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When a patient has external hemorrhoids, they will lie under the skin around the anus. They can become very itchy and may bleed. Sometimes, the blood may accumulate and form a thrombus (clot), which can be painful; the area will swell and become inflamed. External hemorrhoids are more likely to present with pain.
Surgical treatment of hemorrhoids. Surgery for hemorrhoids is reserved for those people who do not respond to more conservative therapies. The important factor to consider is how much trouble the hemorrhoids are causing. Occassionally, hemorrhoids that become quite large, or bleed so much, will require surgery.