View source for External hemorrhoid

==Background==
{{Hemorrhoid background}}

==Clinical Features==
[[File:M 44 anus 22.jpg|thumb|[[External hemorrhoid]]]]
[[File:Perianal thrombosis 01.jpg|thumb|Thrombosed [[external hemorrhoid]]]]
*Occur distal to dentate line
*Can be seen at external inspection
**More prominent with Valsalva
*Thrombosed hemorrhoids (bluish-purple discoloration) cause painful defecation
**Non-thrombosed hemorrhoids are usually painless
***If patient complains of pain but hemorrhoids are not thrombosed suspect:
****Perianal/intersphincteric abscesses
****Anal fissures
*Prolapse
**Requires periodic reduction by the patient

==Differential Diagnosis==
{{Anorectal DDX}}

{{Lower GI bleeding DDX}}

==Management==
===Not Thrombosed===
*Usually self-limiting with resolution in 1 week

===Thrombosed===
*Consider sitz baths and bulk laxatives if:
**Thrombosis has been present >48 hr
**Swelling has started to shrink
**Pain is tolerable
*Conservative management with topical 0.3% nifedipine and 1.5% viscous lidocaine is alternative<ref>Perrotti P. Conservative treatment of acute thrombosed external hemorrhoids with topical nifedipine. Dis Colon Rectum. 2001 Mar;44(3):405-9.</ref>
*Consider excision if:
**Patient is not immunocompromised, child, pregnant woman, has portal hypertension, coagulopathic
**Thrombosis is acute (<48 hr)
**Extremely painful
**See [[External Hemorrhoid Excision]]

==Disposition==

==See Also==
*[[Anorectal Disorders]]

==External Links==

==References==
<references/>

[[Category:GI]]