External Hemorrhoids: Causes, Symptoms, Treatment, and Cost

In the case of external hemorrhoids, the veins in the rectum and anus swell and become irritated, resulting in discomfort, itchiness, and blood while urinating.

There are two main types of external hemorrhoids:

• Thrombosed external hemorrhoids: This type of hemorrhoid occurs when a blood clot forms in the vein. Around the anus, it may result in excruciating discomfort and swelling.
• Non-thrombosed external hemorrhoids: This type of hemorrhoid is characterized by swelling and inflammation without the presence of a blood clot. It may result in gastrointestinal pain, itchiness, and bleeding.

The bulging of blood vessels beneath the skin around the anus is what causes external hemorrhoids. The exact cause of external hemorrhoids is not always clear, but several factors can contribute to their development, including:

• Straining during bowel movements: Straining when passing stool can increase pressure in the anal area, causing the blood vessels to swell and become inflamed.
• Chronic constipation or diarrhea: Constipation may result in difficult-to-pass, firm stools, which can cause straining and increased pressure in the anus. By generating frequent bowel movements and irritating the anal region, diarrhea may also contribute to the development of hemorrhoids.
• Pregnancy: Hemorrhoids may form as a result of pregnancy's increased strain on the pelvic area's veins.
• Obesity: Being overweight might increase the risk of hemorrhoids by adding additional pressure to the veins in the anal region.
• Sitting or standing for long periods: Prolonged sitting or standing can contribute to the development of hemorrhoids by causing blood to pool in the veins in the anal area.
• Age: Hemorrhoids are more likely to occur as we age because the tissues in the anal region may weaken.

The following are typical signs of an external haemorrhage:

• Anal area discomfort or pain
• Inflammation or itching in the anus
• lumps or swelling around the anus
• bleeding while going to the toilet
• Stool passage difficulty.

You can avoid External hemorrhoids by adopting these:

• High-fiber diet: Consuming a diet rich in fiber, which includes beans, fruits, vegetables, whole grains, and cereals lowers the chance of developing external haemorrhoids and may help avoid constipation.
• Adequate fluid intake: By ingesting enough water and other fluids to make feces soft, constipation may be prevented.
• Exercise: Regular exercise may promote bowel movements and prevent constipation.
• Avoid straining: Hemorrhoids are more likely to form in those who strain during bowel motions. Avoid sitting on the toilet for too long or pushing too hard.
• Avoid sitting for long periods: Long periods of sitting may strain the anus and raise the possibility of hemorrhoids. Try to move around and get up often.
• Good hygiene: To avoid inflammation and infection, keep the anal region dry and clean. After bowel motions, wash the region with warm water and mild soap.
• Use moist wipes or pads: After bowel movements, the anal region may be cleaned with moist wipes or pads to lessen inflammation.
• Avoid lifting heavy objects: Lifting heavy objects can put a strain on the anal area and increase the risk of developing hemorrhoids.

Here are some of the diagnostic tests that can be used to diagnose external hemorrhoids:

• Physical examination: The doctor will perform a visual and physical examination of the anus and rectum to check for the presence of external hemorrhoids.
• Digital rectal exam (DRE): A gloved, greased finger is inserted into the rectum by the doctor to feel for any irregularities, such as external haemorrhoids.
• Anoscopy: To observe the internal and external haemorrhoids, a thin, flexible tube with a light and camera called an anoscope is placed into the anus.
• Sigmoidoscopy: The bottom portion of the colon and rectum are examined with a longer, flexible tube equipped with a light and camera (sigmoidoscope). If results from further tests are insufficient, this test may be conducted.
• Colonoscopy: A colonoscope, a long, flexible tube containing a light and camera, is used to examine the whole colon and rectum. This test may be performed if other tests do not provide enough information or if the doctor suspects other gastrointestinal conditions.

Around the anus, bulging veins called external haemorrhoids form. This might lead to a variety of issues, including:

• Thrombosis: A blood clot that forms in external haemorrhoids may be very painful and swollen.
• Infection: Bacteria may infiltrate the skin surrounding the haemorrhoid if it breaks, leading to an infection. Cellulitis or abscesses may result from this.
• Anal fissures: The constant irritation and pressure caused by external hemorrhoids can result in anal fissures, which are painful tears in the skin around the anus.
• Strangulation: In rare cases, external hemorrhoids can become so swollen that they cut off the blood supply to the surrounding tissue. Strangulation is what is happening here, and it needs medical treatment right once.
• Anemia: Anemia, which may result in weariness, weakness, and breathlessness, can be brought on by external haemorrhoids that bleed continuously.
• Psychological distress: External hemorrhoids can cause embarrassment, anxiety, and depression, especially if they interfere with daily activities or sexual function.

Some home remedies for External hemorrhoid include:

• Triphala churna: To relieve itching and discomfort, create a paste out of Triphala powder and water, then apply it to the afflicted region.
• Aloe vera: Apply fresh aloe vera gel to the area to reduce swelling and relax the skin.
• Witch hazel: Use a cotton ball to apply witch hazel to the hemorrhoids for pain relief and to reduce swelling.
• Sitz bath: Soak in a warm sitz bath for 15 to 20 minutes to reduce hemorrhoid discomfort, swelling, and inflammation.
• Coconut oil: Apply coconut oil to the hemorrhoids to reduce itching and swelling.
• Buttermilk: Drink a glass of buttermilk with a pinch of salt to improve digestion and reduce constipation, which can cause hemorrhoids.
• Trikatu powder: Mix equal parts of ginger, black pepper, and long pepper powders, and take this mixture with warm water or honey to improve digestion and prevent constipation.
• Indian gooseberry: Drink a glass of fresh amla juice daily to improve digestion and prevent constipation.
• Castor oil: Castor oil may be applied to the region to help with pain relief and inflammation reduction.
• Figs: Eat a few figs daily to improve digestion and prevent constipation, which can cause hemorrhoids.

Items that people with external haemorrhoids should eat:

• High-fiber foods: Fruits, vegetables, whole grains, and legumes are examples of foods high in fiber that may help soften stools and ease bowel motions, lowering the risk of additional inflammation and bleeding.
• Fluids: Regular bowel movements and the prevention of constipation may both be aided by drinking enough water and other fluids. Aim for 8 to 10 glasses of water a day, minimum.
• Lean protein: Consuming lean protein foods like chicken, fish, and tofu may aid in the healing process and the restoration of injured tissues.
• Healthy fats: Olive oil, avocado, and almonds are examples of good fats that may help decrease inflammation and encourage healing.
• Low-sugar foods: By avoiding sugary meals and drinks, you may lessen inflammation and stop future irritability.
• Probiotics: Consuming probiotic-rich foods such as yogurt, kefir, and sauerkraut can help promote healthy gut bacteria and reduce inflammation.
• Warm liquids: Warm liquids, such as herbal tea or warm water with lemon, may be consumed to relax and calm the anal region.
• Spices: Spices like turmeric, ginger, and garlic may help lower inflammation and encourage healing when added to food.

Foods to avoid in External hemorrhoid:

• Spicy and hot foods – Foods that are hot and spicy might irritate the anal region and aggravate external haemorrhoids. Thus it is recommended to stay away from eating such meals.
• Alcohol – Consuming alcohol can lead to dehydration, which makes the stool harder, and increases constipation, which can worsen the external hemorrhoids.
• Processed and fried foods – Foods that have been processed or fried sometimes include harmful fats and other ingredients that may increase the signs and symptoms of external hemorrhoids by causing inflammation.
• Red meat – Red meat is high in fat and difficult to digest, which may cause constipation and make the external hemorrhoids worse.
• Dairy products – Cheese and milk are dairy goods that might make you constipated, which puts further pressure on your enlarged veins.
• Citrus fruits – Citrus fruits like oranges and lemons contain high levels of acidity, which can aggravate external hemorrhoids and cause further pain.
• Caffeine – Caffeine in coffee, tea, energy drinks, and sodas can dehydrate the body, leading to constipation and making the hemorrhoids worse.
• Refined carbs – Refined carbs like white bread, pasta, and rice

Depending on how severe the issue is, several treatment points may be recommended for external haemorrhoids. Some of them consist :

• Hemorrhoidectomy: The hemorrhoidal tissue is removed during this surgical treatment. The more severe instances of external haemorrhoids often need it.
• Stapled hemorrhoidopexy: By stapling the tissue back into place, haemorrhoids are removed using a circular stapling instrument. Hemorrhoidectomy is less invasive than this operation.
• Rubber band ligation: This treatment includes cutting off hemorrhoid's blood supply by encircling it with a rubber band. Eventually, the hemorrhoid will come out by itself.
• Sclerotherapy: The haemorrhoid is shrunk by being injected with a chemical solution.
• Coagulation therapy: An electric current or infrared light is used to coagulate, or clot, the blood vessel feeding the hemorrhoid, causing it to shrink.
• Laser surgery: A laser is used to vaporize or excise the hemorrhoid tissue.

If you have an external haemorrhoid, you should see one of these medical professionals:

• General practitioner or primary care physician: Most patients with symptoms of external hemorrhoids will initially seek therapy from their primary care physician. They can provide initial diagnosis, recommend non-surgical treatments such as lifestyle changes, and refer patients to specialists for complicated cases.
• Gastroenterologist: Gastroenterologists specialize in diagnosing and treating digestive disorders. They play a crucial role in examining and treating more severe cases of external hemorrhoids, including diagnostic procedures such as colonoscopies and rectal exams.
• Colorectal surgeon: For severe cases of external hemorrhoids, a colorectal surgeon may be the appropriate specialist to consult. They can perform surgical interventions such as hemorrhoidectomy or hemorrhoidopexy to provide long-term relief from symptoms.
• Proctologist: An expert in rectal and anal disorders, such as external haemorrhoids, is known as a proctologist. They may recommend conservative treatment options, such as topical creams or lifestyle changes, or procedures such as rubber band ligation or laser coagulation.
• Rural health experts: Rural health professionals, who can be general practitioners, family medicine practitioners, nurse practitioners, physician assistants, or certified nurse midwives, are important sources of care for those living in rural areas. They can provide basic diagnosis and non-surgical treatment options for external hemorrhoids and can refer patients to specialists if required.

Medications and drugs that are important for external hemorrhoids include:

• Topical creams and ointments: These can help relieve itching and irritation, reduce inflammation, and shrink the size of the hemorrhoids. Some examples include hydrocortisone creams, witch hazel wipes, and lidocaine ointments.
• Pain relievers: Acetaminophen and ibuprofen, two over-the-counter painkillers, may help ease the discomfort brought on by external haemorrhoids.
• Stool softeners and fiber supplements: They may lessen straining during bowel motions and help avoid constipation, both of which can exacerbate haemorrhoids.
• Sitz baths: The anal region may be soothed and cleaned by soaking in warm water for 10-15 minutes numerous times throughout the day.
• Prescription medications: A doctor may recommend stronger drugs, such as corticosteroid creams or pain relievers with prescription strength if over-the-counter therapies do not work.

Mild instances often get better on their own in a few days to a week with the help of appropriate self-care techniques like warm sitz baths, more fiber, and topical ointments.

Medical intervention, such as surgery or less invasive techniques, may be necessary for moderate to severe instances that may take several weeks to recover.

Surgery for external hemorrhoids can be an effective treatment option for those who have not found relief from other treatments. Patients might anticipate a considerable improvement in their symptoms and quality of life with the right therapy and follow-up.

After undergoing surgery for external hemorrhoids, patients should follow these post-surgical treatment steps:

• Pain Management: After surgery, patients could feel pain and discomfort. The doctor may prescribe painkillers or recommend over-the-counter pain relief medication. To lessen discomfort and swelling, ice packs may also be placed on the afflicted region.
• Hygiene: Patients should maintain good hygiene to prevent infection. Sitz baths, where the patient sits in warm water for 15-20 minutes, can help reduce pain and inflammation. The region should be cleansed with a wet wipe or mild soap and water after a bowel movement.
• Diet: To avoid constipation, patients should consume a high-fiber diet and get enough of liquids. Stool passage may be impeded by constipation, aggravating the surgery site. Foods that might irritate patients, such as spicy and acidic meals, should be avoided.
• Physical Activity: Patients should avoid strenuous activities for at least two weeks after surgery. Walking is a simple workout that may aid healing and avoid blood clots.
• Follow-up Appointments: Patients should show up for their doctor's follow-up visits to guarantee appropriate healing and to address any worries or issues that may develop.

Depending on how severe the issue is, external haemorrhoids treatment in India may cost anywhere from:

On average, the cost can range from Rs. 10,000 to Rs. 50,000. This covers the price of any required consultations, medications, and treatments including surgery or rubber band ligation.

If hospitalization is required, the cost can increase from around Rs. 75,000 to Rs. 1,00,000, which includes room charges, nursing care, and other associated expenses.

The real cost, however, may vary based on the facility and region and is just an estimate at this point.

Common side effects of External hemorrhoid treatments include:

• Pain and Discomfort: The treatment of external hemorrhoids can cause pain and discomfort in the treated area. The use of topical creams or ointments, for instance, can cause burning, stinging, and itching.
• Bleeding: In some cases, the treatment of external hemorrhoids may result in bleeding. This is especially true with hemorrhoidectomy, a surgical operation in which the afflicted tissue is removed.
• Swelling: The affected area may also swell up after treatment. This may be uncomfortable and have an impact on daily activities.
• Infection: There is also a risk of infection during and after treatment. The use of unsterilized instruments or unsanitary conditions during surgery can cause infections that may require antibiotics to treat.
• Recurrence: In some cases, external hemorrhoids may recur after treatment. This is more likely to happen if the underlying cause of the hemorrhoids, such as constipation or diarrhea, is not addressed.
• Fecal incontinence: Surgery to remove external haemorrhoids sometimes results in fecal incontinence. This can be because the anal sphincter was harmed during the procedure.
• Unintended Consequences: The treatment for external hemorrhoids can sometimes cause unintended consequences. For example, if a blood clot is present in the affected area and is not detected before treatment, it can cause severe pain and may require additional treatment.

External haemorrhoids may have problems including 'Thrombosis, Anal Fissure, infection, etc.,' with treatment regimens ranging from a few months to years depending on the severity of the condition. You should get quick medical attention from a local physician if you are having any problems.