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External Haemorrhoids and Their Treatment

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Haemorrhoids are blood vessels that reside within the anus. If they swell they can protrude through the anus as external lumps. 

On occasion the blood within them may clot (thrombose) which can result in a hard lump and cause discomfort, itching and considerable pain if left untreated.  The pain can worsen during bowel movements, causing the area to become inflamed.

What are the causes of external haemorrhoids?

  1. Straining during bowel movements:

This is one of the most common causes of external haemorrhoids. If there are repeated episodes of straining during bowel movements, this can be the primary cause. Straining commonly occurs during bouts of constipation or diarrhoea.

  1. Sitting on the toilet for long periods of time:

Sitting on the toilet for long periods of time can put pressure on the skin tissue around the rectum and anus, worsening the swelling and protrusion.

  1. Weakened skin support tissue

As we age, our skin tissues tend to weaken. This counts for the skin around the anus and the rectum. If pressure or straining happen, it can affect the weakened skin.

  1. Pregnancy

Pregnant women may be at an increased risk of developing external haemorrhoids because of the increased pressure of the abdomen on the veins found in this area.

  1. Obesity

Having excess weight and an unhealthy diet has been associated with having external haemorrhoids. 

  1. Heavy lifting

There is a higher risk of developing haemorrhoids if an individual regularly heavy lifts objects. This is because it adds pressure and straining to the body. 

  1. Not eating enough fibre / staying hydrated

A low fibre diet, or not drinking enough water, can cause constipation, which can later lead to straining during bowel movements which leads to haemorrhoids.

Treating External Hemorrhoids

In most cases with improvement in lifestyle and avoidance of straining and constipation, haemorrhoids can improve and become manageable without the need for surgery. Medical treatment is necessary if bleeding is persistent, if the protrusion (prolapse) causes irritation, nuisance, itching and pain.

Home treatment options include:

Over the counter medication: Using over-the-counter creams or ointments from a pharmacy can alleviate itching and irritation. 

Sitz Baths: Adding Epsom salt to bathwater can alleviate any pain or discomfort and provide relief.

Diet and lifestyle changes: Adding a high fibre diet can encourage regular and healthy bowel movements, which reduces the chance of constipation and hemorrhoid flare ups. Staying hydrated with plenty of water can also help this.

Practising good anal hygiene: Keeping the area clean can reduce the risk of any worsening infection or irritation.

External Haemorrhoids Treatment – Surgical Options

If surgery becomes necessary, there are various options available for the treatment of haemorrhoids, depending on the severity of the condition and the degree of prolapse. Some less invasive day-case procedures, such as rubber band ligation or the Rafaelo procedure, can provide a speedy recovery. However, if the prolapse is more pronounced, a more aggressive surgical approach may be required, typically performed under general anaesthesia but still as a day case procedure. The HALO (haemorrhoid artery ligation operation) procedure for example involves the placement of an absorbable stick to both tie off feeding blood vessels and to lift prolapsed tissue to correct the protrusion.

Note that bleeding from the back passage may not always be due to piles. On occasion other pathology within the bowel such as cancer or inflammation (colitis) may be causal. If you have bleeding and pain that doesn’t settle quickly you must consult with your doctor to see if further tests such as with a camera, are required.

Contact Mr Andrew Clarke

If you suspect that you have external haemorrhoids, and are experiencing distressing symptoms, Mr. Andrew Clarke offers treatment for this condition. If you are concerned about the worsening of your symptoms, please don’t hesitate to reach out to us for further advice and support.


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