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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.
Surgery - Recommended for extreme cases of hemorrhoids. The most extreme cases of hemorrhoids stem from what is called prolapsed hemorrhoids. These hemorrhoids have grown to the point where they are an external appendage and cause great discomfort. Many suffering with prolapsed hemorrhoids are recommended by their doctor to consider a surgical approach to their suffering.