External Anal Sphincter Hemorrhoids 

External anal sphincter hemorrhoids are swollen blood vessels located around the anus, specifically affecting the external anal sphincter—the muscle that controls the opening and closing of the anus. Understanding their anatomy, causes, symptoms, diagnosis, treatment, prevention, and when to seek medical help can help manage and alleviate discomfort effectively.

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Anatomy of External Anal Sphincter Hemorrhoids

Structure

• External Anal Sphincter: A ring of muscle surrounding the anal canal, responsible for maintaining continence.
• Hemorrhoids: Swollen veins in the lower rectum and anus. External hemorrhoids occur below the dentate line, covered by skin.

Blood Supply

• Superior Rectal Artery: Supplies blood to internal hemorrhoids.
• Inferior Rectal Artery: Supplies blood to external hemorrhoids.

Nerve Supply

• Pudendal Nerve: Provides sensation to the external hemorrhoids, making them sensitive to pain and discomfort.

Types of Hemorrhoids

1. Internal Hemorrhoids: Located inside the rectum.
2. External Hemorrhoids: Located under the skin around the anus.
3. Prolapsed Hemorrhoids: Internal hemorrhoids that have protruded outside the anus.
4. Thrombosed Hemorrhoids: Hemorrhoids with blood clots, causing severe pain.

Causes of External Anal Hemorrhoids

1. Straining during bowel movements
2. Chronic constipation
3. Prolonged sitting on the toilet
4. Low-fiber diet
5. Pregnancy
6. Obesity
7. Heavy lifting
8. Aging
9. Genetics
10. Anal intercourse
11. Diarrhea
12. Inflammatory bowel disease
13. Liver disease
14. Sedentary lifestyle
15. Excessive alcohol consumption
16. Smoking
17. Repeated cycling
18. Lack of physical activity
19. Poor bathroom habits
20. Dehydration

Symptoms of External Anal Hemorrhoids

1. Pain or discomfort around the anus
2. Itching or irritation
3. Swelling or a lump near the anus
4. Bleeding during bowel movements
5. Leakage of feces
6. Thrombosis (blood clot) causing severe pain
7. Difficulty cleaning after bowel movements
8. Redness around the anus
9. A feeling of fullness
10. Discomfort when sitting
11. Mucus discharge
12. Sensation of a foreign object
13. Bruising around the anus
14. Cramping
15. Sharp pain during bowel movements
16. Hemorrhoid prolapse
17. Skin tags
18. Persistent irritation
19. Itchy skin folds
20. Discomfort during physical activities

Diagnostic Tests for Hemorrhoids

1. Physical examination
2. Visual inspection
3. Digital rectal exam
4. Anoscopy
5. Proctoscopy
6. Sigmoidoscopy
7. Colonoscopy
8. Ultrasound
9. MRI (for severe cases)
10. CT scan
11. Biopsy (to rule out cancer)
12. Anorectal manometry
13. Defecography
14. Flexible sigmoidoscopy
15. Infrared coagulation assessment
16. Doppler ultrasound
17. Hemorrhoidal grading
18. Stool tests
19. Blood tests
20. Flexible endoscopic evaluation

Non-Pharmacological Treatments

1. Dietary Changes
   • Increase fiber intake (fruits, vegetables, whole grains)
2. Hydration
   • Drink plenty of water
3. Regular Exercise
   • Promote bowel movements
4. Proper Bathroom Habits
   • Avoid straining
   • Don’t sit too long on the toilet
5. Warm Sitz Baths
   • Soak the anal area in warm water
6. Cold Compresses
   • Reduce swelling and pain
7. Topical Treatments
   • Use of witch hazel or aloe vera
8. Good Hygiene
   • Keep the anal area clean
9. Avoid Heavy Lifting
   • Reduce pressure on anal veins
10. Use of Soft Toilet Paper
    • Minimize irritation
11. Elevate Feet During Bowel Movements
    • Use a footstool to change posture
12. Pelvic Floor Exercises
    • Strengthen anal muscles
13. Limit Alcohol and Caffeine
    • Reduce dehydration and irritation
14. Avoid Constipating Foods
    • Reduce strain
15. Use Moist Wipes
    • Gentle cleaning
16. Wear Loose-Fitting Clothing
    • Prevent irritation
17. Use of Hemorrhoid Cushions
    • Relieve pressure when sitting
18. Biofeedback Therapy
    • Improve muscle control
19. Avoid Prolonged Standing or Sitting
    • Reduce pressure on anal area
20. Maintain a Healthy Weight
    • Reduce strain on veins
21. Use of Stool Softeners
    • Ease bowel movements
22. Avoid Spicy Foods
    • Reduce irritation
23. Incorporate Probiotics
    • Improve digestive health
24. Use of Sitz Bath Additives
    • E.g., Epsom salts for relief
25. Massage the Anal Area Gently
    • Reduce swelling
26. Limit Processed Foods
    • Promote better digestion
27. Regular Bowel Schedule
    • Prevent constipation
28. Use of Natural Remedies
    • E.g., chamomile tea compress
29. Avoid Smoking
    • Improve circulation
30. Stress Management
    • Reduce stress-related digestive issues

Pharmacological Treatments (Drugs)

1. Topical Hydrocortisone
2. Witch Hazel Creams
3. Topical Lidocaine
4. Over-the-Counter (OTC) Hemorrhoid Creams
5. OTC Suppositories
6. Pain Relievers (Acetaminophen)
7. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
8. Stool Softeners (Docusate)
9. Fiber Supplements (Psyllium)
10. Vasoconstrictors
11. Topical Anesthetics
12. Astringent Creams
13. Botox Injections
14. Glycerin-Based Suppositories
15. Flavonoid Supplements
16. Protective Barriers (Petrolatum)
17. Antihistamines (for itching)
18. Local Steroids
19. Combination Creams (e.g., hydrocortisone + lidocaine)
20. Natural Extracts (Aloe Vera Gel)

Surgical Treatments

1. Hemorrhoidectomy
   • Surgical removal of hemorrhoids
2. Stapled Hemorrhoidopexy
   • Uses staples to remove hemorrhoidal tissue
3. Rubber Band Ligation
   • Ties bands around hemorrhoids to cut off blood flow
4. Sclerotherapy
   • Injects a solution to shrink hemorrhoids
5. Infrared Coagulation
   • Uses infrared light to cut off blood supply
6. Laser Surgery
   • Uses laser to remove hemorrhoidal tissue
7. Cryotherapy
   • Freezes hemorrhoids to reduce them
8. Doppler-Guided Hemorrhoidal Artery Ligation
   • Blocks blood flow using Doppler guidance
9. Staple Transanal Rectal Resection (STARR)
   • Removes excess tissue causing blockage
10. Fibrin Glue Injection
    • Uses glue to close blood vessels

Prevention of Hemorrhoids

1. High-Fiber Diet
   • Consume fruits, vegetables, and whole grains
2. Stay Hydrated
   • Drink plenty of water daily
3. Regular Exercise
   • Promote healthy bowel movements
4. Avoid Straining
   • Don’t force bowel movements
5. Don’t Sit Too Long on the Toilet
   • Limit bathroom time
6. Maintain a Healthy Weight
   • Reduce pressure on veins
7. Lift Properly
   • Use correct techniques to avoid strain
8. Use Moist Wipes
   • Gentle cleaning to prevent irritation
9. Take Stool Softeners if Needed
   • Prevent constipation
10. Avoid Heavy Lifting
    • Reduce strain on anal veins

When to See a Doctor

• Severe Pain: Intense discomfort that doesn’t improve with home treatment.
• Heavy Bleeding: Significant blood loss during bowel movements.
• Persistent Symptoms: Symptoms lasting more than a week.
• Prolapsed Hemorrhoids: Hemorrhoids that don’t retract on their own.
• Unclear Diagnosis: Uncertainty if symptoms are hemorrhoids or another condition.
• Signs of Infection: Redness, swelling, or pus.
• Difficulty Passing Stool: Persistent constipation or obstruction.
• Recurring Hemorrhoids: Frequent episodes despite treatment.
• Fever: May indicate an infection.
• Changes in Bowel Habits: Sudden changes without clear cause.
• Anemia Symptoms: Fatigue, weakness due to blood loss.
• Severe Itching or Irritation: Affecting daily activities.
• Large Hemorrhoids: Causing significant discomfort.
• After Surgery: Follow-up or complications post-treatment.
• Family History: Higher risk requiring medical advice.

Frequently Asked Questions (FAQs)

1. What are external anal sphincter hemorrhoids?
   • Swollen blood vessels around the anus, under the skin, causing pain and discomfort.
2. What causes hemorrhoids?
   • Straining, constipation, pregnancy, obesity, and prolonged sitting are common causes.
3. How can I prevent hemorrhoids?
   • Eat a high-fiber diet, stay hydrated, exercise regularly, and avoid straining during bowel movements.
4. Are hemorrhoids dangerous?
   • Generally not, but severe cases can cause significant discomfort and may require medical treatment.
5. Can hemorrhoids go away on their own?
   • Yes, mild hemorrhoids often improve with home treatments.
6. What is the difference between internal and external hemorrhoids?
   • Internal hemorrhoids are inside the rectum and usually painless, while external hemorrhoids are under the skin around the anus and can be painful.
7. When should I see a doctor for hemorrhoids?
   • If experiencing severe pain, heavy bleeding, or persistent symptoms.
8. Can diet affect hemorrhoids?
   • Yes, a low-fiber diet can lead to constipation and straining, worsening hemorrhoids.
9. What treatments are available for hemorrhoids?
   • Treatments range from lifestyle changes and medications to surgical procedures.
10. Are there natural remedies for hemorrhoids?
    • Yes, warm baths, witch hazel, and aloe vera can provide relief.
11. Can exercise help with hemorrhoids?
    • Regular exercise can improve bowel function and reduce pressure on veins.
12. Do hemorrhoids increase during pregnancy?
    • Yes, due to increased pressure on pelvic veins and hormonal changes.
13. Is surgery the only option for severe hemorrhoids?
    • Not always; minimally invasive procedures may also be effective.
14. Can hemorrhoids cause anemia?
    • Severe or chronic bleeding from hemorrhoids can lead to anemia.
15. How long does it take to recover from hemorrhoid surgery?
    • Recovery time varies but typically ranges from a few days to a few weeks.

Conclusion

External anal sphincter hemorrhoids are a common condition that can cause significant discomfort. Understanding their anatomy, causes, symptoms, and treatment options is essential for effective management and prevention. Adopting a healthy lifestyle, maintaining good bathroom habits, and seeking medical advice when necessary can help alleviate and prevent hemorrhoids. If you experience persistent or severe symptoms, consult a healthcare professional for appropriate diagnosis and treatment.

 

Authors Information

 

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

 

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