From the Guidelines
Thrombosed hemorrhoids are best treated with excision under local anesthesia, especially if diagnosed early, as it provides rapid symptom resolution and lower incidence of recurrence, as suggested by the most recent and highest quality study 1. When it comes to treating thrombosed hemorrhoids, the goal is to alleviate pain, reduce swelling, and prevent recurrence.
- For immediate relief, patients can apply over-the-counter hemorrhoid creams containing hydrocortisone (0.5-1%) or use witch hazel pads to reduce pain and swelling.
- Oral pain relievers like acetaminophen (Tylenol) 500-1000mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours can be taken as needed.
- Sitz baths in warm water for 15-20 minutes, 2-3 times daily, can provide significant comfort, and ice packs wrapped in cloth can be applied to the area for 15-20 minutes several times daily to reduce swelling. However, excision under local anesthesia is the preferred treatment for thrombosed hemorrhoids, especially if diagnosed early, as it provides rapid symptom resolution and lower incidence of recurrence, as suggested by the most recent and highest quality study 1. It's also important to note that incision and drainage of the thrombus is not recommended due to the higher incidence of bleeding and relapse of symptoms 1. To prevent recurrence, increasing fiber intake to 25-30g daily, drinking plenty of water, avoiding straining during bowel movements, and not sitting on the toilet for extended periods can help. Additionally, flavonoids may be beneficial in relieving symptoms of complicated hemorrhoids, as suggested by a meta-analysis 1. Overall, prompt treatment of thrombosed hemorrhoids is crucial to alleviate pain, reduce swelling, and prevent recurrence, and excision under local anesthesia is the most effective treatment option, especially if diagnosed early 1.
From the Research
Treatment Options for Thrombosed Hemorrhoids
- Conservative treatment is considered the first-line approach for thrombosed hemorrhoids, with options including:
- Wait and see approach
- Mixture of flavonoids
- Mix of lidocaine and nifedipine
- Botulinum toxin injection
- Topical application of 0.2% glyceryl trinitrate 2
- Medical management may also include stool softeners, topical over-the-counter preparations, and topical nitroglycerine, as well as dietary modifications such as increased fiber and water intake, and behavioral therapies like sitz baths 3
Surgical Treatment
- Surgical treatment is recommended when thrombosed hemorrhoids fail to respond to conservative management or when symptoms onset falls within the last 48-72 hours 2
- Surgical options include:
- Drainage with radial incision
- Conventional excision
- Excision under local anesthesia
- Stapled technique 2
- Excision of thrombosed external hemorrhoids can greatly reduce pain if performed within the first two to three days of symptoms 3