From the Guidelines
Yes, a thrombosed hemorrhoid can go away on its own, typically within 1-2 weeks as the blood clot is naturally absorbed by the body. During this healing period, you can manage symptoms with warm sitz baths for 15-20 minutes several times daily, over-the-counter pain relievers like acetaminophen or ibuprofen, and topical treatments such as witch hazel pads or creams containing hydrocortisone 1. To prevent worsening and promote healing, increase fiber intake to 25-30 grams daily, drink plenty of water, avoid straining during bowel movements, and use stool softeners like docusate sodium if needed.
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 guidelines 1.
- Some studies suggest that surgery may be superior to conservative management, but the correct duration of non-operative management and the timing for surgery are not known 1.
- Simple incision of thrombosed hemorrhoids with clot removal is not recommended due to persistent bleeding and higher recurrence rates 1.
Management Options
- Non-operative management with dietary and lifestyle changes, such as increased fiber and water intake, is recommended as first-line therapy 1.
- Topical muscle relaxants, such as topical nitrates and calcium channels antagonists, may be used to relieve symptoms 1.
- External thrombectomy within the first 72 hours of development can provide immediate relief by removing the clot 1. However, if pain is severe, the hemorrhoid is very large, or symptoms don't improve after a week, medical intervention may be necessary. A doctor can perform an in-office procedure called external thrombectomy within the first 72 hours of development to provide immediate relief by removing the clot. The body's natural inflammatory response helps break down the clot over time, but larger thrombosed hemorrhoids may take longer to resolve and could leave behind a skin tag after healing.
From the Research
Thrombosed Hemorrhoid Resolution
- A thrombosed hemorrhoid can be painful and may require medical attention, but in some cases, it may go away on its own 2.
- However, the likelihood of a thrombosed hemorrhoid resolving without treatment depends on various factors, such as the size and location of the hemorrhoid, as well as the individual's overall health.
Treatment Options
- Excision of thrombosed external hemorrhoids can greatly reduce pain if performed within the first two to three days of symptoms 2.
- Hemorrhoidectomy is a surgical procedure that can be used to remove thrombosed external hemorrhoids, and it is most effective when performed within 72 hours of symptom onset 3.
- Medical management, dietary modifications, and behavioral therapies can also be used to treat thrombosed hemorrhoids, but these approaches may not be as effective for larger or more painful hemorrhoids 2.