Thrombosed Hemorrhoids: Treatment Options and Recovery

Thrombosed hemorrhoids

Hello Doctor: I underwent a ligation procedure on May 13 due to bleeding from an internal hemorrhoid.
Three days post-surgery, I experienced unbearable pain.
Yesterday, during my visit to a colorectal specialist, the doctor informed me that the ligation failed and resulted in a thrombosed hemorrhoid.
I asked the doctor if it was possible to perform an incision to drain the blood, but he mentioned that it would be a major surgery with a long recovery time (he advised me to wait for the swelling to subside, but the pain is so severe that it makes me tremble).
I have seen others with similar experiences who were able to have the thrombosis drained in about ten minutes in an outpatient setting.
I would like to inquire if draining the blood from the thrombosis, without removing the hemorrhoid, requires hospitalization.
Additionally, how long is the recovery period? Will the incision be more painful? Thank you.

Zhi Ling, 30~39 year old female. Ask Date: 2020/05/24

Dr. Ke Fangxu reply Surgery

Since we are unsure of the size of your thrombus, we cannot determine whether it can be managed in an outpatient setting.
Small thrombi can indeed be treated with local anesthesia through incision, and recovery typically takes about a week.
However, larger thrombi may not be suitable for this approach.
Additionally, since you have recently undergone a ligation procedure, immediate incision may not be advisable due to the increased risk of infection.
It is recommended that you consult another physician for an evaluation before deciding whether to proceed with surgery or drainage treatment.

Reply Date: 2020/05/24

More Info

Understanding thrombosed hemorrhoids can be quite challenging, especially after undergoing a procedure like banding. When you experience severe pain following a hemorrhoid banding procedure, it can sometimes lead to complications such as thrombosed hemorrhoids. This occurs when a blood clot forms within the hemorrhoid, causing significant swelling and discomfort.

In your case, it seems that the doctor has indicated that the banding may not have been successful, leading to the formation of a thrombosed hemorrhoid. The pain you are experiencing is likely due to the increased pressure and inflammation associated with the clot. While it is understandable to want immediate relief, the approach to treatment can vary based on the severity of the condition and the specific circumstances surrounding your case.

Treatment Options
1. Conservative Management: In many cases, doctors may recommend conservative management for thrombosed hemorrhoids, especially if the clot is not too large. This can include:
- Pain Relief: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage pain and inflammation.

- Warm Sitz Baths: Soaking in warm water can provide relief and help reduce swelling.

- Dietary Changes: Increasing fiber intake and staying hydrated can help prevent straining during bowel movements, which can exacerbate hemorrhoid symptoms.

2. Surgical Intervention: If the pain is severe and does not improve with conservative measures, surgical intervention may be necessary. This can involve:
- Incision and Drainage: A minor surgical procedure can be performed in an outpatient setting to relieve the pressure by making a small incision to drain the clot. This is typically a quick procedure and may not require hospitalization.

- Hemorrhoidectomy: In more severe cases, a hemorrhoidectomy may be performed, which involves the removal of the hemorrhoid. This is more invasive and requires a longer recovery time.

Recovery and Pain Management
If you undergo an incision and drainage procedure, the recovery time is generally shorter compared to a full hemorrhoidectomy. Most patients can expect to return to normal activities within a few days, although some discomfort may persist. The pain from the incision may be significant initially, but it usually improves as the area heals.

Concerns About Hospitalization
It is not typically necessary to stay in the hospital for a simple incision and drainage of a thrombosed hemorrhoid, as this can often be done in a doctor's office or outpatient clinic. However, if you are experiencing severe pain or other complications, it is essential to communicate this with your healthcare provider. They can assess your condition and determine the best course of action.

When to Seek Further Help
If you find that your pain is worsening, or if you notice any signs of infection (such as increased redness, swelling, or discharge), it is crucial to seek medical attention promptly. Additionally, if you feel that your concerns are not being adequately addressed, seeking a second opinion from another colorectal specialist may provide you with more options and peace of mind.

In summary, while thrombosed hemorrhoids can be painful and distressing, there are effective treatment options available. It is essential to work closely with your healthcare provider to determine the best approach for your specific situation, balancing the need for relief with the potential for recovery.

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