What type of hemorrhoids are associated with pain, specifically external (external) hemorrhoids?

From the Guidelines

Thrombosed and strangulated hemorrhoids are typically the most painful types of hemorrhoids, as they can cause sudden, severe pain along with swelling and inflammation. This is because external hemorrhoids, which are more prone to thrombosis and strangulation, develop below the dentate line in the anal canal, where there are abundant somatic pain receptors 1. Internal hemorrhoids, on the other hand, are typically not painful because they are located above the dentate line in the rectum, where there are fewer pain-sensing nerve endings. However, prolapsed internal hemorrhoids can become painful if they become strangulated, meaning their blood supply is cut off.

Some key points to consider when managing painful hemorrhoids include:

• The use of topical muscle relaxants, such as topical nitrates and calcium channel antagonists, has been proposed for the treatment of thrombosed hemorrhoids, with some studies showing promising results 1.
• Topical treatments such as witch hazel pads, hydrocortisone creams (0.5-1%), or lidocaine ointments can provide local relief for pain and inflammation 1.
• Warm sitz baths for 10-15 minutes several times daily can also reduce pain and inflammation.
• If pain is severe or persists beyond a week, medical attention should be sought as surgical intervention might be necessary, especially for thrombosed external hemorrhoids 1.

It's worth noting that the management of complicated hemorrhoids, including thrombosed and strangulated hemorrhoids, may involve a combination of medical and surgical therapies, and the best approach will depend on the individual patient's symptoms and circumstances 1.

From the Research

Types of Painful Hemorrhoids

• External hemorrhoids are typically painful, especially when thrombosed, as they can cause extreme pain due to internal anal sphincter hypertonicity, congestion, and swelling 2.
• Thrombosed external hemorrhoids can cause significant pain, but excision of the thrombosed hemorrhoid can greatly reduce pain if performed within the first two to three days of symptoms 3, 4.
• Internal hemorrhoids are generally not painful, but can cause discomfort and bleeding, especially if they prolapse or become thrombosed 3.

Factors Influencing Pain

• Hemorrhoidal size, thrombosis, and location (i.e., proximal or distal to the dentate line) can determine the extent of pain or discomfort 3.
• The degree of prolapse and the presence of comorbidities can also influence the level of pain or discomfort experienced by patients with hemorrhoids 3.