Thrombosed External Hemorrhoids: An Overview

Definition

A thrombosed external hemorrhoid is an external hemorrhoid that develops a blood clot. Due to the blood clot, the hemorrhoid will appear bruised and dark in color. This type of hemorrhoid can bring on sudden extreme pain.

Causes

Due to a lack of studies on this potential complication, not as much is known about the potential risk factors, but two factors that are thought to contribute to this problem are recent constipation and traumatic vaginal birth.

Treatment

Non-surgical options include:

  • Increased fiber and fluid intake
  • Warm baths
  • Pain relievers (over the counter and prescription)

However if there is acute pain within 2 to 3 days of onset, then surgical removal (excision) may be the best course of action. Studies comparing incision to other hemroid treatment options favor incision, with patients who undergo incision having lower recurrence, faster symptom recovery, less symptoms, and fewer residual skin tags after one year of treatment.

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Excision May Not Be Appropriate In These Cases:

  • Patient has known coagulopathy (blood clotting problems)
  • Patient has known hemodynamic instability (circulation problems)
  • Allergy to anesthesia
  • Anal fissures or infections
  • If the thrombosed external hemorrhoid is associated with a grade IV internal hemroid
  • If there is the possibility that symptoms may be due to another cause such as a painless rectal mass
  • Possible systemic illnesses that could increase risk factors
    Inflammatory bowel disease
  • Hypertension
  • Complications

Common Complications

  • Bleeding – The most common complication usually managed with applied pressure. In some cases cauterizing or stitches may be needed.
  • Pain During the Excision – Managed by performing the procedure with a local anesthesia and sometimes even sedation.
  • Skin tags – A common, but benign complication.

Uncommon Complications

  • Infection – Infection only occurs in less than 5% of patients and the risk is minimized with antibiotics.
  • Incontinence – As long as the underlying muscles aren’t damaged during the procedure, the risk of incontinence is very low.
  • Narrowing of the anal canal (stricture) – This risk is also minimized by making sure the underlying anal muscles aren’t damaged during the procedure.

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