From the Guidelines
External hemorrhoids, particularly when thrombosed or strangulated, are typically painful, whereas internal hemorrhoids are usually not painful unless they prolapse or become severely enlarged. This is because the skin around the anus, where external hemorrhoids develop, has many pain-sensing nerve endings 1. In contrast, internal hemorrhoids form inside the rectum, an area with fewer pain receptors, making them less likely to cause pain unless they protrude outside the anus or become significantly enlarged. The pain associated with thrombosed external hemorrhoids can be sudden and severe, often accompanied by swelling, and may require medical intervention for relief, such as drainage by a healthcare provider.
Some key points to consider about painful hemorrhoids include:
- Thrombosed external hemorrhoids are a common cause of acute anal pain and a palpable perianal lump 1.
- The use of topical muscle relaxants, such as nifedipine, has been suggested for the treatment of thrombosed hemorrhoids to help alleviate pain by reducing anal sphincter spasm 1.
- Over-the-counter pain relievers, topical creams containing hydrocortisone, sitz baths, and cold compresses can help reduce swelling and discomfort associated with painful external hemorrhoids.
- It's crucial to differentiate between painful hemorrhoids and other conditions that may cause similar symptoms, such as inflammatory bowel disease or colorectal cancer, especially if there's a concern based on patient history or physical examination 1.
Given the potential for significant pain and the need for proper diagnosis and treatment, if pain is severe or persistent, medical evaluation is recommended to determine the best course of action and to rule out other serious conditions that may require immediate attention 1.
From the Research
Types of Painful Hemorrhoids
Characteristics of Painful Hemorrhoids
- Thrombosed external hemorrhoids are typically associated with acute pain 2, 3, 4, 5, 6
- The pain is often exacerbated by standing, sitting, or defecating 5
Treatment of Painful Hemorrhoids
- Excision of thrombosed external hemorrhoids can greatly reduce pain if performed within the first two to three days of symptoms 3, 5
- Conservative treatment, such as wait and see, mixture of flavonoids, mix of lidocaine and nifedipine, botulinum toxin injection, and topical application of 0.2% glyceryl trinitrate, can also be effective in managing painful external hemorrhoids 4