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Two Types Of External Hemorrhoids
There are two types of external hemorrhoids: Type I external hemorrhoids protrude from the area around the outside of the anus. Type 2 external hemorrhoids are internal hemorrhoids that stick out outside the anus. This article concerns external hemorrhoids, and will discuss both types.
The first type of external hemorrhoid occurs outside the anal verge. The anal verge is the surface of the anus that is outside the sphincter when the anal muscle/valve is closed. The term hemorrhoid is defined in an anatomical sense because the tissue that forms the joint where the anus is attached to the rectum. This tissue is dense with arteries, veins, vessels and capillaries. If someone 'has hemorrhoids' the reference is to hemorrhoid tissue that is afflicted with varicose veins of some kind. Varicosity could manifest as twisted and/or enlarged and/or swollen veins within the hemorrhoid tissue.
True external hemorrhoids (as opposed to interior hemorrhoids that are protruding outside through the anus) are rare and are often not a hemorrhoid at all, but a misdiagnosed case of perianal hematoma. The perianal blood vessels are in fact underneath the dermis surrounding the anus. When these vessels are damaged they can bleed internally, creating bruising and swelling. Painful as perianal hematoma can be, it is treated in a different manner when compared to hemorrhoids.
External hemorrhoids come about when the veins that drain the area of the inferior rectal arteries become varicose. Internal hemorrhoids occur when the veins that drain the area of the superior rectal arteries become varicose. External hemorrhoids are prone to thrombosis, which means they cause blood clots in blood vessels. When a vein in the drainage area of the lower rectal arteries (they connect to the pudental artery) ruptures or an inter-vessel blood clot develops, the hemorrhoid is classified as a thrombosed hemorrhoid.
Hemorrhoid treatments exist for a wide range of symptoms, from treatments that sooth minor itching to surgery under full anesthetic. For most people, hemorrhoids get no worse than a slight, occasional annoyance. Symptoms are mild and temporary. The condition heals spontaneously or symptoms are easily alleviated using local treatments that might include using a bidet or extendable shower head or a warm sitz bath to sooth the inflamed tissue, followed by a cold compress and a topical analgesic.
External hemorrhoids with little lumps get better with warm baths. The warm water relaxes the vessels around the rectum. Use of medicated creams must be closely monitored if they contain steroid preparations. Steroid preparations can weaken the skin, which could possibly be a factor to future outbreaks. With that warning given, however: used early in an outbreak, steroidal cremes are one of the most assured ways of reversing the course of a flare-up.
Remember that excessive washing or rubbing of the anus is no cure and will aggravate the situation. So far as actually touching the spot goes, it should be limited to soaking, rinsing and the application of topical ointments or cremes.
A strangulated hemorrhoid is an interior hemorrhoid that has prolapsed (protruded outside the anus during defecation and will not spontaneously withdraw). The anus goes into spasm because it can't close and ends up cutting off the oxygen supply to the hemorrhoid. These must be looked at by a doctor.
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