Haemorrhoids external

Overview

External haemorrhoids are swollen blood vessels that form under the skin around the anus (the opening at the end of the bowel). They can cause pain, itching, and discomfort, especially when you sit or pass stool.

Yes, haemorrhoids are very common. About 3 out of 4 adults will have them at some point, and external haemorrhoids are one of the most frequent types.

Anyone can get external haemorrhoids, but they are more common in adults over 30, pregnant women, people who often strain during bowel movements, and those with a family history.

Symptoms

Common symptoms

• Pain or discomfort around your anus, especially when sitting
• Itching or irritation in the anal area
• A hard, tender lump near your anus (this may be a thrombosed haemorrhoid)
• Swelling or redness around your anus
• Difficulty keeping the area clean

Symptoms in children

• Children can get external haemorrhoids, but it is less common. Symptoms may include pain during bowel movements, visible lumps, or itching. If your child has these symptoms, it is best to see a doctor.

Symptoms in older adults

• Older adults may have more persistent symptoms due to weaker tissues and constipation. They might also have less obvious pain but more bleeding or skin tags.

Causes

Main causes

• Straining during bowel movements (from constipation or hard stools)
• Sitting on the toilet for long periods
• Pregnancy and childbirth (increased pressure in the rectal area)
• Chronic constipation or diarrhea

Risk factors

• Being overweight or obese
• A diet low in fibre (fruits, vegetables, whole grains)
• Not drinking enough water
• Lifting heavy objects repeatedly
• A family history of haemorrhoids

When to see a doctor

See a doctor urgently if:

• You have a very painful lump near your anus that appeared suddenly
• Bleeding from your anus that is heavy or lasts more than a few days
• You have severe pain that does not go away with home care

Book a routine appointment if:

• Symptoms (itching, discomfort) have lasted more than a week despite trying home care
• You notice a lump or skin tag that worries you
• You want to confirm it’s haemorrhoids and not something else

Diagnosis

A doctor can diagnose external haemorrhoids by asking about your symptoms and examining the area around your anus. This is usually done during a short, gentle exam while you lie on your side.

Tests that may be done

• Visual examination of the anus and surrounding skin
• A digital rectal exam (the doctor gently inserts a gloved, lubricated finger into the rectum to check for internal haemorrhoids or other issues)
• Sometimes a proctoscopy (a small tube with a light) to see inside the anal canal

What to expect at your appointment

The exam is quick and usually not painful, though it may be a little uncomfortable. You’ll likely be asked to lie on your side with your knees bent. The doctor will check for lumps, swelling, and signs of bleeding. If needed, they may recommend additional tests to make sure nothing else is causing your symptoms.

Treatment

Treatment for external haemorrhoids focuses on relieving symptoms and preventing them from coming back. Most people can manage with simple home care. For more severe or persistent cases, your doctor may suggest medical treatments or a procedure.

Self-care at home

• Take warm baths (sitz baths) for 10-15 minutes, two to three times a day, to soothe discomfort
• Apply a cold pack wrapped in a cloth to the area for 10-15 minutes to reduce swelling
• Use gentle, unscented wipes or wet toilet paper instead of dry toilet paper
• Avoid sitting on hard surfaces for long periods; take breaks to stand or walk
• Drink plenty of water and eat high-fibre foods (fruits, vegetables, whole grains) to keep stools soft

Medical treatments

If self-care isn’t enough, a doctor may recommend over-the-counter creams or ointments that help with pain and itching. They may also perform a minor procedure, such as draining a thrombosed (clotted) haemorrhoid under local anaesthetic, or removing the haemorrhoid entirely with a simple surgery called haemorrhoidectomy. These are done in a doctor’s office or clinic, and you can usually go home the same day.

When is surgery considered?

Surgery (haemorrhoidectomy) is generally considered only for external haemorrhoids that cause severe, ongoing pain, or for large, recurring haemorrhoids that don’t respond to other treatments. Your doctor will discuss the options with you.

Living with this condition

Living with external haemorrhoids often means making small adjustments to keep symptoms under control. Keep the anal area clean and dry, avoid straining on the toilet, and use a cushion if sitting is uncomfortable. Most flare-ups last a few days and settle with home care.

Lifestyle tips

• Eat a high-fibre diet with plenty of fruits, vegetables, and whole grains
• Drink at least 8 glasses of water a day to prevent constipation
• Don’t delay bowel movements – go when you feel the urge
• Exercise regularly, like walking, to boost circulation and reduce pressure on veins
• Avoid heavy lifting or straining during exercise

Diet and exercise

A diet rich in fibre (aim for 25-30 grams daily) and plenty of fluids helps keep stools soft and reduces the need to strain. Regular, moderate exercise – such as walking, swimming, or cycling – can help prevent constipation and lower pressure in the rectal veins.

Mental health and emotional wellbeing

External haemorrhoids can be uncomfortable and sometimes embarrassing, which can affect your mood and quality of life. It’s normal to feel frustrated or anxious, but remember that this is a very common condition and most people get relief with simple steps. If you feel distressed, talk to your doctor or a trusted friend.

Prevention

You can reduce your chance of developing external haemorrhoids by avoiding constipation and straining. Eat a high-fibre diet, drink plenty of water, exercise regularly, and don’t spend too long on the toilet. These habits also help prevent flare-ups if you already have haemorrhoids.

Vaccines

There is no vaccine for haemorrhoids.

Screening programmes

There is no routine screening for haemorrhoids. However, if you have symptoms like bleeding, your doctor may recommend a check-up to rule out other causes.

Complications

If left untreated

• A thrombosed haemorrhoid (a blood clot inside the haemorrhoid) can cause severe pain and swelling, but it often resolves on its own over days to weeks
• External haemorrhoids may lead to skin tags (small pieces of extra skin) that can be itchy or hard to clean
• Rarely, infection can occur if the skin breaks down

Long-term outlook

The outlook for external haemorrhoids is very good. Most people find relief with simple home care, and even when more treatment is needed, procedures are safe and effective. With the right lifestyle changes, you can keep symptoms under control and prevent them from coming back. You don’t have to live with discomfort – help is available.

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