Managing Recurrent Thrombosed Hemorrhoids: When to Consider Surgery?

Q: Managing Recurrent Thrombosed Hemorrhoids: When to Consider Surgery?

Answer： If there is no pain or bleeding, surgical treatment is not necessary. <br>If dietary and bowel habits do not improve, symptoms may quickly recur after surgery. <br>Generally, surgery to remove the condition is not recommended unless there is significant bleeding or severe

Frequent occurrence of small thrombosed hemorrhoids?

Hello, doctor.
After giving birth naturally in June last year, my pre-existing hemorrhoids worsened.
It has been ten months since then, and I experience a feeling of swelling after walking for a long time.
Although there is no pain or bleeding most of the time, I have had a few episodes of small thrombosed hemorrhoids.
However, my hemorrhoids do not cause pain severe enough to prevent me from walking.
I previously consulted a doctor who prescribed oral anti-inflammatory medication and ointment.
After soaking and applying the medication for a while, the symptoms would subside, but the recurrence makes me hesitant to do squats or walk for extended periods.

Yesterday (April 23), I stayed home and suddenly experienced swelling.
When I touched the area, I felt a small hard spot inside, which I suspect might be another thrombosed hemorrhoid, so I applied medication (Hemorhoid Ointment) and soaked in warm water.
This morning (April 24), after soaking and applying the ointment, the swollen hemorrhoid seems to have softened.
In addition to a frequently occurring thrombosed hemorrhoid, I also have internal hemorrhoids that protrude during bowel movements, which are larger than the thrombosed one but do not cause pain and retract after a while.

I previously had a rubber band ligation for this hemorrhoid, and there is some excess skin outside the anus (I'm not sure if it's an external hemorrhoid or excess skin, but it is neither painful nor itchy).
Given the occasional presence of small thrombosed hemorrhoids, do you recommend surgery? I am unsure if surgery for thrombosed hemorrhoids would lead to improvement, as I have heard that post-operative recovery can be quite painful.
What degree of symptoms would warrant surgical treatment? Thank you.

Miss Zhou, 30~39 year old female. Ask Date: 2017/04/24

Dr. Ke Fangxu reply Surgery

Answer: If there is no pain or bleeding, surgical treatment is not necessary.
If dietary and bowel habits do not improve, symptoms may quickly recur after surgery.
Generally, surgery to remove the condition is not recommended unless there is significant bleeding or severe prolapse.

Reply Date: 2017/04/24

More Info

Managing recurrent thrombosed hemorrhoids can be a challenging issue, especially for individuals who have experienced significant discomfort and complications. In your case, it seems that you have been dealing with thrombosed hemorrhoids since your natural delivery, and while you have had some relief with medications and topical treatments, the recurrence of symptoms is understandably concerning.

Thrombosed hemorrhoids occur when a blood clot forms in the external hemorrhoidal tissue, leading to swelling and discomfort. While you mentioned that your symptoms are not severe enough to prevent you from walking, the persistent swelling and the occasional formation of blood clots indicate that your condition may require further evaluation.
In general, the decision to consider surgery for hemorrhoids depends on several factors:
1. Severity of Symptoms: If your symptoms are recurrent and significantly impact your quality of life, such as causing discomfort during daily activities or leading to anxiety about future episodes, surgery may be warranted.
2. Response to Conservative Treatments: If you have tried conservative measures, such as topical treatments, dietary changes, and lifestyle modifications (like increasing fiber intake and hydration), without lasting relief, it may be time to consider surgical options.
3. Frequency of Recurrences: If you are experiencing frequent episodes of thrombosis, as you mentioned, this could indicate that your hemorrhoids are not responding to conservative management and may benefit from surgical intervention.

4. Physical Examination Findings: A thorough examination by a healthcare provider is essential. They can assess the size and condition of your hemorrhoids, as well as any associated complications, such as skin tags or other issues that may require surgical correction.

5. Type of Hemorrhoids: You mentioned having both external and internal hemorrhoids. Surgical options may vary depending on the type and severity of the hemorrhoids. For external thrombosed hemorrhoids, procedures like excision can provide immediate relief. For internal hemorrhoids, options such as rubber band ligation or hemorrhoidectomy may be considered.

Regarding your concerns about postoperative pain, it is true that hemorrhoid surgery can be painful, and recovery may involve discomfort. However, many patients find that the long-term benefits of surgery, such as reduced recurrence and improved quality of life, outweigh the temporary discomfort associated with the procedure. Pain management strategies, including medications and proper wound care, can help alleviate postoperative pain.

In conclusion, if your recurrent thrombosed hemorrhoids are causing you significant distress or if conservative treatments have failed, it may be time to consult with a colorectal surgeon. They can provide a comprehensive evaluation and discuss the potential benefits and risks of surgical intervention tailored to your specific situation. Remember, the goal of any treatment is to improve your quality of life and reduce the frequency and severity of your symptoms.

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