From the Guidelines
The best treatment for thrombosed hemorrhoids is surgical excision within the first 72 hours of symptom onset, as it offers faster pain relief and lower incidence of recurrence, although the decision should be based on local expertise and patient preference 1.
Treatment Options
- Surgical excision: involves making an incision over the hemorrhoid under local anesthesia, removing the blood clot, and excising the redundant tissue.
- Conservative management: includes sitz baths, topical analgesics, oral pain medications, and stool softeners, which can provide relief within 7-14 days as the clot naturally resolves.
Pharmacological Regimen
- Dietary and lifestyle changes, such as increased fiber and water intake, are recommended as first-line therapy 1.
- Flavonoids may be used to relieve symptoms, and topical muscle relaxants may be used for thrombosed or strangulated hemorrhoids 1.
Prevention of Recurrence
- Maintaining soft stools through adequate hydration, high-fiber diet, and avoiding prolonged sitting on the toilet can help prevent recurrence.
- Increasing fiber intake to 25-30 grams daily and drinking plenty of water can also help prevent constipation and reduce the risk of recurrence 1.
From the Research
Treatment Options for Thrombosed Hemorrhoids
- The best treatment for thrombosed hemorrhoids depends on the severity of the condition and the individual patient's needs 2, 3, 4.
- For thrombosed external hemorrhoids, excision is the most effective treatment, especially if performed within the first two to three days of symptoms 3, 4, 5.
- For internal hemorrhoids, rubber band ligation is a preferred treatment option, with a lower failure rate compared to infrared photocoagulation 2, 3, 4.
- Medical management, including stool softeners, topical over-the-counter preparations, and dietary modifications, is often the first line of treatment for hemorrhoids 2, 3, 5.
- Surgical options, such as traditional hemorrhoidectomy or stapled hemorrhoidopexy, may be considered for higher-grade hemorrhoids or for patients who do not respond to other treatments 2, 3.
Non-Surgical Treatment Options
- Dietary modifications, including increased fiber and water intake, can help alleviate symptoms of hemorrhoids 2, 3, 5.
- Topical treatments, such as hydrocortisone creams or ointments, can provide relief from pain and discomfort 2, 3, 5.
- Sitz baths and other behavioral therapies can also be effective in managing symptoms of hemorrhoids 3.
- New oral and topical treatment options, such as sublingual nanoemulsions and liquid bandages, are being developed and may offer additional treatment options for patients with hemorrhoids 6.
Surgical Treatment Options
- Traditional hemorrhoidectomy is a common surgical treatment for higher-grade hemorrhoids, but it can be associated with more pain and a longer recovery time compared to other options 2, 3.
- Stapled hemorrhoidopexy is a surgical procedure that can be used to treat higher-grade hemorrhoids, with the advantage of reduced postoperative pain and faster recovery, but it may have a higher recurrence rate compared to traditional hemorrhoidectomy 2, 3.
- Hemorrhoidal artery ligation is another surgical option that may be useful for grade II or III hemorrhoids, with the advantage of less pain and faster recovery compared to traditional hemorrhoidectomy 2, 3.