From the Guidelines
Thrombosed hemorrhoids are best treated with a combination of non-operative management and early surgical excision, with the decision based on local expertise and patient preference, as suggested by the most recent guidelines 1. The treatment of thrombosed hemorrhoids involves both home remedies and medical interventions. For immediate relief, patients can apply over-the-counter hemorrhoid creams containing hydrocortisone (0.5-1%) or witch hazel pads to reduce pain and swelling. Oral pain relievers like acetaminophen (Tylenol, 500-1000mg every 6 hours, not exceeding 4000mg daily) or ibuprofen (Advil, 400-600mg every 6-8 hours with food) can also be taken. Sitz baths in warm water for 15-20 minutes, 2-3 times daily, can provide significant comfort, while cold compresses applied for 10-15 minutes several times daily can reduce swelling.
Some key points to consider in the treatment of thrombosed hemorrhoids include:
- Non-operative management as first-line therapy, with dietary and lifestyle changes (i.e., increased fiber and water intake together with adequate bathroom habits) 1
- The use of flavonoids to relieve symptoms, although the evidence is moderate and the recommendation is weak 1
- Avoiding the use of incision and drainage of the thrombus due to higher incidence of bleeding and relapse of symptoms 1
- Considering early surgical excision for severe cases that develop within 72 hours, as it provides immediate relief and is most effective when done within three days of symptom onset 1
It's also important to note that most thrombosed hemorrhoids resolve on their own within 1-2 weeks with conservative treatment. To prevent recurrence, maintaining regular bowel movements through adequate fiber intake (25-30g daily), proper hydration (8 glasses of water daily), and avoiding straining during bowel movements is crucial.
The most recent and highest quality study 1 suggests that the decision between non-operative management and early surgical excision should be based on local expertise and patient preference, highlighting the importance of individualized treatment approaches for thrombosed hemorrhoids.
From the Research
Treatment Options for Thrombosed Hemorrhoids
- Excision is the most effective treatment for thrombosed external hemorrhoids, as stated in 2 and 3.
- For internal hemorrhoids, rubber band ligation is a preferred treatment option, with a lower failure rate compared to infrared photocoagulation, as mentioned in 2, 4, and 3.
- Conservative treatment, including a fiber-enriched diet, topical ointments or suppositories, and flavonoids, can be effective for some patients, as discussed in 5 and 3.
- Surgical procedures, such as traditional hemorrhoidectomy or stapled hemorrhoidopexy, may be necessary for more severe cases or recurrent hemorrhoids, as described in 2, 5, and 3.
Specific Treatment Approaches
- Excision of the entire hemorrhoidal mass and overlying skin is recommended for acutely thrombosed external hemorrhoids, as stated in 6 and 3.
- Rubber band ligation is a suitable treatment option for persistently bleeding or painful internal hemorrhoids, as mentioned in 6 and 4.
- Hemorrhoidal artery ligation may be useful for grade II or III hemorrhoids, as it can result in less pain and faster recovery, as discussed in 5 and 3.