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External Hemorrhoids Located below the dentate line Rich in pain receptors painful Symptoms: Painful swelling near anus Itching Hard lump (if thrombosed) Causes / Risk Factors Chronic constipation Straining during defecation Low fiber diet Prolonged sitting on toilet Pregnancy Obesity Heavy lifting Chronic diarrhea Aging weakening of supporting tissues Symptoms Bright red bleeding (especially with internal hemorrhoids) Perianal pain (external hemorrhoids) Itching or irritation Swelling/lump near anus Mucus discharge Feeling of incomplete evacuation Diagnosis Clinical exam Digital rectal exam Anoscopy Colonoscopy if bleeding cause unclear or patient is older Management 1

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