How to Get Rid of External Hemorrhoids: Evidence‑Based Guide
External hemorrhoids are swollen veins under the skin around the anus. They can cause pain, itching, swelling, and sometimes bleeding, especially when a clot (thrombosis) forms. Below is a concise, evidence‑based overview of how to get rid of external hemorrhoids and relieve symptoms, based strictly on current medical sources.
What Are External Hemorrhoids?
External hemorrhoids are dilated veins of the hemorrhoidal plexus located under the skin around the anal opening. According to the American Society of Colon and Rectal Surgeons (ASCRS), symptoms may include pain, bleeding, itching, swelling, and hygiene difficulties from prolapsing or enlarged tissue (ASCRS patient information).
When Can External Hemorrhoids Go Away on Their Own?
Many mild external hemorrhoids improve with conservative (non‑surgical) treatment:
- Pain and swelling from a thrombosed external hemorrhoid often peak within 48–72 hours and gradually improve over days to weeks, even without surgery, as the clot resorbs and the skin tag may remain (ASCRS).
- Symptom relief typically begins once inflammation decreases and stool passage becomes less traumatic.
However, persistent, severe, or recurrent symptoms may need medical or surgical treatment.
At‑Home Treatments to Get Rid of External Hemorrhoid Symptoms
1. Warm Sitz Baths
The American College of Gastroenterology (ACG) and ASCRS recommend warm water soaks (sitz baths) for symptomatic relief:
- Sit in warm (not hot) water for about 10–15 minutes several times a day, especially after bowel movements.
- This can help reduce pain, itching, and sphincter spasm (ASCRS guideline summary via patient info).
2. Fiber and Hydration
Straining and hard stools worsen hemorrhoids. Increasing fiber is a core part of treatment:
- Use dietary fiber (fruits, vegetables, whole grains) or supplements such as psyllium or methylcellulose.
- ASCRS notes that fiber can reduce bleeding and symptoms of hemorrhoids and is part of first‑line therapy (ASCRS).
- Drink enough fluids (unless medically restricted) to help keep stools soft.
3. Avoid Straining and Prolonged Sitting on the Toilet
The American Academy of Family Physicians (AAFP) notes that prolonged sitting and straining increase venous pressure and aggravate hemorrhoids (AAFP clinical review on hemorrhoids):
- Go as soon as you feel the urge.
- Do not sit on the toilet for long periods (avoid reading or phone use there).
- Avoid heavy straining and holding your breath (Valsalva) during bowel movements.
4. Topical Treatments and Pain Control
Over‑the‑counter products can ease symptoms, though they do not “cure” the hemorrhoid:
- Topical anesthetics (e.g., lidocaine) can reduce pain temporarily.
- Short‑term use of low‑potency topical corticosteroids may decrease itching and inflammation, but long‑term use is not recommended because it can thin the skin (AAFP).
- Oral nonsteroidal anti‑inflammatory drugs (NSAIDs) like ibuprofen can help with pain, provided there are no contraindications.
Always follow product instructions and consult a clinician if unsure.
Medical Procedures for External Hemorrhoids
For external hemorrhoids, especially when thrombosed or persistently symptomatic, procedural options may be considered.
1. Excision of Thrombosed External Hemorrhoid
For a very painful, recently developed clot:
- ASCRS notes that excision of a thrombosed external hemorrhoid within 72 hours of symptom onset can provide quicker pain relief and faster symptom resolution than conservative care alone (ASCRS hemorrhoid information).
- This is typically done under local anesthesia in an outpatient or office setting.
- After 48–72 hours, pain may already be improving spontaneously; at that point, conservative management is often preferred unless pain remains severe.
2. Hemorrhoidectomy (Surgical Removal)
When external hemorrhoids are large, recurrent, or combined with significant internal hemorrhoids:
- Conventional excisional hemorrhoidectomy is recommended by ASCRS for patients with significant external disease or mixed hemorrhoids, particularly grades III–IV (AAFP summary of treatment options).
- This is a more invasive surgery, usually done in an operating room, with a longer recovery period but low recurrence of the removed hemorrhoids.
3. Other Office‑Based Procedures
Most office procedures (rubber band ligation, infrared coagulation, sclerotherapy) primarily treat internal hemorrhoids. They may be used when internal hemorrhoids are the dominant problem:
- Rubber band ligation is considered effective for grades I–III internal hemorrhoids (AAFP).
- These are not the main treatments for strictly external hemorrhoids but are important if both internal and external disease coexist.
Lifestyle Changes to Prevent Recurrence
Evidence‑based preventive steps focus on bowel habits and anal hygiene:
- Maintain soft, regular stools via high‑fiber diet, adequate fluids, and, when needed, fiber supplements (ASCRS).
- Respond promptly to the urge to defecate; do not delay bowel movements.
- Limit time on the toilet and avoid straining.
- Regular physical activity can help promote regular bowel function and reduce constipation risk.
- Gentle anal hygiene: use soft, unscented toilet paper or moistened wipes without alcohol or strong fragrances to minimize irritation.
When to See a Doctor Urgently
Seek prompt medical evaluation if you notice:
- Significant rectal bleeding, especially if you pass clots or the blood is dark/tarry.
- Severe pain around the anus, a hard tender lump that appears suddenly, or inability to sit/walk comfortably.
- Change in bowel habits, weight loss, or anemia, which can suggest other conditions such as colorectal cancer.
Multiple sources, including AAFP and ASCRS, emphasize that not all rectal bleeding is due to hemorrhoids, and appropriate evaluation (sometimes including anoscopy, sigmoidoscopy, or colonoscopy) may be required, especially in older adults or those with risk factors (AAFP clinical guidance).
Summary: How to Get Rid of External Hemorrhoids
- Many external hemorrhoids improve with conservative care: warm sitz baths, increased fiber and fluids, avoiding straining, and short‑term use of topical anesthetics or mild steroids.
- A thrombosed external hemorrhoid that is very painful and recent (within ~72 hours) can often be treated effectively with surgical excision in an office or outpatient setting.
- For large, recurrent, or mixed hemorrhoids, formal hemorrhoidectomy may be the most definitive option.
- Long‑term control depends on bowel habit modification and prevention of constipation and straining.
Discuss symptoms and options with a qualified healthcare professional to determine the safest and most effective way for you personally to get rid of external hemorrhoids.
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