External hemorrhoids: What They Are, Causes & How to Get Rid of Them

Updated in November 2021

External hemorrhoids are small, swollen veins that are found in the skin around the anus. Symptoms associated with hemorrhoids include anal pain, especially when passing stool, and anal itching.

In most cases, external hemorrhoids disappear within two days with simple remedies like sitz baths, hemorrhoid cream, and avoiding long periods of standing. Increasing intake of fibre and water help to soften feces, which will decrease irritation to the anus.

If hemorrhoids are not resolved conservatively, surgery is usually advised to remove them permanently.

What they look like

External hemorrhoids are swollen veins that bulge out of the anus due to intense straining when having a bowel movement or due to chronic constipation. Symptoms that emerge with hemorrhoids include:

  • Acute pain in the anal area which worsens when passing stool or sitting down
  • Itchiness in the anus due to a build-up of mucus and small particles of stool around the hemorrhoid
  • One or more lumps or bulges in the anus
  • Slight bleeding after straining

Most of the time, because there is vascular trauma, external hemorrhoids also bleed when passing stool or after wiping with toilet paper. In this case, it is best to clean the area with water and soap each time you poop. This can help to reduce pain and itching and aid with a quicker recovery.

Main causes

Hemorrhoids are related to:

  • Sedentary lifestyle
  • Inflammation of the anal area;
  • Obesity
  • Chronic constipation
  • Working on your feet for a long time
  • Aging and degeneration of anal sphincter tone
  • Pregnancy
  • Excessive alcohol intake
  • Low fibre intake

Hemorrhoids affect about half of the adult population, but not everyone presents with long-lasting symptoms. It is common for hemorrhoids to appear once or twice in your life, after pregnancy, for example, or after trying a different diet. However, if a person has hemorrhoids once, probability of reoccurrence is higher.

How to get rid of hemorrhoids

Warm sitz baths can be helpful with relieving painful external hemorrhoids. Oftentimes, hemorrhoids that protrude from the anus can be manually pushed back in. Since sitz baths can reduce swelling and anesthetize the anal area, manual reinsertion should be attempted while in the sitz bath.

Other measures to take when treating hemorrhoids include avoiding the use toilet paper (and opting for wet wipes instead) and cleansing the area with water and soap. It’s also important to avoid lifting heavy weights or any strenuous activity, avoid straining when pooping, and avoid standing or sitting for too long. A diet rich in fibre and lots of hydration is also recommended.

In more serious cases, when hemorrhoids do not resolve with a conservative approach, surgery may be necessary to remove them.

When to go to the doctor

Seeking medical evaluation is recommended for hemorrhoid symptoms that last over 48 hours, especially if these symptoms interfere with your daily tasks. If symptoms are not relieved with medication, creams, and lifestyle changes, you may be referred to a gastroenterologist to assess whether you are a good candidate for surgical removal.