Thrombosed External Hemorrhoids: Symptoms and Treatment Options

The issue of thrombosed external hemorrhoids?

Hello Doctor, four days ago on my way home from work, I felt pain in my anal area.
When I got home and looked in the mirror, I noticed a small lump (about 0.5 cm in diameter).
That night and the next day, I experienced significant pain, even when coughing.
After another day or two, the pain has decreased by about 70-80%, but the lump has not shrunk.
Today, I visited a surgeon who diagnosed it as a thrombosed external hemorrhoid.
The doctor mentioned that the treatment options include leaving it alone to see if it shrinks on its own, which may take a long time, or opting for a minimally invasive surgical procedure (which takes about 10-20 minutes).
It seems the doctor is suggesting surgery, but I am really afraid of the pain.
I searched online and found many people recommending warm saltwater sitz baths; I wonder if this is truly effective? The doctor also prescribed a topical ointment for hemorrhoids but said I don't need to apply it if I'm not experiencing discomfort.
If I want the thrombosed external hemorrhoid to resolve on its own, should I be doing sitz baths daily and applying the ointment? I would appreciate your advice.
Thank you very much.
🙏

Xiao Bao, 40~49 year old female. Ask Date: 2022/10/14

Dr. Ke Fangxu reply Surgery

Thrombotic external hemorrhoids do not necessarily require treatment if there is no pain or discomfort.
The time for spontaneous absorption varies depending on the size of the thrombus, typically ranging from 2 to 8 weeks.
Warm sitz baths can be done, but there is no need to add salt.
In an outpatient setting, thrombectomy can be performed under local anesthesia, which is a quicker option.
Both approaches have their own advantages and disadvantages, so you can make a decision based on your personal preferences.

Reply Date: 2022/10/14

More Info

Thrombosed external hemorrhoids can be quite uncomfortable and distressing, as you've experienced. It's important to understand the nature of this condition, the symptoms associated with it, and the various treatment options available.

Understanding Thrombosed External Hemorrhoids
A thrombosed external hemorrhoid occurs when a blood clot forms in the external hemorrhoidal tissue, leading to swelling, pain, and sometimes a visible lump near the anal opening. The symptoms you described, including pain that worsens with activities like coughing, are common. The lump you noticed is likely the thrombosed hemorrhoid, which can be quite painful, especially during the initial days following its formation.

Symptoms
The primary symptoms of a thrombosed external hemorrhoid include:
- A painful lump near the anus
- Swelling and inflammation in the area
- Discomfort during bowel movements
- Pain that may worsen with sitting or certain movements
In your case, the pain has significantly decreased after a few days, which is a positive sign. However, the lump may remain for some time, as it can take weeks to months for the body to reabsorb the clot and for the hemorrhoid to shrink.

Treatment Options
1. Conservative Management:
- Observation: If the pain has decreased and you are not experiencing significant discomfort, your doctor may recommend a wait-and-see approach. Many thrombosed hemorrhoids resolve on their own over time.

- Sitz Baths: Soaking in warm water (sitz baths) can help relieve discomfort and promote healing. Adding salt to the water can provide additional soothing effects, but it's not strictly necessary. Aim for 15-20 minutes, several times a day, especially after bowel movements.

- Topical Treatments: The ointment your doctor prescribed can help alleviate discomfort. If you are not experiencing any pain, you may not need to apply it regularly. However, if you feel any discomfort, applying it as directed can be beneficial.

2. Surgical Intervention:
- If the thrombosed hemorrhoid is particularly painful or does not improve over time, your doctor may suggest a minor surgical procedure to remove the clot. This procedure is typically quick (10-20 minutes) and can provide immediate relief. While the idea of surgery may be daunting, many patients find that the benefits outweigh the temporary discomfort of the procedure.

Recommendations
- Daily Care: Continue with sitz baths and consider using the topical ointment if you experience discomfort. Keeping the area clean and dry is essential for healing.

- Dietary Adjustments: Ensure you are consuming a high-fiber diet to prevent constipation, which can exacerbate hemorrhoid symptoms. Staying hydrated is also crucial.

- Follow-Up: If the lump does not decrease in size or if you experience a return of pain, it would be wise to follow up with your healthcare provider for further evaluation.

Conclusion
Thrombosed external hemorrhoids can be managed effectively with conservative measures, and many patients find relief without the need for surgery. However, if the pain persists or worsens, surgical options are available and can provide quick relief. Always communicate openly with your healthcare provider about your symptoms and concerns, as they can guide you toward the best treatment plan tailored to your needs.

Similar Q&A

Managing Thrombosed External Hemorrhoids: Causes and Treatment Options

Hello, doctor. I previously inquired about hemorrhoids in April and May, and I appreciate your responses. I followed your advice, but recently the hemorrhoids have started to hurt again, and occasionally there is bleeding. After seeing a colorectal surgeon, I was diagnosed with t...

Dr. Ke Fangxu reply Surgery
If the symptoms you described are present, it could potentially be an anal fissure. However, a doctor's examination is necessary to confirm the diagnosis. If there is a prolapsed hemorrhoid, forcing it back in is not a long-term solution. As your doctor mentioned, if the sym...

Understanding Thrombosed External Hemorrhoids: Symptoms and Complications

A few days ago, after having a bowel movement, I did not experience constipation, but in the evening, I started to feel some discomfort in my anus. The next day, I had a persistent tight pain in the anal area, which was noticeably painful when walking, sitting, or standing. After...

Dr. Ke Fangxu reply Surgery
Thrombotic external hemorrhoids and anal abscesses are two different conditions. If there is no pain after medication, it is not a concern. Thrombotic external hemorrhoids typically take 2 to 4 weeks to fully resolve if not surgically excised. As long as there is no pain or disco...

Post-Surgery Care and Pain Management for Thrombosed External Hemorrhoids

Hello Doctor, I underwent an outpatient procedure for a thrombosed external hemorrhoid yesterday (approximately the size of an almond, and the surgery was performed when there was no pain). After the blood clot was removed, the doctor also performed a procedure to ligate the exce...

Dr. Ke Fangxu reply Surgery
Thrombosed external hemorrhoids can be effectively relieved through thrombectomy, which alleviates symptoms and accelerates recovery. However, ligation of external hemorrhoidal tags tends to be more uncomfortable, and it is less commonly performed by specialists due to the signif...

Understanding Thrombosed External Hemorrhoids: Symptoms and Treatment Options

Hello Doctor, four days ago on my way home from work, I felt pain in my anal area. When I got home and looked in the mirror, I discovered a small lump (about 0.5 cm in diameter). That night and the next day, I experienced significant pain, even when coughing. After another day or...

Dr. Ke Fangxu reply Surgery
Thrombotic external hemorrhoids do not necessarily require treatment if there is no pain or discomfort. The time for spontaneous absorption varies depending on the size of the thrombus, typically ranging from 2 to 8 weeks. Warm sitz baths can be beneficial, but there is no need t...