How to Treat Thrombosed Hemorrhoids for Good

Medically reviewed by: Eiman Firoozmand, MD
Last modified on January 4th, 2024

There are many complications of a hemorrhoid. However, a thrombosed hemorrhoid is one of the most painful. A thrombosed hemorrhoid occurs when an external hemorrhoid forms a blood clot. This blood clot can cause severe pain, inflammation, and swelling. That’s why today we wrote about how to treat thrombosed hemorrhoids and get rid of them!

If you have hemorrhoids and now have a severe bout of pain, you may have developed thrombosed hemorrhoids.

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Read ahead to learn why they occur, how they’re treated, and what happens if you leave them untreated.

What are thrombosed hemorrhoids?

Also known as thrombosed external hemorrhoids, these are swollen blood vessels in the anus and rectum that have now developed a blood clot.

If you’re unsure about what external hemorrhoids mean, they’re lumps of veins that can be felt just outside of your anus. In these instances, hemorrhoid bleeding can occur, particularly after a bowel movement, along with swelling. On the other hand, internal hemorrhoids are found inside the rectum.

Thrombosed hemorrhoids usually develop in patients with external hemorrhoids. They may also develop in those with internal hemorrhoids. However, since internal hemorrhoids are usually painless, people don’t usually notice when they develop a blood clot.

Why do thrombosed hemorrhoids occur?

The two known risk factors for thrombosed hemorrhoids are a recent bout of constipation and traumatic vaginal delivery.  Most usually, thrombosis occurs for unknown reasons.

Unfortunately, this is a poorly studied area so there is not a lot of information on why thrombosed hemorrhoids form. However, we do know that the act of straining during a bowel movement can put a lot of pressure on the veins in your anus and rectum. This extra pressure can cause blood to become trapped inside your hemorrhoid.

Since pooled blood has a natural tendency to clot, the more of it is there inside a hemorrhoid, the higher the risk of developing a thrombosed hemorrhoid.

In addition, anything that increases your risk of developing external hemorrhoids also increases your risk of getting thrombosed hemorrhoids. This can include:

  • Pregnancy
  • Being overweight or obese
  • Sitting for long periods of time on the toilet
  • Straining during a bowel movement
  • Chronic constipation or diarrhea
  • Anal intercourse

How do you know if you have thrombosed external hemorrhoids?

The most common symptom of thrombosed hemorrhoids is the abrupt onset of severe pain (in a person who already has external hemorrhoids). 

You may feel a sharp pain when you sit down, stand up, or move your bowels. The pain is caused by the blood clot that’s now strangulating (or constricting) the hemorrhoid. Fortunately, the pain resolves on its own after between 2 and 10 days as the body breaks down the clot.

A thrombosed external hemorrhoid may also ulcerate (or break open). This can cause bleeding, which can aggravate the pain. You may notice blood on your toilet paper when you wipe, or you may actually see blood in the toilet bowl.

In addition, if you inspect your anus with a mirror, you may be able to see the blood clot. The clot will look like a small, purple, or blue lump. The surrounding tissue may also be swollen and tender.

What conditions can mimic a thrombosed external hemorrhoid?

Conditions that can look like thrombosed external hemorrhoids include an intersphincteric abscess and anal fissures.

An intersphincteric abscess is a type of anal infection that forms between the inner and outer sphincter muscles.

This type of abscess is usually caused by an infection, inflammation, or blockage of the anal glands. Symptoms include pain, rectal bleeding, and discharge.

Unlike hemorrhoids, the treatment of an abscess typically involves draining it and may also require antibiotics or surgery.

On the other hand, an anal fissure refers to a break in the lining of the anal canal. Both an abscess and fissure cause severe anal pain, mimicking thrombosed external hemorrhoids. But neither of the two presents with an acute swelling visible around the anal area. 

How do doctors diagnose external thrombosed hemorrhoids?

Your doctor may be able to see if you have external thrombosed hemorrhoids simply by looking. They may also do a physical exam to check for other causes of your bleeding or irritation.

Luckily, you won’t have to undergo any special tests for external thrombosed hemorrhoids. 

In some cases, your doctor may order a sigmoidoscopy or colonoscopy to rule out other causes of your symptoms, like colorectal cancer. However, it’s very rare for doctors to perform additional testing for making the diagnosis of an external thrombosed hemorrhoid.

How are external thrombosed hemorrhoids treated?

External thrombosed hemorrhoids can be treated both by excision and non-surgical options, such as painkillers, anti-inflammatory creams, and stool softeners.

Your doctor will decide the most suitable treatment for you depending on the severity of your symptoms and how quickly you’ve presented to them.

Surgical excision

If you see a doctor within 3-4 days of your symptoms and have severe pain, they might recommend an incision of the hemorrhoid. This is where they make a small cut in the tissue around your hemorrhoid and drain the clot.

Research suggests that compared to non-surgical options, surgical treatment for thrombosed external hemorrhoids results in:

  • Faster pain relief
  • Lower chance of recurrence
  • Longer periods of remission, which means your symptoms come back less often

The surgeon may recommend an excision, where the hemorrhoid is removed in the operating room.  The advantage of this is that it usually will not recur and may offer immediate pain.

However, there are certain conditions where excision of a thrombosed external hemorrhoid cannot be performed. For example, if someone has coagulopathy (a condition that interferes with the blood’s ability to clot), they will be unable to have an excision.

Similarly, patients with severe systemic illness, such as Crohn’s disease, concurrent anorectal disease, such as anal fissures or abscesses, and hemodynamic instability (low blood pressure) will be unable to undergo excision.

All of these patients need more careful and comprehensive surgical care than what’s available at a doctor’s office.

Medical (non-surgical) treatment

If you see a doctor 3-4 days after your symptoms began — or if your pain is not too severe — they might prescribe you non-surgical treatment for your thrombosed external hemorrhoids.

This can include:

  • Treatments aimed at reducing pain, such as warm sitz baths, antispasmodic drugs like nitroglycerine, and analgesic creams like lidocaine.
  • Topical hydrocortisone cream, which helps reduce inflammation and pain.
  • Treatments aimed at improving the passage of stools, such as stool softeners, increased fluid intake, and fiber. All of these will make bowel movements easier and less painful for you.

These treatments don’t really do anything for the thrombosed hemorrhoid. They just help you manage your symptoms until the clot dissolves on its own. In most cases, the clot will go away within a week or two.

What happens before and after surgery for thrombosed external hemorrhoids?

Before a doctor takes out your thrombosed hemorrhoid, they will explain the risks and benefits of the surgery. The surgery is usually done as an outpatient procedure, which means you can go home the same day. 

After the surgery, the doctor will let you know what you need to do for homecare after thrombosed hemorrhoid removal and when you need to return for follow-up. 

At the return office visit, the doctor will re-examine your anal area and treat you according to their findings.

External thrombosed hemorrhoids simplified

External thrombosed hemorrhoids are an extremely painful but self-resolving complication of external hemorrhoids. 

The best thing to do if you get one is to see a doctor as soon as possible. The sooner you see a doctor, the more likely it is that you will begin to get relief from the condition.

If you have any questions regarding your hemorrhoids, feel free to give us a call. We will be happy to answer your queries.

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