Thrombosed External Hemorrhoids: When to Consider Surgery

Thrombosed external hemorrhoid

Hello doctor, I felt uncomfortable while using the restroom a week ago and discovered a thrombosed external hemorrhoid.
Currently, there is no bleeding and it doesn't hurt much, but it hasn't gone down.
Do I need to consider aggressive surgery for this? The hemorrhoid is somewhat large, but it doesn't significantly affect my daily life.
Thank you.

ping, 20~29 year old female. Ask Date: 2022/09/22

Dr. Ke Fangxu reply Surgery

If thrombosed external hemorrhoids are not accompanied by severe pain, it is advisable to patiently wait for the thrombus to be reabsorbed, which typically takes 2 to 4 weeks.
If there is swelling or discomfort, over-the-counter hemorrhoid creams can be applied to alleviate symptoms.
Additionally, frequent sitz baths can help reduce swelling.
Currently, there is no need for aggressive surgical intervention.

Reply Date: 2022/09/22

More Info

When it comes to thrombosed external hemorrhoids, the decision to consider surgery often depends on several factors, including the severity of symptoms, the size of the hemorrhoid, and the impact on the patient's quality of life.
Thrombosed external hemorrhoids occur when a blood clot forms in the external hemorrhoidal tissue, leading to swelling and discomfort. Patients may experience a sudden onset of pain, swelling, and sometimes a visible lump around the anal area. In your case, it seems that while you have identified a thrombosed external hemorrhoid, you are not experiencing significant pain or bleeding, and it is not severely affecting your daily activities.

In general, if the thrombosed hemorrhoid is causing significant pain or discomfort, surgical intervention may be warranted. The most common surgical procedure for thrombosed external hemorrhoids is a simple incision and drainage, which can provide immediate relief from pain and pressure. This procedure is typically performed under local anesthesia and can be done in an outpatient setting.

However, if the hemorrhoid is not causing severe symptoms, as you described, many healthcare providers may recommend a conservative approach. This can include measures such as:
1. Warm Sitz Baths: Soaking in warm water can help alleviate discomfort and promote healing.

2. Over-the-Counter Pain Relief: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain and inflammation.

3. Topical Treatments: Creams or ointments specifically designed for hemorrhoids can provide relief from itching and discomfort.

4. Dietary Changes: Increasing fiber intake and ensuring adequate hydration can help prevent constipation, which can exacerbate hemorrhoid symptoms.

It's also important to monitor the hemorrhoid for any changes. If you notice increased pain, bleeding, or if the hemorrhoid does not improve over time, it would be advisable to consult a healthcare provider for further evaluation.
In summary, if your thrombosed external hemorrhoid is not causing significant pain or affecting your quality of life, surgery may not be necessary at this time. However, if symptoms worsen or if you have concerns about the size or persistence of the hemorrhoid, seeking medical advice would be prudent. Always remember that individual cases can vary, and a healthcare provider can offer personalized recommendations based on your specific situation.

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