From the Guidelines
A strangulated hemorrhoid requires immediate surgical intervention, typically an emergency hemorrhoidectomy, to prevent serious complications and alleviate severe pain. This condition is characterized by the cutting off of blood supply to the hemorrhoid due to excessive swelling and pressure, leading to severe pain, purple or black discoloration, and potential tissue death 1. The American Gastroenterological Association recommends surgery for acutely incarcerated and thrombosed hemorrhoids, which includes strangulated hemorrhoids, as it is the most effective treatment for this condition 1.
Before surgery, patients may receive pain management with medications like acetaminophen or prescribed opioids, along with intravenous fluids to address dehydration. The surgeon will excise the strangulated hemorrhoid under anesthesia, relieving the intense pain and preventing serious complications like tissue necrosis or infection.
Following surgery, patients typically need 2-3 weeks for recovery, during which they should:
- Take prescribed pain medications
- Use sitz baths 2-3 times daily for 10-15 minutes
- Maintain soft stools with fiber supplements (25-30g daily) and adequate hydration (8-10 glasses of water daily)
- Avoid straining during bowel movements
It is essential to note that strangulated hemorrhoids are a medical emergency, and prompt treatment is necessary to prevent serious complications and improve patient outcomes 1.
From the Research
Treatment Options for Strangulated Hemorrhoid
- Acutely strangulated hemorrhoids may be treated either conservatively or operatively 2
- Conservative treatment may involve manual reduction of the hemorrhoid, which can be facilitated by the use of sugar 3
- Operative treatment, such as emergency hemorrhoidectomy, is also an option, but it is recommended to avoid it when possible 3, 4
- Early operative intervention for strangulated internal hemorrhoids is safe and effective, and can prevent the negative economic and psychological effects of a prolonged recovery 4, 5
- The choice of treatment depends on the individual case and the severity of the symptoms, and a suggested algorithm for treatment can be based on the published literature 5
Considerations for Treatment
- The risks of sepsis and sphincter damage from operative treatment are less significant than previously thought 2
- There is an increased risk of anal stenosis after acute surgery 2
- Conservative treatment may not be effective in all cases, and the majority of patients who are treated conservatively will still require definitive treatment at a later date 2
- Minimally invasive operations, such as Ligasure hemorrhoidectomy and doppler-guided hemorrhoidal artery ligation, have been introduced to avoid post-hemorrhoidectomy pain 6