From the Guidelines
Yes, hemorrhoids can be seen outside the anus, specifically external hemorrhoids, which appear as swollen, sometimes painful lumps around the anal opening. These external hemorrhoids develop when veins beneath the skin around the anus become inflamed and enlarged, and can cause discomfort, itching, bleeding, and in some cases, can form blood clots (thrombosed hemorrhoids) which appear as bluish-purple, hard lumps that are particularly painful 1. According to the American Gastroenterological Association, external hemorrhoids usually do not cause symptoms unless thrombosis occurs, in which case the patient experiences acute pain 1.
Key Characteristics of External Hemorrhoids
- Appear as swollen, sometimes painful lumps around the anal opening
- Develop when veins beneath the skin around the anus become inflamed and enlarged
- Can cause discomfort, itching, bleeding, and in some cases, can form blood clots (thrombosed hemorrhoids)
- Thrombosed hemorrhoids appear as bluish-purple, hard lumps that are particularly painful
Diagnosis and Evaluation
A precise patient history and a careful physical examination are essential for accurate diagnosis of hemorrhoids, as symptoms caused by other conditions are frequently attributed to hemorrhoids 1. External examination will enable the discovery of pathology such as perianal abscess or anal fistula, and any skin tags, thrombosed external hemorrhoids, mixed hemorrhoids, and incarcerated rectal mucosal prolapse will be evident on external examination 1.
Treatment and Management
Treatment for external hemorrhoids includes over-the-counter creams containing hydrocortisone or witch hazel to reduce swelling and discomfort, warm sitz baths for 10-15 minutes several times daily, and oral pain relievers like acetaminophen or ibuprofen. Keeping the anal area clean and dry, using moist wipes instead of dry toilet paper, and increasing fiber and water intake can help manage symptoms and prevent worsening 1. If a hemorrhoid becomes thrombosed, medical attention within 72 hours may be necessary for possible drainage. Hemorrhoids develop due to increased pressure in the lower rectum, often from straining during bowel movements, chronic constipation, prolonged sitting, or pregnancy.
From the Research
Hemorrhoids Visibility
- Hemorrhoids can be internal or external, with internal hemorrhoids developing from the intraluminal corpus cavernosum recti and external hemorrhoids from the perianal marginal veins 2.
- Internal hemorrhoids are typically not visible outside the anus, while external hemorrhoids can be seen as a swelling near the anus 2.
- In some cases, internal hemorrhoids can prolapse, or protrude, outside the anus, making them visible 3, 2.
- External hemorrhoids, on the other hand, are typically visible as a lump or swelling near the anus and can be painful 2.
Diagnosis and Symptoms
- Symptoms of hemorrhoids can include rectal bleeding, pain, and prolapse, with the specific symptoms depending on the type and severity of the hemorrhoids 3, 2.
- Diagnosis of hemorrhoids is typically made through physical examination, including digital rectal examination and anoscopy 4, 5.
- In some cases, further testing, such as colonoscopy, may be necessary to rule out other conditions, such as colorectal cancer 3.
Treatment Options
- Treatment for hemorrhoids depends on the severity and type of hemorrhoids, with options ranging from conservative management with increased fiber intake and sitz baths to surgical procedures such as rubber band ligation and hemorrhoidectomy 3, 6, 4.
- Rubber band ligation is a common and effective treatment for internal hemorrhoids, with a high success rate for grades I, II, and III hemorrhoids 6, 4.