Hemorrhoid Thrombosis: Treatment and Recovery Insights

Thrombus ligation wound?

Hello Dr.
Chen, I have a thrombosis about the size of a tapioca pearl in my anus.
I went to the hospital on February 21 of this year to get a stool softener because there are not many colorectal surgeons in my rural area; they are all referred from the main hospital.
After the examination, the doctor said it was a thrombosis and that he would help me.
I mentioned that I knew a doctor who was still on holiday, and I thought a simple procedure would be manageable.
I have had thrombosis before, so I agreed.
The nurse contacted the operating room.
I asked the doctor why I needed to go to the operating room, and he said it was more convenient for hemostasis and stitching.
I mentioned that in Taipei, they just used local anesthesia to scrape a bit of the wound and squeeze out the blood clot, sometimes using ligation.
The doctor said that ligation for external hemorrhoids would be very painful.
I insisted that I didn't want stitches, as I also respect the new doctors and want to give them a learning opportunity.
I went to the operating room, changed clothes, and had my blood pressure taken.
When I got home, I immediately looked in the mirror and saw that my small thrombosis had turned into a larger one.
I called the doctor, who said that my method in Taipei was like squeezing a pimple and wouldn't be completely clean.
He made the incision about one centimeter larger to clean it out properly.
Due to the anesthetic, it was swollen, and he advised soaking in warm water, which would help reduce the swelling by the next day.
The next morning, I looked in the mirror, and the swelling had not gone down.
The doctor asked me to return on February 23.
Upon examination, he saw that there was still a blood clot.
I explained that it was because there were no stitches.
The doctor said he had cauterized to stop the bleeding and suggested squeezing it again in the outpatient setting, taking advantage of the existing wound.
After a few minutes of squeezing, he said the blood clot was too deep to extract and apologized for the condition of my anus.
I thanked him and was advised to soak in warm water.
That blood clot was not small, and soaking would take some time.
I had to manage my classes while dealing with the thrombosis.
Later, I met a doctor who returned to the clinic after the holiday on February 24.
He said it was okay to just soak in warm water.
I initially asked if ligation was possible, but the doctor said it was not advisable for external hemorrhoid thrombosis.
However, the doctor I knew said it might be possible to push it in.
After discussion, we decided to proceed with the ligation surgery.
On February 27, the ligation fell off, and I noticed that the ligation site had a dent where some tissue was missing.
When I returned on February 28, the doctor said the blood clot was large, and the ligation falling off would create a larger wound.
He advised me to be careful to avoid infection and provided me with powder for my bottom, along with regular follow-up appointments.
He also mentioned that there might be some granulation tissue and that I shouldn't worry about it.
The area around the anus would feel prickly and painful due to the wound, but it would heal gradually.
From February 27 to April 10, I had regular follow-ups, and the tissue gradually grew back.
On April 10, during the follow-up, the doctor said the tissue had grown back, but after using the restroom and cleaning with toilet paper, I sometimes felt a slight pain when pressing on the anus.
After the examination, he noted some swelling and said it would take a month to heal completely.
He also mentioned that there was a hard area next to the wound that would take 2 to 3 months to recover.
I am a special volunteer from Taipei working in a rural area and do not want to travel back to Taipei for every medical issue due to the long distance.
Therefore, I need to adapt to the healthcare in remote areas.
If I have questions, I can ask the nurse, who will then call in the next patient.
I find the doctors on the Taiwan e-Hospital Network very attentive in answering public medical questions, so I would like Dr.
Chen to help explain my current issues.
1.
Why is there new tissue growing in my anus, yet it is still swollen and will take a month to heal? I don't understand.
2.
What is the reason for the hard area around the wound?
3.
Dr.
Chen, I had a colonoscopy in June 2017 where a serrated polyp was found, also done in a rural area.
I have gastroesophageal reflux and regularly undergo gastroscopies at NTU Hospital.
I informed the NTU doctor about the colon polyp, and they said they would schedule a colonoscopy for me this year.
I will return to NTU in May for an appointment.
My anal wound has just started to grow back tissue, but it is still thin.
During the colonoscopy, a lubricant will be used, but it may irritate the wound, and I am concerned about re-injury.
If I wait for my anus to fully heal, I am unsure how long that will take.
The new skin sometimes feels prickly, especially if I have frequent bowel movements.
Dr.
Chen, based on your outpatient experience, how long do you think it will take for the wound to be ready for a colonoscopy? Should I continue soaking in warm water to help with the swelling? Once the swelling goes down, can I proceed with the colonoscopy? If the new skin is still not thick enough, can I still undergo the procedure?
I apologize for the lengthy story and any inconvenience it may cause you.
Thank you for your help.
[I am eager to schedule a colonoscopy at NTU because the doctor who previously examined me in the rural area asked if I had gone to NTU.
Last year, he helped me remove a 0.6 cm polyp, but there was a section nearby that was not very clear.
He suggested that if there were any concerns, I should go to NTU for a gastroscopy, which I would also do for the colonoscopy.
If the polyp is located on a blood vessel, they may not be able to stop the bleeding due to a lack of equipment.
This was not mentioned during the initial examination.]

Kai Ma, 50~59 year old female. Ask Date: 2018/04/12

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Please consult a colorectal surgeon.

Reply Date: 2018/04/12

More Info

Understanding hemorrhoid thrombosis and its treatment can be quite complex, especially when considering the nuances of recovery and the potential for complications. Hemorrhoid thrombosis occurs when a blood clot forms in an external hemorrhoid, leading to significant pain and swelling. The treatment typically involves either conservative management or surgical intervention, depending on the severity of the thrombosis and the symptoms presented.

In your case, it seems you underwent a surgical procedure to remove the thrombosed hemorrhoid. The fact that you experienced swelling and the formation of new tissue (granulation tissue) is quite common following such procedures. The healing process can vary significantly from person to person, and several factors can influence the duration and quality of recovery.

1. Why is there new tissue growth and swelling?
After surgery, the body initiates a healing response, which includes the formation of new tissue. This granulation tissue is a sign that the body is repairing itself. However, it can also lead to temporary swelling as the area becomes inflamed. This inflammation is part of the healing process, but it can take time for the swelling to subside. Typically, it can take several weeks to a few months for the area to fully heal, depending on the individual’s health, the extent of the surgery, and how well they follow post-operative care instructions.

2. What is the cause of the hard area around the wound?
The hard area you are feeling around the wound is likely scar tissue or a result of the healing process. As the body heals, it may produce more collagen in the area, leading to a firmer texture. This is normal, but if the hardness persists or is accompanied by pain, it would be wise to consult your healthcare provider to rule out any complications such as infection or excessive scar formation.

3. Concerns about undergoing a colonoscopy after hemorrhoid surgery:
It is understandable to be concerned about the timing of a colonoscopy following your hemorrhoid surgery. Generally, it is advisable to wait until the surgical site has fully healed before undergoing any procedures that might irritate the area. This can take anywhere from a few weeks to a couple of months, depending on the individual’s healing process. You should discuss your specific situation with your gastroenterologist, who can provide guidance based on the condition of your healing tissue and any potential risks involved.

4. Continued care and management:
Continuing to soak in warm water (sitz baths) can be beneficial for your recovery. This practice helps to soothe the area, reduce swelling, and promote blood flow, which is essential for healing. It is also important to maintain a high-fiber diet and stay hydrated to prevent constipation, which can strain the healing area during bowel movements.

In summary, while the healing process can be frustrating and may seem prolonged, it is essential to be patient and follow your healthcare provider's recommendations. If you have any concerns about your recovery or the timing of your upcoming procedures, do not hesitate to reach out to your doctors for personalized advice. They can provide the best guidance based on your specific medical history and current condition.

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