My asshole is swollen and painful

Almost nine out of ten people suffer from anal hemorrhoids. Hemorrhoids are also classified. If there is a swollen ball in the anus and it feels painful, it should be an external hemorrhoid. There are several types of external hemorrhoids. Is this lump formed due to varicose veins, thrombosis, or other reasons? We should distinguish them clearly during treatment so that we can prescribe the right medicine. In the following content, we will talk specifically about the classification, main symptoms and other issues of external hemorrhoids.

Classification of external hemorrhoids

Connective tissue external hemorrhoids

Connective tissue external hemorrhoids are named because of their shape. They are also called skin hemorrhoids.

External hemorrhoids caused by hanging objects and cuticles. This type of external hemorrhoids is characterized by thickening and hypertrophy of the skin folds at the edge of the anus, with connective tissue hyperplasia, no varicose veins inside the hemorrhoids, very few blood vessels, a wide base and long tip, yellowish-brown or brown-black in color, protruding and easy to see, and varying in size and shape. Sometimes there is only one, in the middle behind or in front of the anus, and sometimes there are several around the anus.

Etiology and pathology: Often caused by constipation. When dry stool passes through the anus, it over-stretches the anal skin and tears the anal folds, causing infection, inflammation, edema, and fibrosis. After the inflammation subsides, the folds cannot return to normal. Repeated injuries will cause the folds to proliferate and hypertrophy, becoming external hemorrhoids. Various inflammations of the anus and rectum, such as proctitis, anal stenosis, internal hemorrhoids, anal sinusitis, anal fistula, anal fissure, etc., are also the causes of connective tissue external hemorrhoids. In addition, anal surgeries, such as hemorrhoidectomy and anal sinusectomy, can affect the return of anal lymph and blood due to improper skin cutting, suturing, and ligation, often causing connective tissue external hemorrhoids.

If there is no inflammation in connective tissue external hemorrhoids, the patient may only feel a foreign body sensation in the local area or the anus is difficult to clean after defecation. There is often a small amount of secretions and feces accumulated, which irritates the anus and may cause eczema and itching. If it becomes inflamed, you will feel pain and have difficulty sitting, standing or walking. At first, it is just the folds that are swollen, with feces and secretions accumulated in the middle, the skin is dark red, and the epidermis is peeling; due to repeated inflammatory stimulation, the skin outside the anus has protrusions, which are soft and yellow in color, often on the midline behind the anus, and sometimes in front of or on both sides of the anus.

Varicose external hemorrhoids

Varicose external hemorrhoids are varicose external hemorrhoidal venous plexus below the dentate line, forming round, oval or prismatic soft lumps at the edge of the anus. If there is edema, the shape will become larger. In traditional Chinese medicine, it falls into the category of qi hemorrhoids. As stated in the Complete Book of Experience on Sores and Ulcers: Illustrated Explanation of Hemorrhoids and Fistulas: “Hemorrhoids caused by gas will go out when exposed to gas.” This disease is generally painless and does not cause bleeding. The only complaint is a feeling of heaviness or foreign body in the anus. It often occurs with third-stage internal hemorrhoids and mixed hemorrhoids.

Etiology and pathology: All kinds of causes that cause hemorrhoids can cause varicose external hemorrhoids. The main factors are: due to improper diet, sitting or standing for a long time, long-term constipation or diarrhea stimulation, long-term continuous increase in abdominal pressure, and infection and damage, the external hemorrhoidal venous plexus dilates, becomes congested, and is tortuous.

Inflammatory external hemorrhoids

Etiology and pathology: It is often caused by infection after anal damage, or anal fissure causing inflammation and edema of anal folds. Hemorrhoid patients feel burning pain, wetness and itching in the anus, and the symptoms worsen after defecation or excessive activity. During examination, the anal folds were found to be congested, swollen, and with a small amount of secretions.

Thrombosed external hemorrhoids

Etiology and pathology: Thrombosed external hemorrhoids are the most common type of external hemorrhoids. It is often caused by excessive force during defecation, strenuous activity or forceful coughing, which causes the veins at the edge of the anus to rupture, and blood to seep into the connective tissue and form blood clots, forming round or oval lumps of varying sizes under the skin of the anus, located inside the anal canal or outside the anal edge. The lump is soft at first and becomes hard after a few days. If there is no inflammation, the lump can be completely absorbed and disappear within 3-4 weeks without leaving any trace; if there is repeated inflammation, the connective tissue in the lump will proliferate and it may become connective tissue external hemorrhoids; if infection occurs, an abscess may form.

After defecation or straining, a round or oval lump suddenly appears under the skin at the edge of the anus. The patient feels abnormal pain, which worsens during activity or defecation. Due to sphincter spasm, there is a foreign body sensation in the lower rectum and anus, which hinders walking and makes sitting or lying down restless. The surface of the lump is slightly darker in color, sometimes purple-red, slightly hard, and obviously painful to touch. Sometimes after 2-3 days, the blood clot is absorbed, the pain is relieved, and it can heal itself. Sometimes the infection becomes purulent and the epidermis breaks, resulting in anal fistula.

Distinguishing between external and internal hemorrhoids

External hemorrhoids are located below the tooth line, with pain and lumps as the main symptoms, and skin tags of varying sizes and shapes growing around the anus. According to different pathological characteristics, it can be divided into four types: varicose vein, connective tissue, thrombotic and inflammatory. Among them, inflammatory external hemorrhoids are the most common, with the main manifestations being protruding skin folds at the anus, redness, swelling, heat, pain, edema, obvious congestion, tenderness, increased pain during defecation, and a small amount of secretions. Some may be accompanied by general discomfort and fever.

Internal hemorrhoids occur above the dentate line of the anal canal. They are generally painless, and the main symptoms are bleeding during bowel movements and prolapsed hemorrhoids. In severe cases, blood may spurt out, and prolapsed hemorrhoids may not return to their original position on their own. There may also be difficulty in defecation, inability to wipe clean after defecation, and a feeling of heaviness and distension. According to the severity of internal hemorrhoids and clinical manifestations, they can be divided into three stages: Stage I internal hemorrhoids are bleeding during defecation, but there is no prolapse, and the mucosa above the tooth line is nodular; Stage II internal hemorrhoids are bleeding, dripping or spurting during defecation, and hemorrhoids prolapse, but can be reduced on their own after defecation; Stage III internal hemorrhoids prolapse during defecation or when abdominal pressure increases due to coughing, fatigue, or weight bearing, and need to be reduced manually.

Symptoms of external hemorrhoids

Varicose external hemorrhoids

It is a venous mass formed by dilated veins under the skin of the anus. If the infection recurs, thrombosed external hemorrhoids and connective tissue external hemorrhoids may form. Treatment can be done with local hot compresses and sitz baths to prevent infection.

Connective tissue external hemorrhoids

It is a skin tag formed by the enlarged skin wrinkles around the anus. It contains proliferating fibrous connective tissue and rarely dilated blood vessels. The skin tag has a wide base and a long and pointed body and free end. It can have various shapes and can be single or multiple. Its presence affects the cleanliness of the anal area, and those with infection may feel pain. The primary ones are mostly thrombosed external hemorrhoids and the consequences of anal surgery. Skin tags are generally soft and flexible and are covered with normal skin epidermis. Hemorrhoids behind the anus are often secondary to anal fissures. These hard and swollen hemorrhoids often cause sphincter spasms and pain due to the stimulation of defecation.

The treatment is mostly conservative treatment with laxatives, keeping the anal area clean and preventing infection. For those with local infection, hot compresses and sitting baths can be used for treatment. When the treatment is ineffective, the skin at the root of the external hemorrhoids is incised under local anesthesia and completely removed.

Thrombosed external hemorrhoids

Intravascular thrombosis is caused by venous inflammation of the inferior rectal venous plexus, or due to defecation and strenuous activities, the veins at the edge of the anus rupture and blood seeps into the subcutaneous tissue, causing the local tissue to form a lump. The clinical manifestations are severe pain and local swelling. At first, the local area is hard and painful to touch. After a few days, the pain will be relieved and the local swelling will become soft and absorbed. Finally, skin tags will remain, which become connective tissue external hemorrhoids. When a vein ruptures, local bleeding forms blood clots and is accompanied by infection, which may form abscesses and anal fistulas.

If the pain does not subside within one hour of onset, thrombectomy can be considered under local anesthesia. A fusiform radial incision is made on the skin of the lump, the varicose veins are peeled out and the thrombus is removed. The remaining wound can heal on its own. In cases where the pain lasts for more than an hour and is mild, conservative treatment is adopted to maintain smooth bowel movements, such as local hot compresses, sitting baths, and appropriate amounts of painkillers. The lump can generally shrink on its own, gradually dissipate and be absorbed.

1) Painful lumps appear at the edge of the anus. The pain is severe at first, making it difficult to walk and making one feel restless. The symptoms will subside and the lump will become soft after a few days.

2) Connective tissue external hemorrhoids are often asymptomatic, with occasional anal itching, a feeling of heaviness or a foreign body sensation. Concurrent infection may cause pain.

Inflammatory external hemorrhoids

Inflammatory external hemorrhoids are mainly caused by anal damage and infection. When an infection occurs in the anus, local symptoms such as redness, swelling, fever, and pain will appear in the folds around the anus. Examination of the anus may reveal hyperplastic skin tags in the anal area, obvious congestion and edema in the anal folds, and a small amount of secretions will flow out. The pain is felt quite strongly and can be caused by a slight touch. It is also accompanied by symptoms such as anal moisture and anal itching. The symptoms may worsen after defecation or activity.