This information is approved and/or reviewed by U-M Health System providers but it is not a tool for self-diagnosis or a substitute for medical treatment. You should speak to your physician or make an appointment to be seen if you have questions or concerns about this information or your medical condition.
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Thrombosed External Hemorrhoids

Definition:

A thrombosed external hemorrhoid is a painful swelling in the anal tissues that result from formation of a clot (or “thrombus”) in one or more of the small veins in this area. This is sometimes caused by prolonged sitting or constipation. The swollen tissues often have a characteristic bluish color, because of the underlying clot. Although very painful, the condition is not serious and resolves without specific treatment over days to a week or two. At times, if the thrombosed hemorrhoid is very large, your doctor may remove some of the clot under local anesthesia. This is called ‘incision and drainage’ of thrombosed hemorrhoid. The area will continue to be painful even after this treatment. It is unclear if this treatment is helpful.

 

You should not have a fever with a thrombosed hemorrhoid. If you have fever, it is more likely that you have a perianal abscess

 

Medical Treatment:

Conservative management consists of avoiding constipation by increasing the fluid and dietary fiber in your diet, taking anti-inflammatory pain medication such as Tylenol, ibuprofen or naproxen, and reducing activity.  Sitz baths (i.e., soaking in warm water) may be used for comfort as well. The local pain and swelling should begin to subside after a few days, but it may take 2-3 weeks for lump to go away completely. 

If you have had an incision and drainage:

  1. Apply an ice pack to the area. Reduce activity for 12-24 hours.
    2. You can expect some minor bleeding or bloody drainage for a day or two
    after your procedure.
  2. You may remove the initial dressing 12-24 hours.
  3. If you have to move your bowels before then, you may remove the dressing at that time.
    after the dressing is removed, replace it with a plain cotton gauze dressing to absorb any drainage.
  4. You may sit in a tub of warm water (Sitz bath) for 15-20 minutes 2-3 times a day and after bowel movements for comfort and cleanliness. You may also shower normally.

Diet:
Eat a regular diet. Make sure you have adequate fiber (>30 grams/day) and non-caffeinated fluids (6-8 glasses) daily to prevent constipation.

 

Medication:
If you received a prescription, take pain medication as directed. Do not drive or operate machinery if taking a narcotic pain medication. You should be aware that narcotic medications (Norco, Vicodin, etc.), cause constipation, which can make your pain worse. Extra Strength Tylenol, ibuprofen or naproxen (Motrin, Aleve, etc.) may be used for mild to moderate pain.

 

Activity:
Resume activities as tolerated. Avoid strenuous activities or
those likely to cause discomfort.

 

Follow-up:
Whether surgically incised and drained or left to resolve on their own, thrombosed hemorrhoids do not normally require special follow-up. Having had a thrombosed hemorrhoid is not a sign of some other, underlying problem. There are no special preventive measures aside from avoiding constipation and straining at stools, and avoiding prolonged sitting.

Information provided by UMHS Division of Colorectal Surgery
Decenber, 2007