From the Guidelines
For a thrombosed hemorrhoid, the most effective treatment is surgical excision, specifically external hemorrhoid thrombectomy, which involves making a small incision to remove the blood clot and provides immediate relief, and this procedure is most effective when performed within 72 hours of symptom onset 1. The decision between non-operative management and early surgical excision should be based on local expertise and patient’s preference 1. Some key points to consider in the management of thrombosed hemorrhoids include:
- Initially, trying conservative measures including warm sitz baths, over-the-counter pain relievers, and topical treatments containing hydrocortisone or witch hazel to reduce inflammation and pain 1
- Applying a cold compress to the area for 10-15 minutes several times daily to reduce swelling
- Keeping the anal area clean and dry, using unscented wipes instead of toilet paper, and avoiding straining during bowel movements
- Considering surgical excision if conservative measures do not provide relief within 2-3 days or if pain is severe 1 It's also important to note that the use of incision and drainage of the thrombus is not recommended due to the higher incidence of bleeding and relapse of symptoms 1. Additionally, the role of NSAIDs, topical steroids, other topical agents, or injection of local anesthetics for complicated hemorrhoids is not well established, and no recommendation can be made regarding their use 1. Proper hydration, a high-fiber diet, and regular exercise can help prevent recurrence of thrombosed hemorrhoids 1. It's worth mentioning that the evidence for the treatment of thrombosed hemorrhoids is limited, and more research is needed to determine the best course of treatment 1. However, based on the available evidence, surgical excision within 72 hours of symptom onset is the most effective treatment for thrombosed hemorrhoids 1.
From the Research
Treatment Options for Thrombosed Hemorrhoid
- Conservative treatment is often considered the first-line approach for thrombosed hemorrhoids, with options including wait and see, mixture of flavonoids, mix of lidocaine and nifedipine, botulinum toxin injection, and topical application of 0.2% glyceryl trinitrate 2
- Medical management, such as stool softeners, topical over-the-counter preparations, and topical nitroglycerine, can also be effective in treating thrombosed hemorrhoids 3
- Dietary modifications, including increased fiber and water intake, and behavioral therapies, such as sitz baths, can also help alleviate symptoms 3
Surgical Treatment
- Surgical treatment is recommended when conservative management fails or when symptoms onset falls within the last 48-72 hours, with options including drainage with radial incision, conventional excision, excision under local anesthesia, and stapled technique 2
- Excision of thrombosed external hemorrhoids can greatly reduce pain if performed within the first two to three days of symptoms 3
- Minimally invasive operations, such as Ligasure hemorrhoidectomy, doppler-guided hemorrhoidal artery ligation, and stapled hemorrhoidopexy, have been introduced to avoid post-hemorrhoidectomy pain 4
Pharmacological Treatment
- Topical nifedipine has been shown to be effective in treating acute thrombosed external hemorrhoids, with significant relief of pain and reduction of analgesic use 5
- Phlebotonic drugs and fiber supplements can also be useful in managing hemorrhoid symptoms 6
- Medical therapy can be useful in minimizing anal symptoms as a bridge-to-surgery treatment, and in relieving post-hemorrhoidectomy pain 6