Management of Minor External Hemorrhoids in Young Adult
Case at a Glance
A 30-year-old Caucasian male presents with concerns about a small external hemorrhoid and seeks guidance on management and activity restrictions.
Patient's Story
The patient is a 30-year-old male (height 5'7", weight 137 lbs) who has been previously evaluated by a colorectal specialist for rectal symptoms. He reports having been told multiple times that he has a small hemorrhoid that should not cause significant concern. The patient has been taking psyllium fiber supplement (Metamucil) 1-2 teaspoons daily to improve bowel regularity. He reports recent bowel movements requiring some straining, followed by what he believes to be irritation of the hemorrhoidal tissue. The patient expresses concerns about the appearance of the area and its impact on intimate activities.
Initial Assessment
Physical examination reveals a small external hemorrhoid presenting as a skin tag-like protrusion on the right lateral aspect of the anal verge. The patient also notes a prominent vein extending from the perineum, which appears to be normal perineal raphe anatomy. No acute thrombosis or significant inflammation is observed.
The Diagnostic Journey
The patient's previous evaluations by a colorectal specialist confirmed the presence of a minor hemorrhoid. Current presentation shows typical external hemorrhoid characteristics without signs of complications such as thrombosis or significant prolapse.
Final Diagnosis
Grade I-II external hemorrhoid with mild irritation. Normal perineal raphe anatomy (patient's concern about prominent vein).
Treatment Plan
- Continue fiber supplementation with gradual increase to recommended dosage (up to 3 teaspoons daily as tolerated). 2. Topical hemorrhoidal preparation (Preparation H) for symptom relief and to reduce swelling. 3. Avoid excessive straining during bowel movements. 4. Maintain adequate hydration. 5. Sitz baths for comfort if needed.
Outcome and Follow-up
Patient counseled that external hemorrhoids typically do not completely resolve without surgical intervention but can become asymptomatic with conservative management. Once inflammation subsides and the hemorrhoid becomes smaller and non-tender, normal activities including intimate relations can be resumed safely. Patient advised to monitor for increased pain, bleeding, or enlargement and return if symptoms worsen.