The term “hemorrhoids” refers to normal clusters of highly vascular structures, blood vessels, muscle, and connective tissue that form that can be found in the anal canal of the lower pelvic region. In some individuals, these cushions can become swollen and painful. External hemorrhoids specifically are swollen veins that develop under the skin around the anus while internal hemorrhoids develop in the lower rectum. A thrombosed hemorrhoid occurs when a blood clot forms inside the hemorrhoidal vein, resulting in painful swelling of the tissues surrounding the anus. The pressure and inflammation from the process of clotting can cause severe pain and discomfort. Often, the process resolves in a few days. Sometimes, it can persist for a few weeks.
Symptoms of Thrombosed Hemorrhoids
Symptoms of thrombosed hemorrhoids include significant pain in the perineal area and the presence of a painful lump near the anus. Hemorrhoids are typically painless unless they are thrombosed, prolapsed, or strangulated. Pain while sitting, walking, or using the toilet can also indicate that a hemorrhoid has been thrombosed. In addition, itching around the anal area, bleeding when passing a stool, and any unusual growths around the anus should all be considered possible thrombosed hemorrhoids symptoms. If a thrombosed hemorrhoid becomes infected, an abscess may develop that can result in additional symptoms such as a fever, and redness around the anus. Infection of a thrombosed hemorrhoid is rare. However, perirectal abscesses which do not originate from hemorrhoids are often initially confused for thrombosed hemorrhoids due to their location and similar set of symptoms.
Diagnosis of Thrombosed Hemorrhoids
Diagnosis of thrombosed external hemorrhoids is generally more straightforward than diagnosing internal hemorrhoids because there is usually a visual component to the thrombosed hemorrhoid. The most acute symptom of a thrombosed hemorrhoid is sudden and intense pain around the anus, along with the detection of a painful lump or swelling of the surrounding perineal tissues. Additional information about the nature of the lump may be requested from the patient in order to pinpoint an exact diagnosis. If there is any indication of rectal bleeding, an anoscopy or colonoscopy may eventually be performed to rule out other diseases such as anal fissure, cancer, or inflammatory bowel disease (IBS). The American Society of Colon and Rectal Surgeons provides guidance on how to identify and treat benign disorders and cancers of the colon, rectum, and anus.
Causes of Thrombosed Hemorrhoids
Thrombosed hemorrhoids can be brought on by constipation, straining while passing stool, sitting on the toilet for prolonged periods of time, lifting heavy objects, obesity, and pregnancy. Any activity that weakens the connective tissue within the anal cushions, reduced blood flow to the pelvic region, and increases intra-abdominal pressure will increase one’s risk for thrombosed hemorrhoids. Those experiencing constipation or difficulty passing stool should be mindful of practicing good bowel habits to avoid developing hemorrhoids.
Treatment of Thrombosed Hemorrhoids
Typically, the body is able to reabsorb the blood clot that initially composed the thrombosed hemorrhoid without any intervention. In individuals with severe pain associated with thrombosed hemorrhoids, surgical excision of the blood clot is recommended within the first one to two days.
At RS Surgical, this process can be performed in an office procedure that typically takes between five and ten minutes to perform. With the aid of a local anesthetic, the hemorrhoids are treated with excision of the excess skin and the underlying hemorrhoid. This procedure takes into account the sensitive nature of the skin in this location of the body, with discomfort typically lasting only seconds. Pain control after excision is typically accomplished with over-the-counter pain relief medication such as Tylenol. Most patients are pain-free when leaving the office. Even when the local anesthetic wears off, their residual post-procedure discomfort is significantly less than the pain with which they arrived.
After the procedure, for 24-48 hours, topical pain relievers and warm water sitz baths may be used to counteract any discomfort. Often after the initial clot resolves, the perianal skin does not reduce back to its normal structure, but can instead leave perianal skin tags that can cause persistent itching or discomfort. After diagnosing and treating any external hemorrhoids, the medical staff at RS Surgical can remove these skin tags to alleviate any discomfort associated with external hemorrhoids and provide relevant medical advice to prevent the recurrence of hemorrhoids in the future.
It is important to note that surgical excision of a thrombosed hemorrhoid should always be performed by a trained medical professional due to the level of risk associated with this procedure. Risks to at-home excision of a hemorrhoid may result in incomplete removal of the blood clot, bleeding that cannot be controlled, and an infection of the skin and tissues surrounding the anus.
Any constipation or straining when using the bathroom can be alleviated by maintaining a diet that is high in fiber, staying hydrated, and adding a fiber supplement or stool softener as needed. Taking warm baths can also soothe any pain associated with hemorrhoids. With appropriate medical intervention and sustainable lifestyle changes, patients typically find that the pain and discomfort associated with hemorrhoids will subside and they can resume their normal lives.