External hemorrhoids can be painful and embarrassing. They can also lead to other health issues and lifestyle changes. Learn your treatment options.

A popular myth has it that Napoleon Bonaparte lost the Battle of Waterloo due to external hemorrhoids so painful he couldn’t ride his horse to survey the battlefield. While historians argue the tale, this much is true: External hemorrhoids can lead you to battle more serious wellness complications, if untreated.

Most people think of external hemorrhoids as an embarrassing condition of the butt. But hemorrhoids are in fact a normal part of each of our bodies – they are cushion-like clusters of veins in the lowest part of the rectum and anus that help hold in your stool and protect the sphincter muscles.

Hemorrhoids become a familiar medical condition when extra pressure on those veins causes them to swell and distend, like varicose veins.

If you have external hemorrhoids, chances are you know someone else who has them, too, besides Napoleon. An estimated one in 20 Americans lives with internal and/or external hemorrhoids, and nearly half of people over 50 have them, according to the National Institute of Health.

Yet only about one-third of people who recognize the symptoms of hemorrhoids seek treatment, likely because they feel awkward talking about it. This could mean even more than one in 20 people have them.

You don’t have to suffer in silence. This blog details the symptoms and care options for external hemorrhoids, at home and with the help of your doctor.

The Facts About External Hemorrhoids and Why They Occur

External hemorrhoids and internal hemorrhoids have the same cause, but they can affect you very differently:

Internal hemorrhoids exist inside the lining the anus and lower rectum and can bleed and bulge out while having a bowel movement (prolapse). Still, they are often painless.

External hemorrhoids are dilated veins just under the skin surrounding the anus, looking like small lumps. They tend to be more painful than internal hemorrhoids because the outside of the anus is very sensitive. If the hemorrhoids form blood clots (thrombosis), this pain can be severe.

Causes and risk factors for external hemorrhoids include:

• Repeatedly lifting heavy objects.
• Lack of fiber in your diet.
• Chronic constipation that makes you strain and sit on the toilet for long periods.
• Fluid buildup that adds pressure to your abdomen and gut (ascites).
• Obesity.
• Age.
• Pregnancy.

When You Should See a Doctor for External Hemorrhoids

In addition to pain and itching, the telltale signs of external hemorrhoids are smaller lumps around the anus and bright red blood on the stool.

Complications from external hemorrhoids are uncommon, but you should be alert to signs, especially if you have been experiencing symptoms of external hemorrhoids for some time. Be aware of the following:

• Anemia – Hemorrhoids often bleed during bowel movements, so if they are long-term or chronic they can lead to anemia – loss of red blood cells. If you notice more than a small amount of bright red blood (or darker blood) in your stool, see a doctor.
• Infection – Because external hemorrhoids itch, they can be broken open into sores that are highly susceptible to infection, considering their proximity to the anus and stool (E.coli bacterium).
• Thrombosis – If clots form in an external hemorrhoid, they will block blood from reaching those veins. Usually, the body will slowly reabsorb the clot, or it will pass, but until then, the pain can be extreme. A thrombosed hemorrhoid will appear purple to black, depending on your skin tone.
• Skin tags – After a thrombosis passes or dissolves into your body, it can leave a small flap of skin, or skin tag. Due to their proximity to the anus, these tags are prone to catch stool and cause hygiene issues. While not painful, they can be uncomfortable.
• Diminished quality of life – The pain of external hemorrhoids could prevent you from enjoying a range of everyday activities that enrich your life, from riding a horse (like Napoleon) to weight lifting to sitting through a movie or plane trip.

Ideally, you would see a doctor before such complications arise, but sometimes the symptoms of external hemorrhoids are less obvious. If you do feel pain on the outside of your anus after a bowel movement, however, you could benefit from treatment advice.

Your Treatment Options for External Hemorrhoids

Your doctor can diagnose external hemorrhoids through a physical exam and by assessing your symptoms, so it might be helpful to jot down details. The doctor will look for swelling, lumps, and small tears around the anus.

Your first treatment pathway will likely involve changes in diet and lifestyle:

• Eat more fiber-rich foods such as fresh vegetables, fruits, whole grain breads, and cereals, while reducing red meat, processed foods, and dairy.
• Drink more fluids, ideally water (aim for pale yellow urine).
• Get regular physical activity to stimulate healthy digestion, but avoid heavy lifting.
• Do not sit on the toilet for extended periods.
• Bathe your butt and hips in warm, shallow water (sitz baths).
• Apply ice packs to reduce swelling.

If these modifications fail to reduce external hemorrhoids and/or symptoms, your doctor might advise one of the following minimally invasive procedures:

• Medications – Some prescribed medications, including topical nitroglycerin and Botox injections, can relieve external hemorrhoids.

• External hemorrhoid thrombectomy – This procedure would be referred to a colorectal surgeon who would remove the blood clots in the external hemorrhoid by making a small incision that drains the clot. A surgeon performs this while you are under local anesthesia.

Surgical removal of external hemorrhoids, called a hemorrhoidectomy, is recommended in severe or recurrent cases. This procedure can also remove blood clots in thrombosed hemorrhoids.

The tale of Napoleon’s hemorrhoids and Waterloo is up for debate, but even if the story is true, you don’t have to give in to defeat. Pursue the above treatment options for external hemorrhoids with your doctor, and you can get back on your “horse.”

External hemorrhoids can occur in anyone and should be discussed. To learn more, visit our hemorrhoids website for details on diagnosis and care. We also offer procedures at Cincinnati GI, such as sigmoidoscopy and colonoscopy, that may be used to detect hemorrhoids.