External hemorrhoids, due to increased pressure from staining or trauma to the tissue, can bleed under the perianal skin. The body responds by initiating the clotting mechanism to stop the bleeding. Unfortunately, the pressure and inflammation from this process causes severe and acute perianal pain and discomfort. The natural history of this process is that the discomfort reaches peak intensity in a few days and can last for a little over a week. The clot eventually liquifies and resolves.
Once an external hemorrhoid has had a clotting event, it is likely to experience recurrent episodes in the future. Often, after the initial clot resolves, the perianal skin does not reduce back to the normal structure and can leave perianal skin tags that can cause issues with hygiene as well as persistent itching or pruritus ani associated with it. As such, our expert doctors remove these lesions in the acute and chronic setting.
Due to the sensitive nature of the skin in this location, these hemorrhoids are best treated with excision of the excess skin and the underlying hemorrhoid with the aid of a local anesthetic. The process is performed in our office and is associated with less than 5 seconds of discomfort from the local anesthetic. The procedure usually takes 5- 10 minutes to perform. People are able to drive themselves home afterwards and the anesthetic lasts for 4 to 8 hours. Pain control after this is usually adequate with over-the-counter medicines such as Tylenol and Ibuprofen.