Is It a Thrombosed Hemorrhoid? Symptoms and Treatment Options

Is it an external hemorrhoid with thrombosis?

1.
Current symptoms: For about 2 weeks, there is a sharp pain when pressed, but no pain if ignored.
I have been doing warm water sitz baths (using tap water) for two days.
The first week, the area felt soft when pressed, but in the second week, it feels firmer.

2.
Medical records: - In the second week, I visited Taipei Mackay Memorial Hospital, where the doctor informed me that I have hemorrhoids, but they are not severe.
I was advised to focus on diet, take medication, and apply ointment.
- That same week, feeling uneasy, I visited a clinic again, where the doctor advised me to continue warm water sitz baths and prescribed antibiotics and antibiotic ointment for external application.

3.
Wound images: [link to images]
4.
Inquiry: Dear Doctor, I usually work in an office setting and sit for long periods.
Since both doctors I consulted mentioned that it is likely hemorrhoids and advised continued observation, I would like to ask if this could be a thrombosed hemorrhoid, and whether its size requires surgical intervention or if it can be left to resolve on its own.
I have been quite anxious about this issue for the past two weeks and hope you can provide some clarity.
Thank you.

Mas, 20~29 year old female. Ask Date: 2024/02/05

Dr. Zhang Shuhao reply Surgery

1.
If two doctors have already diagnosed you with thrombosed hemorrhoids, you can follow their treatment recommendations, which may include warm sitz baths, oral anti-inflammatory and pain relief medications, using hemorrhoid ointments, and adjusting your diet and bowel habits.
Most symptoms can improve without the need for surgery.

2.
If there is no improvement or if you experience severe redness, swelling, heat, and pain, based on the location of the swelling shown in the images, it could potentially be an anal fistula.
However, it is unlikely that a general colorectal surgeon would overlook this diagnosis, so the probability is low.

Reply Date: 2024/02/05

More Info

When considering the symptoms and treatment options for a potential thrombosed hemorrhoid, it is essential to understand both the clinical presentation and the recommended management strategies. Based on your description, it seems you have been experiencing discomfort for about two weeks, with a sharp pain upon pressure but no pain when left alone. You have also been advised to engage in warm sitz baths and have been prescribed antibiotics and topical ointments.

Understanding Thrombosed Hemorrhoids
A thrombosed hemorrhoid occurs when a blood clot forms in the external hemorrhoid, leading to swelling and pain. Symptoms typically include:
1. Pain: This is often severe and can be exacerbated by sitting, bowel movements, or pressure.

2. Swelling: The area around the hemorrhoid may appear swollen and can feel firm to the touch.

3. Discoloration: The skin over the hemorrhoid may appear bluish or dark due to the clot.

4. Bleeding: While not always present, some individuals may notice blood during bowel movements.

Diagnosis and Treatment
Given that you have already consulted with healthcare professionals who have confirmed the presence of hemorrhoids but deemed them not severe, it is likely that your condition is manageable without surgical intervention. However, the ongoing discomfort and changes in the consistency of the area warrant further discussion.

1. Observation: Many thrombosed hemorrhoids can resolve on their own within a few weeks. The body can absorb the clot, and symptoms may gradually improve.

2. Conservative Management:
- Warm Sitz Baths: Continue with warm sitz baths, which can help alleviate discomfort and promote healing.

- Dietary Changes: Increasing fiber intake can help prevent constipation and reduce straining during bowel movements, which can exacerbate hemorrhoids.

- Topical Treatments: Over-the-counter creams or ointments containing hydrocortisone can reduce inflammation and itching.

- Pain Relief: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain.

3. When to Consider Surgery: Surgical intervention may be necessary if:
- The pain becomes unbearable.

- There is significant swelling that does not improve with conservative measures.

- There are complications such as persistent bleeding or infection.

Follow-Up and Monitoring
Since you have already seen two doctors who have provided similar advice, it is crucial to monitor your symptoms closely. If the pain worsens, or if you notice any signs of infection (such as increased redness, swelling, or discharge), you should seek further medical evaluation.

Emotional Well-Being
It is understandable to feel anxious about your condition, especially when it affects your daily life. Engaging in stress-reducing activities, such as light exercise (if comfortable), meditation, or talking to a friend or counselor, can help alleviate some of the worry associated with your symptoms.

Conclusion
In summary, while your symptoms suggest a thrombosed hemorrhoid, the conservative management approach you are currently following is appropriate. Continue with warm sitz baths, maintain a high-fiber diet, and monitor your symptoms. If there is no improvement or if symptoms worsen, do not hesitate to seek further medical advice. Remember, it is always better to err on the side of caution when it comes to your health.

Similar Q&A

Managing Thrombosed Hemorrhoids: Insights and Treatment Options

Hello, Dr. Ke. I apologize for having so many questions and would like to seek your professional opinion. Thank you! I have seen three doctors regarding my hemorrhoids. One said the issue was too minor and not worth his time, another said it was severe and I definitely needed sur...

Dr. Ke Fangxu reply Surgery
If thrombosed hemorrhoids do rupture on their own and there is no severe pain, then thrombectomy is not necessary. Application of topical ointments along with warm sitz baths is sufficient, and massage is not particularly helpful.

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 Post-Thrombosed Hemorrhoids: Causes and Treatment Options

Hello Dr. Ke, Previously, I had a thrombosed external hemorrhoid, which completely resolved after a month. However, over the past two weeks, I've noticed occasional swelling around the anal area, similar to what is shown in the image (https://upload.cc/i1/2020/09/29/JrkYU9...

Dr. Ke Fangxu reply Surgery
Based on the imaging, it appears to be a small thrombosed external hemorrhoid, which can be managed with topical ointments. If the recurrence rate is high, it is likely due to poor lifestyle habits and bowel habits. It is recommended to avoid constipation and shorten the time spe...

Understanding Thrombosed External Hemorrhoids: Healing and Concerns

Hello, doctor. I had an outpatient procedure for a thrombosed external hemorrhoid last week. I currently experience only occasional mild pain, but the original thrombosed external hemorrhoid feels hard to the touch. Is this a blood clot? Will it naturally resolve on its own if le...

Dr. Ke Fangxu reply Surgery
It is recommended that you take warm sitz baths regularly. Over-the-counter hemorrhoid ointments can also be applied. If the symptoms do not resolve after two weeks, you should consult a physician for further evaluation.