Thrombosed Hemorrhoid Symptoms and Treatment

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Thrombosed hemorrhoids are hemorrhoids that have no blood flow due to blood clots. They're most often external but can be internal, as well. Thrombosed hemorrhoids are not considered to be dangerous, yet they can be quite painful.

Thrombosed hemorrhoids are also known as:

  • Acute hemorrhoidal disease
  • Perianal thrombosis, which is becoming more common because the tissue involved may not necessarily be that of a hemorrhoid

Thrombosed hemorrhoids may present as a single lump or a circle of lumps. In most cases, the blood clot is eventually reabsorbed by the body and the symptoms resolve themselves.

If symptoms don't resolve, or if you have symptoms that need to be managed, multiple treatment options are available to you, ranging from topical creams to surgery.

Hemorrhoid Basics

Hemorrhoids form when the blood vessels that line your anal canal become inflamed or dilated. Most of them are painless, but they can cause pain in certain circumstances, including when they're thrombosed.

Anything that causes increased pressure on the veins in your rectum can lead to a regular hemorrhoid, and once you have one, it's possible for it to become thrombosed. Doctors don't know why some people develop blood clots in their hemorrhoids and others don't.

Some possible triggers of hemorrhoids include:

  • Pregnancy, from pressure caused by the baby
  • Childbirth, due to pushing during delivery
  • Physical exertion, especially repeated heavy lifting
  • Prolonged sitting, such as on a long trip
  • Straining on the toilet, such as when you're constipated or trying to pass a hard stool
  • Inadequate fiber in the diet, which leads to hard stools and constipation
  • Diarrhea
  • Obesity
  • Anal intercourse
  • Not using the toilet regularly

Symptoms

A thrombosed hemorrhoid is usually visible as a small lump on the exterior of your anus. They're a dark bluish color due to the clot inside the blood vessel. A normal hemorrhoid, if it's visible on the exterior, will look like a rubbery lump and won't have the dark blue coloration.

Symptoms of thrombosed hemorrhoids include:

  • Pain when sitting, walking, or defecating
  • Bleeding when defecating
  • Itching around the anus
  • Swelling or lumps around the anus

Pain tends to be worst during the first 24-48 hours, after which it generally begins to taper off.

If you have a fever with a thrombosed hemorrhoid, it may be that the hemorrhoid has become infected and led to a perianal abscess. Look for a boil-like lump that may be red and feel warm. You should seek medical treatment if you suspect a perianal abscess as it should be drained quickly to avoid complications.

Never take rectal bleeding for granted or assume that it's due to a hemorrhoid. It could be a sign of a serious health problem, including anal cancer or colorectal cancer. Be sure to see your doctor if you have rectal bleeding.

The pain will be at its worst for the first 24 to 48 hours. After that time, the blood clot will be slowly reabsorbed and the pain will reduce.

Treatment

If over-the-counter topical hemorrhoid medications don't relieve your pain, it's a sign of a thrombosed hemorrhoid. That's because the pain is the result of pressure and swelling within the tissue, not on the surface.

Most thrombosed hemorrhoids will resolve on their own, although it may take two to three weeks for them to be completely gone. Self-care measures for a thrombosed hemorrhoid include:

  • Taking sitz baths (a shallow, warm bath to clean the area around the anus) or just a warm bath
  • Keeping your stool soft, such as by drinking plenty of fluids and eating a high-fiber diet
  • Avoiding straining during bowel movements and instead lean forward, relax, and breathe slowly, allowing the stool to come out in its own time

If those treatments aren't enough to control your symptoms, your doctor may prescribe some topical treatments. Lidocaine ointment has traditionally been a common option, but newer drugs such as topical nifedipine are showing promise as more effective treatments. However, these medications haven't been shown to speed up the resolution of symptoms or lessen the frequency of recurrence.

Surgery

When other treatments are inadequate or ineffective, your doctor may suggest a surgical procedure to remove the blood clot. This is especially likely if you have a lot of bleeding and pain.

Surgical excision can usually be done in a doctor's office. It's considered safe, has low complication rates, and can help keep the thrombosed hemorrhoid from coming back. Patient satisfaction rates tend to be high.

A Word From Verywell

The good news about a thrombosed hemorrhoid is that it will most likely start getting better after a couple of days and resolve on its own. If it doesn't seem to be resolving, your doctor should be able to help you find the right treatment so you can get rid of the discomfort and get back to your life.

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