully using cold compresses or ice packs on the area can help with pain and itching caused by the inflammation, but remember to never use an ice pack directly on any bare skin, always put a towel in between.
External hemroid remedies are fairly simple:
Acetaminophen or ibuprofen can both be used to deal with the discomfort of external hemroids.
Using petroleum jelly or aloe vera salve can help keep the external hemroid area from drying out and itching further and, if the irritation gets really bad, there are several over-the-counter preparations that can help.
The most effective medications for external hemroids are salves and creams that include lidocaine or hydrocortisone. Lidocaine is a mild local topical anesthetic, it won't actually treat hemroids but it will reduce or eliminate the discomfort while other treatments are taking place. Hydrocortisone is a corticosteroid external hemroid medicine that serves to physically reduce the inflammation and swelling, but this medication is not recommended without a prescription because corticosteroids can eventually start to thin the muscle walls of the anus, which can eventually lead to incontinence.
Astringents, such as calamine, zinc oxide, or witch hazel can also help as they serve to relieve inflammation.
Both times after giving birth, my OB/GYN sent me home with witch hazel wipes to pat with after bowel movements, and I found it very soothing. However, I was warned to never scrub with anything, as that only makes the problem worse, and never use baby wipes or alcohol based wipes.
If you don't have access to witch hazel, the same effect can be gotten out of a vinegar-soaked sterile cotton swab, but most people find the witch hazel to be best for external hemroids.
If these home remedies do not start to get rid of external hemroids within one week, if any symptom gets worse after beginning treatment, or if the symptoms are interfering with daily life, see a doctor about your external hemroids immediately.
External Hemroid Treatment by Surgery:
There are a variety of surgeries available to treat external hemroids, and your doctor can help you decide which one is the correct surgery for YOUR external hemroids.
All medical surgeries for external hemroids basically work by cutting off the blood supply to the lump, and using the natural strength of scar tissue to make sure that the veins around the site of the external hemroid do not have the opportunity to enlarge again.
In all surgeries except full surgery, there will generally be a slight bit of rectal bleeding for about a week after the external hemroid surgery is performed. Taking frequent sitz baths after the surgery usually helps with discomfort, and many doctors recommend taking a non-steroidal anti inflammatory such as ibuprofen for four or five days both before and after the treatment to help with pain, swelling, and bleeding. Keep in mind that with any medical surgery, infection and ulceration is always a risk, and none of these external hemroids surgeries are any different in that regard.
However, the choice of surgery for external hemroids is more limited than for internal hemroids. The most common hemroid treatment, latex band ligation and the less common sclerotherapy, are both UNSUITABLE surgeries for use with external hemroids
The procedure used is hemorrhoidectomy, wherein you are generally placed under anesthesia and have the external hemroids surgically removed.
This external hemroids surgery can be performed with either traditional scalpels or lasers, though which option is best is still a matter of hot debate.
Bleeding and infection are less of a risk with lasers, but lasers can cause very deep tissue scarring and no studies have been done to prove that they actually work better on external hemroids in comparison to surgery performed with properly sterilized instruments.
While this external hemroids surgery is usually done with no hospital stay, your doctor may instruct you to take a couple of days of bed rest. This is the best method to use if the external hemroids are quite severe or if they've come back after treatment with other procedures.
Again, maintain open and honest communication with your doctor to find the best external hemroids treatment for you.
External Hemroids In Summary:
External hemroids are usually a relatively mild health problem, and the home treatments are usually the most effective ones.
Using over the counter creams and salves for external hemroids relief also helps whether you've chosen a doctor-administered procedure or not, but you should stop using them after the treatment.
For any external hemroid medical procedure to be effective, you usually have to make a commitment to practice things like diet change anyway, so it's best to start there.
After all, by making a commitment to eating better and exercising more, you're helping more than just your external hemroids.
Research and main write by Loni L. Ice, editing by D. S. Urquhart.
Main book reference "Taber's Cyclopedic Medical Dictionary" F.A. Davis Company, Philadelphia, 1997 + several more modern references.
External Hemroids Spelling:
External hemroids can also be spelt as external hemorrhoids, incorrectly as external hemorroids and many other variations thereof.
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