From the Guidelines
Treatment for a thrombosed hemorrhoid typically involves pain management and measures to reduce swelling, with surgical excision within 72 hours of onset providing the most rapid relief for severe cases. For immediate relief, over-the-counter pain medications like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can be taken as directed 1. Applying cold compresses to the area for 15 minutes several times daily helps reduce swelling and numb pain. Warm sitz baths (sitting in plain warm water for 15-20 minutes) 2-3 times daily can provide significant relief. Topical treatments containing hydrocortisone 1% or witch hazel can reduce inflammation and itching.
Key Considerations
- The decision between non-operative management and early surgical excision should be based on local expertise and patient’s preference, as suggested by the 2021 guidelines from the World Journal of Emergency Surgery 1.
- Surgical excision is not required for patients whose symptoms are resolving, as the pain associated with hemorrhoidal thrombosis typically resolves after 7–10 days 1.
- Increasing fiber intake to 25-30 grams daily, drinking plenty of water, and avoiding straining during bowel movements helps prevent recurrence by keeping stools soft and reducing pressure on hemorrhoidal vessels.
Management Options
- Conservative management with pain relief measures and lifestyle changes typically resolves symptoms within 1-2 weeks as the body naturally absorbs the clot.
- Surgical excision performed within 72 hours of onset provides the most rapid relief for severe cases, with a low recurrence and complication rate 1.
- The use of incision and drainage of the thrombus is not recommended due to the higher incidence of bleeding and relapse of symptoms 1.
From the Research
Treatment Options for Thrombosed Hemorrhoid
- Medical management, including stool softeners, topical over-the-counter preparations, and topical nitroglycerine, is often the first line of treatment 2
- Dietary modifications, such as increased fiber and water intake, and behavioral therapies, like sitz baths, can also be effective in managing symptoms 2
- For external hemorrhoidal thrombosis, conservative treatment options, including wait and see, mixture of flavonoids, mix of lidocaine and nifedipine, botulinum toxin injection, and topical application of 0.2% glyceryl trinitrate, can be considered 3
- Surgical treatment, such as excision of thrombosed external hemorrhoids, can be recommended when symptoms are severe or when conservative management fails, especially if performed within the first 48-72 hours of symptom onset 2, 3
Effectiveness of Conservative vs. Surgical Treatment
- A study found that conservative treatment with sitz baths and oral pain medication can be effective in managing perianal thrombosis and thrombosed hemorrhoids, with most patients experiencing resolution of symptoms within 10 days 4
- Another study found that surgically treated patients had a lower frequency of recurrence and a longer time interval to recurrence than conservatively treated patients 5
- However, the choice of treatment remains controversial, and both medical and surgical treatment have been proven effective, but randomized clinical trials and structured consensus-based guidelines are warranted 3
Considerations for Treatment
- The decision to pursue surgical treatment should be based on the severity of symptoms, the patient's overall health, and their personal preferences 2
- Patients with a prior history of thrombosed external hemorrhoids may be more likely to require surgical treatment 5
- The management and treatment of external hemorrhoidal thrombosis is still controversial, and further research is needed to determine the most effective treatment approach 3