Managing Thrombosed External Hemorrhoids: Causes and Treatment Options - Surgery

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Managing thrombosed external hemorrhoids can be quite challenging, especially when they recur. Hemorrhoids, particularly external ones, can become thrombosed when blood pools in the veins around the anus, leading to the formation of a clot. This can cause significant pain, swelling, and sometimes bleeding.

Causes of Thrombosed External Hemorrhoids
Several factors can contribute to the development of thrombosed external hemorrhoids:
1. Increased Pressure: Activities that increase pressure in the rectal area, such as straining during bowel movements, prolonged sitting, or heavy lifting, can lead to the formation of hemorrhoids.

2. Chronic Constipation or Diarrhea: Both conditions can cause straining, which may exacerbate hemorrhoid formation.

3. Pregnancy: The increased pressure from the growing uterus and hormonal changes can lead to the development of hemorrhoids.

4. Obesity: Excess weight can put additional pressure on the pelvic veins, contributing to hemorrhoid formation.

5. Sedentary Lifestyle: Lack of physical activity can lead to poor circulation and increased pressure in the rectal area.


Treatment Options
For thrombosed external hemorrhoids, treatment options vary based on the severity of symptoms:
1. Conservative Management: This includes warm sitz baths, topical treatments (such as hydrocortisone creams), and oral pain relievers (like acetaminophen or ibuprofen). These measures can help alleviate pain and reduce inflammation.

2. Medications: As prescribed by your physician, oral medications and topical ointments can help manage symptoms. It's essential to follow the doctor's instructions regarding dosages and application.

3. Surgical Intervention: If the thrombosed hemorrhoid is particularly painful or recurrent, surgical options may be considered. This could involve a procedure to remove the thrombosed hemorrhoid (excisional hemorrhoidectomy) or a less invasive procedure to drain the clot.

4. Preventive Measures: To prevent the recurrence of thrombosed hemorrhoids, consider the following:
- Dietary Changes: Increase fiber intake to promote regular bowel movements and reduce straining. Foods rich in fiber include fruits, vegetables, whole grains, and legumes.

- Hydration: Drink plenty of fluids to help soften stools.

- Regular Exercise: Engage in regular physical activity to improve circulation and reduce pressure on the pelvic veins.

- Avoid Prolonged Sitting: Take breaks to stand or walk around if you sit for long periods.


Addressing Your Concerns
Regarding your specific symptoms, the pain during bowel movements and the sensation of tightness around the anus could be due to inflammation or irritation of the hemorrhoid. If the thrombosed hemorrhoid is not resolving with conservative measures, it may be worth discussing with your doctor the possibility of a minor surgical procedure to alleviate the pain and prevent further complications.

Attempting to manually push the hemorrhoids back can cause more pain and may not be effective, especially if they are thrombosed. It is generally not advisable to force them back into place. Instead, focus on managing symptoms and preventing further irritation.


Conclusion
If your symptoms persist or worsen, it is crucial to follow up with your healthcare provider. They can assess your condition and determine if further intervention is necessary. Surgical options may be considered if conservative treatments fail, especially if you experience recurrent thrombosis or significant bleeding. Always communicate openly with your healthcare provider about your symptoms and concerns to ensure you receive the most appropriate care.