External Hemorrhoids – What They Are and How To Deal With Them

External hemorrhoids differ from internal hemorrhoids not only because of their location, but also because of their nature, their causes, symptoms and treatment.  External hemorrhoids are simply blood veins that have expanded beyond their normal size resulting in a prolapse of the vein into adjoining spaces.  When these veins expand and do not retract it is a sign that the lining of the walls of these veins are in a weakened state.  They manifest themselves as pea or marble sized mass at the opening of the anus.  They may form just outside the anus, inside the anus or at the anal verge.  When this has occurred, they are then termed external hemorrhoids.

Researchers still does not understand the true nature of why external hemorrhoids form.  Clearly the veins expand and do not retract.  Clearly they are susceptible to increased expansion with straining.  Beyond these facts, little is understood as to what causes these veins to bulge out and become problematic.  What are their symptoms?

Besides the visible bump or swollen area on or near the anal verge, the color of the bump may change.  Initially, the color will closely match the perianal skin tissue, however, if a clot forms in this bump, then the color can become blue or purple.  At this point, the external hemorrhoid has become thrombosed.  Itching is also a typical symptom as the perianal skin is stretched with the expanding hemorrhoid.

The most prominent symptom associated with external hemorrhoids, especially thrombosed ones is severe pain.  This differs from internal hemorrhoids for one very good reason.  Internal hemorrhoids form in an area of the anal canal above a line called the dentate line.  Nerve tissue servicing the area above this line senses pressure but not pain.  Therefore, even if internal hemorrhoids prolapse below this line and out of the anus, because their origin occurs in the area above the dentate line, little pain is typically felt.

External hemorrhoids on the other hand, form below the dentate line and thus are serviced by a great number of pain receptive nerves.  As the hemorrhoid expands, pain signals immediately are generated, especially with the passage of stool or straining which causes undue pressure on the ballooned hemorrhoid.  So what can be done about it?

Thankfully, many over the counter products exist to treat the symptoms of pain, burning, inflammation and itching.  These products, offer temporary reprieve by introducing bio-chemical compounds to the tissue that variously reduce swelling, reduce pain and sooth itching tissue.  Additionally, therapeutic measures including the use of sitz baths and ice packs can be used to initiate relief.

One thing you should not do is to apply pressure manually to these protrusions in an attempt to push them back into the anal canal.  If they are external to begin with, this will have no effect on their position and it will simply worsen their condition.  As you apply pressure, the weakened surface of the veins will only bulge out further, causing more expansion and more swelling.  The body responds to any swelling as a sign of damage and sends more blood to the area in an attempt to deliver nutrient carrying blood to the area.  More blood means more expansion and more pain.  It is a vicious cycle.  Adding more pressure to it only encourages this process.

Long term, the key is to remove those causal factors which are known to aggravate existing symptoms.  This involves taking measures to eliminate constipation, diarrhea, and any activities which introduce pressure and straining to the veins which make up the external hemorrhoids.  This is followed up by the introduction of herbal compounds designed to strengthen the cells and structures of the veins servicing the area.  These are examples of conservative measures that can be taken at home.  In severe cases, surgical intervention may be necessary, although external hemorrhoids are almost always manageable at home.