External hemorrhoids are a condition that causes distressing symptoms such as bleeding, itching, and burning around the anus, significantly disrupting a patient’s daily life. Therefore, accurate understanding and timely treatment of external hemorrhoids are extremely important.
What are external hemorrhoids?
External hemorrhoids are a venous disorder occurring at the anal margin, formed by excessive dilation of the venous plexus around the anus. They are always located outside the anal canal and are covered by perianal skin.
The most common causes include excessive straining during bowel movements or prolonged sitting (especially in office workers or long-distance drivers). The condition can occur at any age but is most prevalent between 18 and 60 years, with women affected more frequently than men.
Other contributing risk factors include:
Low-fiber diet or frequent consumption of spicy foods
Heavy lifting
Pregnancy
Obesity or ascites
Genetic predisposition
Inadequate water intake
Decreased collagen in the perianal area
In the early stages, hemorrhoids are small, about the size of a pea. Over time, they may enlarge, leading to itching, pain, and bleeding due to thrombosis. Without timely treatment, external hemorrhoids can progress to serious complications such as anal infections or anemia, significantly affecting the patient’s health and quality of life.
External hemorrhoidal mass at the anal margin
Signs and symptoms of external hemorrhoids
External hemorrhoids typically present with distinctive symptoms, including:
Prolapsed hemorrhoidal mass: Hemorrhoids may protrude during squatting, walking, or bowel movements, sometimes accompanied by bleeding. Initially, the mass may retract on its own when standing, but over time, manual reduction may be required. In advanced stages, bleeding during defecation may occur, and the hemorrhoidal mass can no longer be pushed back into the anal canal, even manually.
Enlarged hemorrhoidal mass: Appears as a red, fleshy lump resembling excess tissue. On closer inspection, engorged veins can be seen crossing and intertwining.
Other common symptoms of external hemorrhoids include:
Anal pain and burning: Caused by friction or pressure, especially when sitting or walking.
Moisture and discharge: Larger hemorrhoids tend to secrete fluid, leading to a persistent feeling of dampness in the anal area, sometimes accompanied by odor and a higher risk of infection.
Perianal itching: Often due to mucus discharge from the hemorrhoids.
Rectal bleeding: Although less common with external hemorrhoids, bleeding may still occur in advanced stages, visible in the stool or on toilet paper.
Swelling and inflammation: In severe cases, significant swelling may develop, with a high risk of infection.
Stages of external hemorrhoids
Unlike internal hemorrhoids, which are classified into distinct grades, external hemorrhoids are generally divided by physicians into four stages:
Stage I: Hemorrhoids are newly formed, with mild symptoms such as a slight sensation of fullness or itching around the anus.
Stage II: Twisted and engorged veins become visible outside the anus. Patients may experience pain and discomfort during bowel movements. At this stage, inadequate hygiene can easily lead to infection.
Stage III: Bleeding occurs during bowel movements due to strangulated hemorrhoids. Patients often suffer from persistent pain, and in severe cases may develop anemia or anal fissures.
Stage IV: Hemorrhoids become larger, swollen, and increasingly uncomfortable, accompanied by itching. In many cases, infection develops, causing intense pain.
Can external hemorrhoids be cured? How can they be treated definitively?
As with most medical conditions, external hemorrhoids in their early stages are easier to treat completely, with faster recovery and lower costs for the patient. Conversely, if left untreated, self-medicated, or managed with unstandardized procedures at non-specialized healthcare facilities, symptoms may worsen. This not only makes treatment more difficult but also significantly increases the cost compared to receiving appropriate medical care from the beginning.
External hemorrhoids can be effectively treated if detected and managed in a timely manner.
What does a hemorrhoid examination include? Important notes for patients
When should you see a doctor for hemorrhoids?
Hemorrhoids are a common condition, especially among postpartum women, office workers, and drivers who sit for long periods. However, due to the sensitive nature of the disease, many patients hesitate to seek medical care. As mentioned above, without timely and proper treatment, hemorrhoids may worsen and lead to dangerous complications.
Therefore, patients should visit a reputable healthcare facility and consult with a specialist in gastrointestinal surgery or colorectal surgery as soon as they notice unusual symptoms such as anal pain, itching, or moisture; difficulty passing stool or bleeding during bowel movements; anemia; or persistent fatigue.
What does a hemorrhoid examination include?
First, the specialist will ask several questions regarding medical history and related risk factors, such as:
Is there a family history of hemorrhoids?
What is your occupation?
What is your daily diet like? Do you often eat spicy or fatty foods? Do you drink enough water? Do you eat enough vegetables?
Have you ever given birth?
Have you ever suffered from chronic constipation?
What symptoms do you experience during bowel movements?
Have you tried any medications or treatments before? If yes, for how long?
Next, the physician will conduct a physical examination of the anal area, including visual inspection and internal examination of the anus and rectum. This helps assess lesions, evaluate hemorrhoidal status, and determine the severity of the disease. For greater diagnostic accuracy, additional tests may be recommended, such as blood tests or recto-anal endoscopy.
Based on the examination and test results, the doctor will provide an accurate diagnosis and recommend the most appropriate treatment plan. Patients will also receive guidance on dietary and lifestyle modifications to support recovery.
Finally, patients are advised to attend follow-up visits as instructed to promptly manage complications or any disease progression.
A physician examining and providing treatment consultation for a patient with external hemorrhoids.
Important notes when visiting a doctor for hemorrhoids
Patients should maintain good personal hygiene and carefully clean the anal area before the examination. It is also advisable to bring all relevant medical records or previous test results. In addition, patients should avoid alcohol and stimulants prior to the consultation.
Lifestyle modification combined with medical therapy
For patients with stage I and stage II external hemorrhoids, physicians often recommend lifestyle and dietary adjustments, including:
Increasing consumption of fiber-rich foods such as fruits, vegetables, and whole grains
Adding collagen-rich foods such as salmon, tuna, and seaweed
Drinking adequate amounts of water daily
Engaging in regular physical activity with light exercises such as walking, swimming, or yoga
Avoiding prolonged sitting or standing; taking short breaks to walk every hour
Establishing a regular bowel movement routine to promote smooth digestion and prevent constipation
Cleaning the anal area after defecation using wet wipes or soft cotton pads to reduce friction
In addition, common medical treatments may include:
Topical creams or ointments containing hydrocortisone or witch hazel extract
Medications to regulate bowel movements: anti-constipation or anti-diarrheal agents, venotonic drugs to strengthen vessel walls, and anti-inflammatory drugs
Suppositories and protective ointments: applied locally to cover and protect hemorrhoidal tissue while easing stool passage
Pain relievers such as ibuprofen, acetaminophen, or aspirin (used only under medical supervision)
Cold compresses: applying ice wrapped in a soft cloth to the anal area to relieve swelling and pain
Using hypertonic saline frozen into ice cubes for local application in cases of thrombosed external hemorrhoids
However, before using any medication for external hemorrhoids, patients should seek medical evaluation at a reputable healthcare facility. Only a specialist can provide an accurate diagnosis, guide appropriate treatment, and ensure safe and effective management, ultimately helping patients achieve complete recovery while minimizing costs.
Use of medications in the treatment of hemorrhoids
Procedural and surgical interventions
For patients with stage III and stage IV external hemorrhoids, who present with symptoms such as infection, swelling, large hemorrhoidal masses, thrombosed hemorrhoids causing acute vascular obstruction, heavy bleeding, severe pain, continuous discharge, or ulceration, physicians may recommend surgical treatment options such as sclerotherapy, cauterization, hemorrhoidectomy, or the Longo procedure.
However, in cases of external hemorrhoids, specialists often advise surgical excision (hemorrhoidectomy) as the preferred method. This is because the anal region contains a high density of sensory receptors, and other surgical interventions may result in prolonged and severe postoperative pain.
For patients with mild external hemorrhoids, laser hemorrhoid surgery is an effective and increasingly popular option. This modern technique does not involve traditional surgical instruments; instead, a high-energy laser beam targets the root of the hemorrhoid, coagulating the blood vessels supplying it. As a result, the hemorrhoidal tissue rapidly shrinks and undergoes fibrosis, promoting faster recovery and minimizing trauma.
Advantages of laser hemorrhoid surgery
High treatment efficacy: Laser hemorrhoid surgery offers a success rate of over 90%, largely due to the expertise of specialized surgeons and appropriate patient selection. It is particularly effective in treating bleeding hemorrhoids at stages I, II, and III, as well as small hemorrhoidal masses.
Safe and minimally invasive: The laser beam targets only the hemorrhoidal tissue and the submucosal layer, without affecting surrounding structures. This ensures optimal preservation of the anal sphincter’s anatomical integrity, physiological function, and the nerve supply of the anorectal region, while protecting the rectal and anal mucosa.
Rapid recovery: Patients can usually resume normal walking within 5 hours after laser hemorrhoid surgery.
Cost-effective: Faster recovery and shorter postoperative care reduce hospitalization time, thereby lowering overall treatment costs.
Laser hemorrhoid surgery is indicated for mild cases of external hemorrhoids.
Where is the best place to be examined and treated for external hemorrhoids?
With the principle of “the right method for the right disease,” Hong Ngoc General Hospital has become a trusted destination for thousands of patients seeking treatment for hemorrhoids, thanks to:
Accurate diagnosis and definitive treatment by leading experts:
Assoc. Prof. Dr. Nguyen Xuan Hung: People’s Doctor; former Director of the Colorectal and Pelvic Floor Surgery Center at Viet Duc University Hospital; Vice President of the Vietnam Association of Colorectal Surgery; Member of the French Association of Colorectal Physicians.
Assoc. Prof. Dr. Pham Van Cuong: People’s Physician; nearly 40 years of experience; Member of the Vietnam Association of Endoscopic Surgery and Surgery.
Dr. Cu Trung Kien, MSc: Specialized training in gastrointestinal surgery in Hong Kong; former physician at Bach Mai Hospital; Deputy Head of the Department of Gastrointestinal Surgery, Hong Ngoc General Hospital – Yen Ninh.
Dr. Bach Phuc Huy: Specialist Level I; over 15 years of experience; Head of the Gastrointestinal Surgery Unit, Hong Ngoc General Hospital – Phuc Truong Minh.
Pain-free hemorrhoid surgery with a comprehensive pain-control protocol developed by Dr. Nguyen Thi Thu Ba, MSc – who completed advanced residency training in France. The anesthesiology team ensures safe monitoring before, during, and after surgery.
Proactive pain management strategy: Careful pre-anesthesia evaluation, continuous monitoring throughout the procedure, and preventive pain control measures implemented before discomfort begins.
Comprehensive inpatient care: 24/7 medical support and attentive nursing care throughout hospitalization.
Hotel-standard facilities: Spacious, comfortable inpatient rooms equipped with full amenities.
For detailed consultation, please contact:
Hotline for appointment booking with specialists: 0911 908 856
Hotline for surgical consultation (hemorrhoidectomy): 0949 646 556
Note: The information provided in this article by Hong Ngoc General Hospital is for reference only and does not replace professional diagnosis or medical treatment. Patients should not self-medicate. To accurately determine your condition, please visit a hospital for direct examination, diagnosis, and personalized treatment planning by qualified physicians.
Follow Hong Ngoc General Hospital’s official fanpage for more useful health information and updates on special promotional programs.
External hemorrhoids are a condition that causes distressing symptoms such as bleeding, itching, and burning around the anus, significantly disrupting a patient’s daily life. Therefore, accurate understanding and timely treatment of external hemorrhoids are extremely important.
What are external hemorrhoids?
External hemorrhoids are a venous disorder occurring at the anal margin, formed by excessive dilation of the venous plexus around the anus. They are always located outside the anal canal and are covered by perianal skin.
The most common causes include excessive straining during bowel movements or prolonged sitting (especially in office workers or long-distance drivers). The condition can occur at any age but is most prevalent between 18 and 60 years, with women affected more frequently than men.
Other contributing risk factors include:
Low-fiber diet or frequent consumption of spicy foods
Heavy lifting
Pregnancy
Obesity or ascites
Genetic predisposition
Inadequate water intake
Decreased collagen in the perianal area
In the early stages, hemorrhoids are small, about the size of a pea. Over time, they may enlarge, leading to itching, pain, and bleeding due to thrombosis. Without timely treatment, external hemorrhoids can progress to serious complications such as anal infections or anemia, significantly affecting the patient’s health and quality of life.
External hemorrhoidal mass at the anal margin
Signs and symptoms of external hemorrhoids
External hemorrhoids typically present with distinctive symptoms, including:
Prolapsed hemorrhoidal mass: Hemorrhoids may protrude during squatting, walking, or bowel movements, sometimes accompanied by bleeding. Initially, the mass may retract on its own when standing, but over time, manual reduction may be required. In advanced stages, bleeding during defecation may occur, and the hemorrhoidal mass can no longer be pushed back into the anal canal, even manually.
Enlarged hemorrhoidal mass: Appears as a red, fleshy lump resembling excess tissue. On closer inspection, engorged veins can be seen crossing and intertwining.
Other common symptoms of external hemorrhoids include:
Anal pain and burning: Caused by friction or pressure, especially when sitting or walking.
Moisture and discharge: Larger hemorrhoids tend to secrete fluid, leading to a persistent feeling of dampness in the anal area, sometimes accompanied by odor and a higher risk of infection.
Perianal itching: Often due to mucus discharge from the hemorrhoids.
Rectal bleeding: Although less common with external hemorrhoids, bleeding may still occur in advanced stages, visible in the stool or on toilet paper.
Swelling and inflammation: In severe cases, significant swelling may develop, with a high risk of infection.
Stages of external hemorrhoids
Unlike internal hemorrhoids, which are classified into distinct grades, external hemorrhoids are generally divided by physicians into four stages:
Stage I: Hemorrhoids are newly formed, with mild symptoms such as a slight sensation of fullness or itching around the anus.
Stage II: Twisted and engorged veins become visible outside the anus. Patients may experience pain and discomfort during bowel movements. At this stage, inadequate hygiene can easily lead to infection.
Stage III: Bleeding occurs during bowel movements due to strangulated hemorrhoids. Patients often suffer from persistent pain, and in severe cases may develop anemia or anal fissures.
Stage IV: Hemorrhoids become larger, swollen, and increasingly uncomfortable, accompanied by itching. In many cases, infection develops, causing intense pain.
Can external hemorrhoids be cured? How can they be treated definitively?
As with most medical conditions, external hemorrhoids in their early stages are easier to treat completely, with faster recovery and lower costs for the patient. Conversely, if left untreated, self-medicated, or managed with unstandardized procedures at non-specialized healthcare facilities, symptoms may worsen. This not only makes treatment more difficult but also significantly increases the cost compared to receiving appropriate medical care from the beginning.
External hemorrhoids can be effectively treated if detected and managed in a timely manner.
What does a hemorrhoid examination include? Important notes for patients
When should you see a doctor for hemorrhoids?
Hemorrhoids are a common condition, especially among postpartum women, office workers, and drivers who sit for long periods. However, due to the sensitive nature of the disease, many patients hesitate to seek medical care. As mentioned above, without timely and proper treatment, hemorrhoids may worsen and lead to dangerous complications.
Therefore, patients should visit a reputable healthcare facility and consult with a specialist in gastrointestinal surgery or colorectal surgery as soon as they notice unusual symptoms such as anal pain, itching, or moisture; difficulty passing stool or bleeding during bowel movements; anemia; or persistent fatigue.
What does a hemorrhoid examination include?
First, the specialist will ask several questions regarding medical history and related risk factors, such as:
Is there a family history of hemorrhoids?
What is your occupation?
What is your daily diet like? Do you often eat spicy or fatty foods? Do you drink enough water? Do you eat enough vegetables?
Have you ever given birth?
Have you ever suffered from chronic constipation?
What symptoms do you experience during bowel movements?
Have you tried any medications or treatments before? If yes, for how long?
Next, the physician will conduct a physical examination of the anal area, including visual inspection and internal examination of the anus and rectum. This helps assess lesions, evaluate hemorrhoidal status, and determine the severity of the disease. For greater diagnostic accuracy, additional tests may be recommended, such as blood tests or recto-anal endoscopy.
Based on the examination and test results, the doctor will provide an accurate diagnosis and recommend the most appropriate treatment plan. Patients will also receive guidance on dietary and lifestyle modifications to support recovery.
Finally, patients are advised to attend follow-up visits as instructed to promptly manage complications or any disease progression.
A physician examining and providing treatment consultation for a patient with external hemorrhoids.
Important notes when visiting a doctor for hemorrhoids
Patients should maintain good personal hygiene and carefully clean the anal area before the examination. It is also advisable to bring all relevant medical records or previous test results. In addition, patients should avoid alcohol and stimulants prior to the consultation.
Lifestyle modification combined with medical therapy
For patients with stage I and stage II external hemorrhoids, physicians often recommend lifestyle and dietary adjustments, including:
Increasing consumption of fiber-rich foods such as fruits, vegetables, and whole grains
Adding collagen-rich foods such as salmon, tuna, and seaweed
Drinking adequate amounts of water daily
Engaging in regular physical activity with light exercises such as walking, swimming, or yoga
Avoiding prolonged sitting or standing; taking short breaks to walk every hour
Establishing a regular bowel movement routine to promote smooth digestion and prevent constipation
Cleaning the anal area after defecation using wet wipes or soft cotton pads to reduce friction
In addition, common medical treatments may include:
Topical creams or ointments containing hydrocortisone or witch hazel extract
Medications to regulate bowel movements: anti-constipation or anti-diarrheal agents, venotonic drugs to strengthen vessel walls, and anti-inflammatory drugs
Suppositories and protective ointments: applied locally to cover and protect hemorrhoidal tissue while easing stool passage
Pain relievers such as ibuprofen, acetaminophen, or aspirin (used only under medical supervision)
Cold compresses: applying ice wrapped in a soft cloth to the anal area to relieve swelling and pain
Using hypertonic saline frozen into ice cubes for local application in cases of thrombosed external hemorrhoids
However, before using any medication for external hemorrhoids, patients should seek medical evaluation at a reputable healthcare facility. Only a specialist can provide an accurate diagnosis, guide appropriate treatment, and ensure safe and effective management, ultimately helping patients achieve complete recovery while minimizing costs.
Use of medications in the treatment of hemorrhoids
Procedural and surgical interventions
For patients with stage III and stage IV external hemorrhoids, who present with symptoms such as infection, swelling, large hemorrhoidal masses, thrombosed hemorrhoids causing acute vascular obstruction, heavy bleeding, severe pain, continuous discharge, or ulceration, physicians may recommend surgical treatment options such as sclerotherapy, cauterization, hemorrhoidectomy, or the Longo procedure.
However, in cases of external hemorrhoids, specialists often advise surgical excision (hemorrhoidectomy) as the preferred method. This is because the anal region contains a high density of sensory receptors, and other surgical interventions may result in prolonged and severe postoperative pain.
For patients with mild external hemorrhoids, laser hemorrhoid surgery is an effective and increasingly popular option. This modern technique does not involve traditional surgical instruments; instead, a high-energy laser beam targets the root of the hemorrhoid, coagulating the blood vessels supplying it. As a result, the hemorrhoidal tissue rapidly shrinks and undergoes fibrosis, promoting faster recovery and minimizing trauma.
Advantages of laser hemorrhoid surgery
High treatment efficacy: Laser hemorrhoid surgery offers a success rate of over 90%, largely due to the expertise of specialized surgeons and appropriate patient selection. It is particularly effective in treating bleeding hemorrhoids at stages I, II, and III, as well as small hemorrhoidal masses.
Safe and minimally invasive: The laser beam targets only the hemorrhoidal tissue and the submucosal layer, without affecting surrounding structures. This ensures optimal preservation of the anal sphincter’s anatomical integrity, physiological function, and the nerve supply of the anorectal region, while protecting the rectal and anal mucosa.
Rapid recovery: Patients can usually resume normal walking within 5 hours after laser hemorrhoid surgery.
Cost-effective: Faster recovery and shorter postoperative care reduce hospitalization time, thereby lowering overall treatment costs.
Laser hemorrhoid surgery is indicated for mild cases of external hemorrhoids.
Where is the best place to be examined and treated for external hemorrhoids?
With the principle of “the right method for the right disease,” Hong Ngoc General Hospital has become a trusted destination for thousands of patients seeking treatment for hemorrhoids, thanks to:
Accurate diagnosis and definitive treatment by leading experts:
Assoc. Prof. Dr. Nguyen Xuan Hung: People’s Doctor; former Director of the Colorectal and Pelvic Floor Surgery Center at Viet Duc University Hospital; Vice President of the Vietnam Association of Colorectal Surgery; Member of the French Association of Colorectal Physicians.
Assoc. Prof. Dr. Pham Van Cuong: People’s Physician; nearly 40 years of experience; Member of the Vietnam Association of Endoscopic Surgery and Surgery.
Dr. Cu Trung Kien, MSc: Specialized training in gastrointestinal surgery in Hong Kong; former physician at Bach Mai Hospital; Deputy Head of the Department of Gastrointestinal Surgery, Hong Ngoc General Hospital – Yen Ninh.
Dr. Bach Phuc Huy: Specialist Level I; over 15 years of experience; Head of the Gastrointestinal Surgery Unit, Hong Ngoc General Hospital – Phuc Truong Minh.
Pain-free hemorrhoid surgery with a comprehensive pain-control protocol developed by Dr. Nguyen Thi Thu Ba, MSc – who completed advanced residency training in France. The anesthesiology team ensures safe monitoring before, during, and after surgery.
Proactive pain management strategy: Careful pre-anesthesia evaluation, continuous monitoring throughout the procedure, and preventive pain control measures implemented before discomfort begins.
Comprehensive inpatient care: 24/7 medical support and attentive nursing care throughout hospitalization.
Hotel-standard facilities: Spacious, comfortable inpatient rooms equipped with full amenities.
For detailed consultation, please contact:
Hotline for appointment booking with specialists: 0911 908 856
Hotline for surgical consultation (hemorrhoidectomy): 0949 646 556
Note: The information provided in this article by Hong Ngoc General Hospital is for reference only and does not replace professional diagnosis or medical treatment. Patients should not self-medicate. To accurately determine your condition, please visit a hospital for direct examination, diagnosis, and personalized treatment planning by qualified physicians.
Follow Hong Ngoc General Hospital’s official fanpage for more useful health information and updates on special promotional programs.
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