Managing Persistent Bleeding from Thrombosed External Hemorrhoids: What You Need to Know

Persistent bleeding from a thrombosed external hemorrhoid?

Hello doctor, I occasionally experience constipation due to stress, which led to the development of internal hemorrhoids during my university years.
Last Friday, while using the restroom, I exerted myself improperly, resulting in a thrombosed external hemorrhoid.
For the first three days, I experienced swelling and discomfort, so I consulted a family medicine doctor who prescribed anti-inflammatory medication, a swelling reducer, and a stool softener, along with a topical ointment for hemorrhoids.
After three days, the pain subsided, but I still felt a sensation of fullness, so I went to the hospital to see a colorectal specialist.
The doctor only glanced at it and advised me to continue with warm sitz baths and apply the ointment, prescribing only the topical medication "Pingtizhong." However, I am hesitant to use Pingtizhong due to previous issues with its ingredients, so I am currently only using the ointment "Xiyu Zhi" and taking warm sitz baths twice a day.
I am still experiencing bleeding symptoms, sometimes more (requiring the use of sanitary pads) and sometimes less (only a small amount on my underwear or when wiping with toilet paper).
Is this normal? Can I still engage in weight training and high-intensity activities like spin classes?

Angela, 20~29 year old female. Ask Date: 2018/06/24

Dr. Ke Fangxu reply Surgery

The symptoms of thrombosed hemorrhoids will evolve from pain to swelling, and subsequently, the rupture of the thrombus may lead to mild bleeding, which typically resolves within three to five days.
This is a normal healing process, and as long as there is no significant bleeding or severe pain, there is no cause for concern.
Heavy weight training is temporarily not recommended, as it can increase pressure in the anal area, potentially leading to bleeding or recurrence of the thrombus.

Reply Date: 2018/06/24

More Info

Managing persistent bleeding from thrombosed external hemorrhoids can be a challenging issue, especially when it comes to understanding the underlying causes and appropriate treatment options. In your case, it seems that you have already sought medical attention and received some initial treatments, including anti-inflammatory medications, stool softeners, and topical ointments. However, the ongoing bleeding and discomfort can understandably be concerning.

Firstly, it is important to recognize that thrombosed external hemorrhoids can cause significant discomfort and bleeding, particularly during bowel movements or when straining. The blood you are experiencing could be a result of the hemorrhoid itself, which may still be inflamed or irritated. Even after the pain subsides, it is not uncommon for some bleeding to persist as the area heals. The fact that you are experiencing varying amounts of blood—sometimes more, sometimes less—can be typical as the condition resolves.

In terms of your current treatment, continuing with warm sitz baths and the topical ointment you are comfortable with is a good approach. Warm sitz baths can help soothe the area, reduce inflammation, and promote healing. If you have concerns about the specific ointment you are using, it may be worth discussing with your healthcare provider to explore alternative options that you feel more confident about.

Regarding your question about engaging in high-intensity activities such as weight training and spinning classes, it is generally advisable to avoid strenuous exercise until the bleeding has completely resolved and you feel comfortable. Straining during exercise can exacerbate hemorrhoid symptoms and potentially lead to further bleeding. It would be prudent to listen to your body and allow adequate time for healing before resuming high-impact workouts.

If the bleeding continues or worsens, or if you experience any new symptoms such as increased pain, swelling, or changes in bowel habits, it is crucial to follow up with your healthcare provider. They may recommend further evaluation, which could include a physical examination or additional treatments, such as rubber band ligation or other procedures if necessary.

In summary, while some bleeding can be normal during the healing process of thrombosed external hemorrhoids, persistent or worsening symptoms should be evaluated by a healthcare professional. Continue with supportive measures like sitz baths and topical treatments, and consider postponing high-intensity workouts until you are fully healed. If you have any doubts or concerns, seeking a second opinion from a specialist in colorectal surgery may provide additional reassurance and options for management.

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