External hemorrhoids

Simple External Hemorrhoids

A dilatation of the veins surrounding the anal orifice. The turgescence (condition of being swollen) of which is only evident when the patient strains, forming a distinct cushion-like ring around the anal margin, and producing no symptoms until complications occur. This is classed as a simple external external hemorrhoid.

Thrombosed External Hemorrhoids

Frequently an extravasation of blood takes place around a dilated anal or perianal vein which has been ruptured by violent straining, as, for example, during defecation, or some severe muscular effort. The subsequent clotted extravasated blood forms a thrombus and is then called a thrombosed external hemorrhoid. The symptoms are unusually sudden in onset and often occur during defecation.

When the swelling is opened and the clot turned out, it can often be seen that the clot has been removed from the cavity of the vein. After removing the skin, the thrombosed vein is exposed and it must be opened before the contained clot can be reached and the endotelial lining is found intact.

In this latter condition, there most likely has been some injurty to the endothelial cells lining the dilated vein which is responsible for the beginning of the thrombus.

In some cases both conditions are found; a cloth being partly within and partly without the vein.

From whatever cause, it produces a swelling covered by skin at the anal margin which appears in size from a small pea to a mass three quarters of an inch in diameter, and frequently terminates in a connective tissue pile. The color varies from a livid blue to a deep black, depending upon the thickness of the skin covering the pile. The skin covering the tumor is tense and has a smooth, glazed appearance.

Ruptured External Hemorrhoid

A varicosed anal, or perianal vein may be bursted through the skin by trauma, and it is then know-n as a ruptured external hemorrhoid. There is usually hemorrhage which may be slight or profuse, occurring suddenly and unless it becomes infected, it generally heals spontaneously. The control of
the hemorrhage and prevention of infection are all that is necessary in most cases.

Connective Tissue Hemorrhoid

Connective tissue (dog ear, skin tab, or sentinel) piles consist of all types of hypertrophied tag of perianal, or anal skin. It does not contain varicose veins, and strictly speaking it is not a hemorrhoid. In most cases it is due to stretched hypertrophied skin wich covered a pre-existing thrombosed hemorrhoid which has been treated by the palliative method, allowing the thrombus to be absorbed, leaving the stretched hypertrophied skin tab. In other cases, they follow badly performed operations for internal hemorrhoids, or rough stretching of the sphincter ani muscle. They rarely give any trouble, except in the toilet of the parts, unless they become infected.

Inflamed External Hemorrhoids

Any tupe of external hemorrhoids which has become infected. The treatment of external hemorrhoids is palliative or surgical, and will not be further discussed in this work, as they are not suitable for treatment by the injection method.