05 Sep What’s the best way to treat a thrombosed hemorrhoid?
Do you think you have a thrombosed hemorrhoid? They are troubling, painful, and one of the more common conditions we see. I’ll now tell you about them.
There are two main types of hemorrhoids: Internal and external. Almost all thrombosed hemorrhoids are external hemorrhoids (I talk more about internal hemorrhoids in this post). Thrombosed external hemorrhoids typically are associated with a lump near the anus and acute onset of pain. They don’t usually cause one to have a fever (think abscess). Occasionally, there is bleeding associated with it, but most people don’t have any bleeding. So, it’s basically pain and a lump.
There are two different types of treatment pathways: Removal of the hemorrhoid or wait for it to go away.
Removal is most commonly done in the office under local anesthesia (lidocaine like your dentist uses). If it’s done within the first few days after onset, patients usually recover quicker than if it were left alone.
Thrombosed external hemorrhoids do occur during pregnancy. They can occur after lifting heavy objects. But, more often than anything, they just occur.
But the more common question I get is “If I do nothing, will it go away?” The answer is “Yes, almost always the hemorrhoid will go away.” It will take a few weeks, but the swelling from the hemorrhoid will resolve as your body works to dissolve and resorb the clot in the hemorrhoid.
The second most common question I get about thrombosed external hemorrhoids is “If I have it removed, does that mean it won’t come back?” Many patients have had this happen before (we don’t like to have frequent fliers in the office, but, after all, we’re here to help!). The answer to this question is a little controversial. Some believe that if the hemorrhoid is excised, it will be less likely to recur. Others don’t agree with this assessment.
My personal philosophy is that if it’s within the first few days, removal will help you get better quicker. After that, it’s a matter of pain. If you’re still having a lot of pain, excision of the hemorrhoid will help you get back to speed quicker. If it’s been a while and the pain has gone, but you still have a lump, many times I don’t recommend excision. Nature will take its course and the hemorrhoid will go away with time.
Remember this point: Bleeding should always be investigated.