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Haemorrhoids, also called piles, are caused by straining while having a bowel movement which leads to swollen veins in the anus and lower rectum. Haemorrhoids are of four types - internal, external, prolapsed, and thrombosed. In this article, we will write about external haemorrhoids.
What Causes External Haemorrhoids 
When there is a strain during the bowel movement, the veins around the anus tend to stretch under pressure and may swell up, which is most often caused by constipation or diarrhoea. This type of haemorrhoids is different from other haemorrhoids, mostly due to their location.
External haemorrhoids can also develop from increased pressure in the lower rectum due to having anal intercourse, being obese, eating a low-fibre diet and regular heavy lifting.
The external haemorrhoids bulge out of the anus and they tend to be more painful because the outside area of the anus is sensitive.
Symptoms Of External Haemorrhoids 
- Itching or irritation in the anal region
- Pain or discomfort
- Swelling around the anus
- Blood in the stool
Risk Factors Of External Haemorrhoids 
- Family history
- Sitting or standing for prolonged periods
- Low-fibre diet
Complications Of External Haemorrhoids
- Blood clot
- Strangulated haemorrhoids
When To See A Doctor
Consult a doctor, if you experience bleeding during bowel movements or have haemorrhoids that don't improve after a week. Also if you feel lightheadedness, dizziness or faintness, talk to your doctor immediately.
Diagnosis Of External Haemorrhoids
The doctor will begin with a physical examination and in most cases, the doctor may be able to see the haemorrhoids outside the anus. A series of tests will be conducted by the doctor which includes the following:
- Proctoscopy - It is a common medical procedure in which an instrument called proctoscope is used to scan the rectum, anal cavity or sigmoid colon 
- Colonoscopy - A doctor uses a thin, flexible camera to examine for abnormalities or disease in the colon 
- Digital rectum exam - The doctor inserts a gloved, lubricated finger into the rectum to examine it for any lumps 
- Sigmoidoscopy - A procedure where the doctor uses a flexible tube with a light on it to look inside the sigmoid colon 
- Anoscopy - Another diagnostic procedure where the doctor checks for any abnormality in the gastrointestinal tract, especially in the anus and rectum.
Treatment Of External Haemorrhoids 
Depending on the severity, external haemorrhoids can be treated in a few ways:
If the external haemorrhoids are causing mild discomfort, the doctor prescribes over-the-counter creams, pads and ointments. These products contain ingredients like witch hazel or hydrocortisone that bring relief from itching.
If a painful blood clot has formed within external haemorrhoid, the doctor removes the haemorrhoid under local anaesthesia, which is to be done within 72 hours of developing a clot.
Hemorrhoidectomy is another effective treatment method to treat severe or recurring haemorrhoids, where the surgeon removes excess tissues that cause bleeding.
Sclerotherapy is another treatment procedure, wherein the doctor injects a chemical solution into the haemorrhoid tissue to deflate it.
Prevention Of External Haemorrhoids
- Eat foods rich in fibre
- Drink plenty of water
- Exercise regularly
- Avoid sitting or standing for a long time
- When you feel the urge to urinate go as soon as you can
- Don't strain during the bowel movement
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-  Quinn, J., Zeleny, T., Rajaratnam, V., Ghiurluc, D. L., & Bencko, V. (2018). Debate: the per rectal/digital rectal examination exam in the emergency department, still best practice?. International journal of emergency medicine, 11(1), 20.
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