Many thrombosed external hemorrhoids may go away within a few weeks. An external thrombosed hemorrhoid develops under the skin surrounding the anus and causes discomfort due to the presence of a blood clot in the vein. The pain of thrombosed hemorrhoids may improve within 7-10 days without surgery and may disappear within 2-3 weeks.
- Initial days of a thrombosed external hemorrhoid blood vessel are a combination of pain/discomfort with an associated anal lump.
- After a few days, the pressure of the underlying blood clot on the overlying skin will lead to spontaneous splitting of the skin and bloody drainage of the lump. The appearance of this blood can be alarming but should be self-limited. This drainage event is also associated with a decrease in the anal lump and improvement in the painful symptoms.
- If the pressure of the underlying blood clot does not result in spontaneous drainage during the first several days, then the body will eventually reabsorb the clotted blood within a few days.
Although the blood clot may likely be reabsorbed into the body in a few days to a couple of weeks, complications may occur if the thrombus is not fully reabsorbed. If unhealed, quick treatment of thrombosed external hemorrhoids is necessary to prevent loss of blood supply and damage to the surrounding tissue.
What are the types of hemorrhoids?
Hemorrhoids, commonly called piles, are swollen, inflamed veins around the anus or lower part of the rectum (the terminal part of the large bowel). Hemorrhoids are common in both men and women. It is estimated that one in 20 Americans have hemorrhoids. They occur more commonly with age, and around 50% of Americans over 50 years of age are affected.
Hemorrhoids may be felt as tiny lumps in and around the anus. They may often get better on their own within a few days, but some may need medications and even surgery to go away. Hemorrhoids are of two main types:
- External hemorrhoids: They form under the skin around the anus.
- Internal hemorrhoids: They form in the lining of the anus and lower rectum.
What causes external thrombosed hemorrhoids?
Generally, hemorrhoids occur when there is a lot of pressure on the veins around the anus. This raised pressure may happen because of the following:
- Straining during bowel movements
- Chronic constipation or diarrhea
- Sitting on the toilet for long periods
External thrombosed hemorrhoids may develop from increased pressure in the lower rectum. As an individual ages, the risk of external thrombosed hemorrhoids increases because the tissues that support the veins in your rectum and anus can weaken and stretch. Other causes may include:
What are symptoms of thrombosed external hemorrhoids?
Hemorrhoids are swollen veins in the lower area of the anus/rectum. Hemorrhoids can occur inside the lining of the anus or rectum (internal hemorrhoids), or one may form at the anal opening (external hemorrhoids).
Generally, hemorrhoids may cause the following symptoms:
- Itching in and around the anus
- Hard, tender lumps felt at the bottom (anus)
- Anal pain, especially while sitting
- Bleeding from the rectum was observed as bright red blood in the stool, on toilet paper, or in the toilet bowl after a bowel movement
- A bulging or swelling may be felt through the anus in case of a prolapsed hemorrhoid (hemorrhoid that has bulged or fallen through the anal opening)
A thrombosed hemorrhoid occurs when blood clots become trapped inside hemorrhoid. It is a common complication of hemorrhoids.
Generally, external thrombosed hemorrhoids look like dark bluish lumps. The color is due to a blood clot inside a blood vessel. Symptoms that accompany a thrombosed hemorrhoid are often more severe than normal and may include:
- Intense itching
- Severe pain
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How are thrombosed external hemorrhoids treated?
Symptoms of hemorrhoids may resolve with diet and lifestyle modifications. You must, however, seek immediate medical care if your symptoms do not go away in a week or you experience symptoms such as severe anal pain and bleeding from the rectum, discomfort or pain in the abdomen, diarrhea, or fever. If home management for piles does not help, you may need to seek medical help.
Doctors may recommend one of the following medical procedures for the treatment. These procedures include cutting off the blood supply to a hemorrhoid, which makes it shrink and go away. The procedures include the following:
- Rubber band ligation: In this procedure, the doctor places a special rubber band around the base of hemorrhoid to cut off the blood supply.
- Sclerotherapy: It involves injecting a solution (sclerosant) into an internal hemorrhoid.
- Infrared photocoagulation: This procedure involves using a tool to direct infrared light at an internal hemorrhoid to shrink it.
- Electrocoagulation: In this procedure, a doctor uses a special tool that sends an electric current into an internal hemorrhoid.
- Hemorrhoidectomy: It is a surgical procedure to remove large external hemorrhoids and prolapsing internal hemorrhoids (hemorrhoids that bulge out of the anus).
- Hemorrhoid stapling: In this procedure, the surgeon uses a special stapling tool to remove internal hemorrhoids and pull a prolapsing internal hemorrhoid back into the anus.
For thrombosed external hemorrhoids, if the blood clot has formed within the past 48-72 hours, the doctor may remove it from within the hemorrhoid. This is a simple procedure that may relieve pain. Patients may be under local anesthesia during the procedure. The doctor makes a small incision in the skin and removes the blood clot. Stitches are generally not needed. If more than 72 hours have passed, the doctor may suggest home treatments.
- In the first 24 hours, applying an ice pack to the area can help limit the size of the clotted blood and associated discomfort.
- After 24 hours, gentle warmth may be applied to the area in an attempt to melt the blood clot. This will aid the body in its efforts to disintegrate the clot and resolve the lump.
- Use a stool softener or gentle laxatives such as fiber or Miralax (or generic) to avoid constipation. Warm baths, ointments, suppositories, and witch hazel compresses may be helpful.
- Over-the-counter (OTC) topical medications (acetaminophen and ibuprofen) can bring temporary relief from symptoms. These products include creams and ointments.
- The doctor may also prescribe additional steroid foams and suppositories.
- Persistent bleeding or painful hemorrhoids may require banding, ligation, or removal (hemorrhoidectomy). Surgery to remove hemorrhoids may be done if other treatments don't work.
- Adding fiber to your meals and drinking more water may help in faster healing.
What is the outlook of thrombosed external hemorrhoids?
Thrombosed hemorrhoids may most likely get better after a couple of days and resolve on its own. If it doesn't seem to be resolving, there are various treatment options to get rid of the discomfort and get back to your life. Although it is a very painful condition, it is not serious and resolves without specific treatment over several days to a week or two. No further special evaluation or treatment is needed.
Rarely, if the hemorrhoid is very large, the doctor may remove some of the clot under local anesthesia. Unfortunately, there is no permanent cure that will prevent an individual from ever getting hemorrhoids, but there are several treatments that can manage hemorrhoids.
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