Recurring Thrombosed Hemorrhoids: Expert Insights and Management

Inquiry Consultation

Dear Dr.
Chang,
A few months ago, I asked you about a thrombosed hemorrhoid located on the right side of my anus (approximately 0.5-1 cm).
The situation later changed as the thrombosed hemorrhoid ruptured and bled due to friction during bowel movements, which caused it to shrink and no longer affect my bowel movements, so I didn't pay much attention to it.
Recently, I have noticed a slight swelling and pain in the same area.
Upon examination with my finger, it seems that a thrombosed hemorrhoid has formed again in the same location.
However, this time it feels softer and less painful than before, and I find sitting or walking more comfortable than last time.
I have the following questions for you, Dr.
Chang:
Q1: Does this count as a recurrence? Since it is in a similar location.
Q2: Following up on the previous question, you mentioned that even if a thrombosed hemorrhoid absorbs or ruptures on its own, it may leave behind a small, painless lump.
Does this mean that once a thrombosed hemorrhoid has developed in that location, it may never completely disappear and could leave behind soft tissue (hemorrhoidal tissue) without a thrombosis? Additionally, if complete removal is desired, is surgery the only option?
Q3: For this recurrence, should I manage it in the same way as before? That is, applying medication, taking warm sitz baths, and waiting for it to absorb or rupture on its own? Or are there other management strategies or considerations I should be aware of?
Q4: The size of this recurrent thrombosed hemorrhoid is about 1 cm (slightly larger than the last one), but it does not significantly affect my bowel movements (I only feel a slight obstruction, but even if the stool is somewhat hard, it passes through smoothly).
I also feel that it might rupture and bleed at any moment due to friction from the stool.
If this hemorrhoid ruptures again, what materials would you recommend for absorbing the blood clot afterward? Last time, I used bathroom tissue to absorb the blood clot, but I wonder if there are more suitable materials for this purpose.
Thank you, Dr.
Chang.

Axiang, 40~49 year old female. Ask Date: 2022/10/08

Dr. Zhang Shuhao reply Surgery

1.
Recurrence.
2.
Thrombosed hemorrhoids can be absorbed, but the prolapsed soft tissue will not disappear.
It can be reduced with medication and sitz baths, but to completely remove it, surgical excision is the only option.
3.
The same conservative treatment can be used, such as applying medication and taking warm sitz baths, while waiting for it to absorb or rupture on its own.
It is advisable to increase fluid intake, maintain a light diet, and avoid alcohol.
If symptoms do not improve, medical attention should be sought.
4.
If there is a feeling that it may rupture and bleed at any moment, a doctor can be consulted to administer a local anesthetic and remove the blood clot.
If it ruptures on its own, it is best to use gauze to absorb the fluid; if gauze is not available, materials like cotton pads that do not shed are preferable.

Reply Date: 2022/10/08

More Info

Understanding recurring thrombosed hemorrhoids can be quite complex, especially when considering the nuances of symptoms, treatment options, and the potential for recurrence. Let's address your questions systematically.

Q1: Is this a recurrence?
Yes, it appears that you are experiencing a recurrence of a thrombosed hemorrhoid. Thrombosed hemorrhoids can recur in the same location, especially if there are ongoing factors such as straining during bowel movements, prolonged sitting, or other lifestyle factors that contribute to increased pressure in the anal region. The fact that you are feeling some discomfort and have noticed swelling in the same area suggests that this is indeed a new episode.

Q2: Will the area always have some residual tissue?
After a thrombosed hemorrhoid resolves, it is possible for residual tissue to remain. This can manifest as a soft, non-painful skin tag or excess tissue at the site of the previous thrombosis. While some individuals may experience complete resolution, others may have a small amount of tissue left behind. If this tissue is bothersome or if you are experiencing recurrent thrombosis, surgical options such as hemorrhoidectomy may be considered to remove the excess tissue.

Q3: Should I manage this recurrence the same way?
For managing this recurrence, you can indeed follow a similar approach as before, which includes topical treatments, warm sitz baths, and allowing the hemorrhoid to resolve on its own. Over-the-counter topical treatments containing hydrocortisone can help reduce inflammation and discomfort. Sitz baths can provide relief and promote healing. However, if the pain intensifies or if you notice significant bleeding, it would be prudent to consult with a healthcare provider for further evaluation.

Q4: What materials should I use to manage bleeding?
If the thrombosed hemorrhoid does rupture and you need to manage bleeding, using soft, absorbent materials is key. While toilet paper can be used, it may not be the most comfortable option. Instead, consider using sterile gauze pads or soft cloths that can absorb blood without irritating the area. You can also use a clean, soft towel or a specialized wound dressing to manage any bleeding. Ensure that you keep the area clean and dry to prevent infection.

Additional Considerations
It's important to address the underlying factors contributing to hemorrhoid formation. Dietary changes, such as increasing fiber intake and staying well-hydrated, can help prevent constipation and reduce straining during bowel movements. Regular exercise and avoiding prolonged sitting can also be beneficial.

If you find that your symptoms persist or worsen, or if you experience significant pain or bleeding, it is essential to seek medical advice. A healthcare provider can assess the situation and may recommend further treatments, including minimally invasive procedures or surgical options if necessary.

In summary, while it seems you are experiencing a recurrence of a thrombosed hemorrhoid, managing it with conservative measures is a reasonable approach. However, monitoring your symptoms and seeking medical advice if they worsen is crucial for your overall health and comfort.

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