External Hemorrhoids - Causes, Diagnosis, and Treatment

By Wael Serag Eldin

Hemorrhoids are defined as swollen and inflamed veins of the anorectal area because of increased pressure inside the veins or weakness of the venous walls. They are similar to varicose veins of the lower limb and both share the same pathogenesis and the causes are similar.

According to their location, hemorrhoids are classified into 2 types, external hemroids located outside the anus and internal hemorrhoids located inside the anus. External hemorrhoids are more common than internal hemorrhoids and are caused by inflammation of the external hemorrhoidal veins.

What causes hemorrhoids?

One or both of 2 main factors contribute to the development of hemorrhoids; 1) Increased pressure inside the veins, and 2) Weakness of the walls of the veins. Increased pressure inside the veins is usually caused by excessive straining e.g. chronic constipation, chronic coughing, lifting heavy weights, or prolonged sitting or standing. Weakness of the venous walls is usually genetically determined causing genetic predisposition for hemorrhoids and this explains why hemorrhoids are more common in some families than others.

Other causes of weakness of the venous walls are obesity and pregnancy. Pregnancy actually acts by a double mechanism, as it is associated by increased pressure in the pelvic veins by the pregnant uterus and chronic constipation which is common during pregnancy and the hormonal changes that occur during pregnancy lead to weakening of the venous walls.

Symptoms of external hemorrhoids include anal pain with defecation which is the main presenting complaint. Also, some degree of pain or discomfort may be present in the anal region all the time. Anal bleeding is uncommon and when occurs is usually mild and is usually caused by rupture of the hemorrhoidal veins especially in long lasting cases.

Anal irritation and itching is also present. The hemroidal tissue is felt as a hard mass near the anus. This mass may be painful and tender. The hemorrhoids may undergo thrombosis which is more common with neglected cases, in which, blood clotting or thrombosis occurs in the blood inside the enlarged veins. When this occurs in a case of external hemorrhoids, they are called thrombosed external hemorrhoids. When the external hemorrhoids are thrombosed, they turn into bluish discoloration and become severely painful and may ooze blood contributing to anal bleeding.

Diagnosis of external hemorrhoids is very easy, depending on typical symptoms mentioned above and medical examination, where the hemorrhoids mass can bee seen and felt easily as a hard mass near the anus.

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