and Managing Thrombosed External Hemorrhoids: What to Do Next?

Thrombotic external hemorrhoid

On March 1st, I visited a clinic due to anal pain, and the doctor diagnosed me with thrombosed external hemorrhoids.
An outpatient procedure was performed to evacuate the thrombus, and I was prescribed a topical ointment.
However, on March 3rd, I started experiencing pain again and noticed swelling, although it wasn't as large as before.
Why did it swell again after the thrombus was evacuated? Was it not completely drained? Will applying the ointment alone help it resolve, or do I need to return to the clinic for another thrombus evacuation? Or should I consider surgery to remove it?

Xiao Ning, 40~49 year old female. Ask Date: 2024/03/04

Dr. Zhang Shuhao reply Surgery

After squeezing, if swelling occurs again, it may be due to the swelling of the hemorrhoids themselves, not necessarily caused by a thrombosis.
It is advisable to take warm sitz baths, along with the use of ointments and anti-inflammatory pain relievers, which can help alleviate the symptoms.
Whether surgery is needed depends on the frequency of episodes and the severity of symptoms affecting quality of life; if there is an impact, then surgery should be considered.

Reply Date: 2024/03/04

More Info

Thrombosed external hemorrhoids can be quite painful and distressing, and it’s understandable to have concerns after experiencing a recurrence of symptoms following treatment. Let's break down your situation and discuss the next steps you can take.

When you initially visited the clinic and underwent a procedure to remove the thrombosed blood clot, the goal was to alleviate the pain and swelling associated with the hemorrhoid. However, it’s not uncommon for patients to experience some residual swelling or discomfort even after the clot has been removed. This can happen for several reasons:
1. Incomplete Removal: In some cases, if the thrombosis was extensive, there might still be some residual clot or tissue that was not fully addressed during the initial procedure. This could lead to continued swelling and discomfort.

2. Inflammation: After the procedure, the area can remain inflamed for a period of time. This inflammation can cause pain and swelling, even if the clot itself has been removed.
3. New Thrombosis: It’s also possible that a new thrombosis could occur, especially if there are underlying factors such as straining during bowel movements, prolonged sitting, or other lifestyle factors that contribute to hemorrhoid formation.

Now, regarding your questions about treatment options:
- Topical Treatments: While applying ointments or creams can help soothe the area and reduce inflammation, they may not be sufficient if there is still a significant amount of swelling or if a new thrombosis has formed. These treatments can provide symptomatic relief but are unlikely to resolve the underlying issue if there is still a thrombosed hemorrhoid present.

- Follow-Up Appointment: Given that you are still experiencing pain and swelling, it would be advisable to return to your healthcare provider for a follow-up appointment. They can assess the area to determine if there is still a thrombosis present or if the swelling is due to inflammation. If there is still a significant clot, they may recommend another procedure to remove it.

- Surgical Options: If the thrombosed hemorrhoid is persistent and causing significant discomfort, surgical removal may be considered. This is typically a more definitive solution, especially if conservative measures have not provided relief.

- Lifestyle Modifications: In addition to seeking medical treatment, consider making some lifestyle changes to help manage and prevent future occurrences. This includes increasing fiber intake to soften stools, staying hydrated, avoiding prolonged sitting, and practicing good bowel habits to minimize straining.

In summary, it’s important to follow up with your healthcare provider to evaluate the current state of your hemorrhoids. They can provide a thorough examination and recommend the best course of action based on your specific situation. Remember that while topical treatments can help, they may not be enough if there is still a significant issue present. Taking proactive steps now can help prevent further complications and improve your comfort.

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