Acute Thrombosed Hemorrhoids: Symptoms, Treatment, and Recovery

Acute thrombosed hemorrhoids

Hello, Dr.
Ke.
Thank you for taking the time to answer questions regarding thrombosed hemorrhoids.

1.
In the case of acute thrombosed hemorrhoids, prior to the onset of the condition, using an anoscope to dilate the anus would not reveal any significant abnormalities, as the tissue appears normal.
However, once a thrombosis occurs, the affected area will swell due to the clot, which can be described as a hemorrhoid that has "suddenly" enlarged.
2.
After the thrombosis resolves, if an anoscope is used to dilate the anus, can the previously affected area be distinguished from normal tissue?
3.
Is it possible for a thrombosis to also occur in internal hemorrhoids?
4.
I have a specific area where thrombosed hemorrhoids sometimes occur, and I plan to undergo surgery this year to remove it along with other internal hemorrhoids (Grade III).
Should I wait until a thrombosis occurs before having the surgery, or will it be difficult for the surgeon to identify the area during the procedure otherwise?
5.
Even if the surgery goes smoothly and the hemorrhoids are completely excised, there remains a certain probability that during the postoperative recovery period, issues such as constipation or diarrhea can lead to increased anal pressure, resulting in the development of thrombosed hemorrhoids.
This may leave the patient wondering why they still have hemorrhoids after surgery, raising concerns about the success of the procedure.

Mr. Chen, 30~39 year old female. Ask Date: 2020/06/19

Dr. Ke Fangxu reply Surgery

1.
Most patients experience this, but some can push back the prolapsed tissue during normal times, while during an acute episode, they are unable to do so.

2.
Smaller blood clots may not completely disappear, while larger ones may leave residual tissue after absorption.

3.
Yes, there are also thrombotic internal hemorrhoids.

4.
When surgery is not required, both internal and external hemorrhoids are removed together.

5.
About 50 years ago, the surgical approach involved completely excising the hemorrhoidal tissue to ensure no recurrence; however, it was later found that these patients experienced incontinence and rectal prolapse.
Therefore, the current practice is to only remove the swollen portions while leaving a small amount of hemorrhoidal tissue to maintain anal sphincter function.
The key point is that after surgery, it is essential to maintain good bowel habits to prevent hemorrhoids from recurring in a short period.

Reply Date: 2020/06/19

More Info

Acute thrombosed hemorrhoids can be a painful and distressing condition, and understanding the symptoms, treatment options, and recovery process is essential for effective management. Let's break down your questions and concerns regarding this condition.

1. Symptoms and Diagnosis: Acute thrombosed hemorrhoids typically present with sudden onset pain, swelling, and a palpable lump around the anal area. The lump is often firm and can be quite tender to the touch. Before the thrombosis occurs, a digital examination or an anoscopy may not reveal any abnormalities, as the hemorrhoids may not be engorged or inflamed. However, once a thrombosis occurs, the affected hemorrhoid can become significantly enlarged and painful, leading to the characteristic "sudden growth" you described.

2. Post-Thrombosis Examination: After the thrombosis resolves, the appearance of the affected area may change. While the acute symptoms may subside, there can be residual changes in the tissue. When examined with an anoscope, the previously affected area may show signs of scarring or changes in color, which could indicate prior thrombosis. However, the extent of these changes can vary from person to person.

3. Internal vs. External Hemorrhoids: Thrombosed hemorrhoids can occur in both internal and external hemorrhoids. Internal hemorrhoids are located above the dentate line and are typically not painful unless they prolapse. External hemorrhoids, on the other hand, are located below the dentate line and can become thrombosed, causing significant pain and swelling. It is important to differentiate between the two types, as treatment approaches may vary.

4. Surgical Considerations: If you are considering surgical intervention for your hemorrhoids, it is generally advisable to schedule the procedure when you are not experiencing an acute thrombosis. Operating on an active thrombosed hemorrhoid can be challenging due to the swelling and pain, and it may complicate the surgical procedure. Your surgeon will be better able to assess and remove the hemorrhoids when they are not acutely inflamed.

5. Post-Surgical Complications: After hemorrhoid surgery, it is indeed possible to experience complications such as the recurrence of thrombosed hemorrhoids. Factors contributing to this can include constipation, straining during bowel movements, or diarrhea. To minimize the risk of complications, it is crucial to follow post-operative care instructions, which may include dietary modifications to ensure soft stools, adequate hydration, and possibly the use of stool softeners. Engaging in gentle physical activity can also promote regular bowel movements and reduce the risk of complications.

In summary, acute thrombosed hemorrhoids can be effectively managed with appropriate medical and surgical interventions. If you are experiencing recurrent episodes, it is essential to discuss your symptoms and treatment options with a healthcare provider. They can help you determine the best course of action based on your specific situation, including whether surgery is warranted and how to prevent future occurrences. Remember, maintaining a healthy diet, staying hydrated, and practicing good bowel habits are key components in managing hemorrhoids and preventing complications.

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