Can external hemorrhoids exist separately from the rectum?

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From the Guidelines

External Hemorrhoids Existence

Yes, external hemorrhoids can exist separately from the rectum. External hemorrhoids occur when swollen veins develop outside the anal opening, whereas internal hemorrhoids occur inside the rectum [ 1 ]. In some cases, internal hemorrhoids can prolapse, or protrude, outside the anus, becoming visible and palpable. The main difference between internal and external hemorrhoids is their position relative to the dentate line [ 1 ]. If you suspect you have external hemorrhoids, it is recommended to consult a healthcare professional for proper evaluation and treatment. Some key points to note about external hemorrhoids include:

  • They usually do not cause symptoms unless thrombosis occurs, in which case the patient experiences acute pain [ 1 ].
  • Thrombosed external hemorrhoids are common and present with acute-onset anal pain and a palpable perianal lump [ 1 ]. Over-the-counter medications such as witch hazel or hydrocortisone cream may provide relief, but in severe cases, further medical intervention may be necessary. It's also worth noting that accurate classification of hemorrhoids is important for both assessing the reported efficacy of various hemorrhoidal treatments and selecting the optimal treatment for an individual patient [ 1 ].

From the Research

Definition and Types of Hemorrhoids

  • Hemorrhoids can be divided into two types: internal hemorrhoid and external hemorrhoid 2
  • Internal hemorrhoids develop from the intraluminal corpus cavernosum recti, while external hemorrhoids develop from the perianal marginal veins 3
  • Symptomatic internal hemorrhoids are associated with bleeding and prolapse, while external hemorrhoids are associated with pain 3, 4

Existence of External Hemorrhoids

  • External hemorrhoids can exist separately from the rectum, as they develop from the perianal marginal veins 3
  • External hemorrhoids can cause symptoms such as pain, swelling, and discomfort, and can be treated surgically or conservatively 2, 3, 4
  • Thrombosis in external hemorrhoids can result in painful swelling 4

Relationship between External Hemorrhoids and the Rectum

  • External hemorrhoids are located outside the rectum, in the perianal region 3, 5
  • While internal hemorrhoids are connected to the rectum, external hemorrhoids are distinct and separate entities 3, 4
  • The treatment of external hemorrhoids may not always involve the rectum, and can be focused on the perianal region 2, 4

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Treatment of hemorrhoids: A coloproctologist's view.

World journal of gastroenterology, 2015

Research

[Internal and external haemorrhoids].

Nederlands tijdschrift voor geneeskunde, 2011

Research

Hemorrhoids.

Clinics in colon and rectal surgery, 2007

Research

Hemorrhoids: what the dermatologist should know.

Journal of the American Academy of Dermatology, 1999

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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