External hemorrhoids, also known as piles, are swollen veins under the skin around the anus. They can cause discomfort, itching, and sometimes bleeding. This article explores the safety of pushing them back inside and provides guidance on management and when to seek medical attention.
The Safety of Manual Reduction
Attempting to manually push external hemorrhoids back inside is not recommended. Unlike internal hemorrhoids, which originate inside the rectum and can sometimes be gently pushed back in if prolapsed, external hemorrhoids are located outside the anal canal, beneath the sensitive skin of the anus. Due to their distinct structure and location, they cannot be truly “pushed back in.” Forcing them inward can cause irritation and pain.
Why Manual Reduction Is Not Recommended
Manually manipulating an external hemorrhoid can lead to several complications. Applying pressure to these swollen and sensitive veins may increase pain and inflammation, cause bruising, or damage the delicate perianal skin. There is also a risk of tearing tissue, which can introduce bacteria and lead to infection.
If a blood clot has formed within an external hemorrhoid, known as a thrombosed hemorrhoid, attempting to push it can worsen pain and contribute to further clotting or rupture. Thrombosed hemorrhoids often appear as painful, bluish or purplish lumps. Their anatomical placement means they are not meant to be reinserted into the anal canal, making such attempts futile and harmful.
Managing External Hemorrhoids at Home
Since manual reduction is not advised, focus on safe home care strategies to manage symptoms. Increase dietary fiber to 25-30 grams daily through fruits, vegetables, and whole grains to soften stools and reduce straining. Drink plenty of water to keep stools soft and easy to pass.
Sitz baths, soaking the anal area in warm water for 10-20 minutes several times a day, can reduce pain and discomfort. Over-the-counter topical treatments with witch hazel or hydrocortisone provide relief from itching and inflammation. Pain relievers like ibuprofen or acetaminophen can also help manage discomfort. Avoid prolonged sitting on the toilet and respond promptly to the urge to have a bowel movement.
When to Seek Professional Medical Advice
While many external hemorrhoids resolve with home remedies within a week, certain symptoms warrant a visit to a healthcare provider. Persistent rectal bleeding, especially if heavy or accompanied by changes in stool color, should be evaluated to rule out more serious conditions. Severe or worsening pain, particularly if sudden and associated with a hard, discolored lump, could indicate a thrombosed hemorrhoid requiring medical attention. Signs of infection, such as fever, chills, or increased swelling and redness, also necessitate prompt medical consultation. If home remedies do not provide relief after about a week, or if hemorrhoids recur frequently, a medical professional can offer further treatment options or provide an accurate diagnosis.