From the Guidelines
Blood clots are related to hemorrhoids, specifically external hemorrhoids, and can form when blood pools in an external hemorrhoid, causing sudden, severe pain and a hard lump near the anus. This condition is known as a thrombosed hemorrhoid. According to the most recent and highest quality study, the decision between non-operative management and early surgical excision for thrombosed hemorrhoids should be based on local expertise and patient’s preference 1.
Treatment Options
Treatment options for thrombosed hemorrhoids include:
- Warm sitz baths for 15-20 minutes several times daily
- Over-the-counter pain relievers like acetaminophen or ibuprofen
- Topical treatments containing witch hazel or hydrocortisone to reduce swelling and discomfort
- In-office procedure to remove the clot within 72 hours of formation, providing immediate relief, as suggested by 1
Prevention of Recurrence
To prevent recurrence, it is essential to:
- Maintain regular bowel movements through adequate fiber intake (25-30g daily)
- Proper hydration (6-8 glasses of water daily)
- Avoid straining during bowel movements
Formation of Blood Clots
Blood clots form in hemorrhoids when circulation is restricted in the swollen blood vessels, causing blood to stagnate and coagulate within the hemorrhoidal tissue. The study by 1 suggests that surgical excision may result in more rapid symptom resolution, lower incidence of recurrence, and longer remission intervals. However, the decision between non-operative management and early surgical excision should be based on local expertise and patient’s preference.
Key Points
- Thrombosed hemorrhoids can be managed with non-operative treatment or early surgical excision
- The decision between these two options should be based on local expertise and patient’s preference
- Incision and drainage of the thrombus is not recommended due to higher incidence of bleeding and relapse of symptoms 1
From the Research
Relationship Between Blood Clots and Hemorrhoids
- Blood clots, also known as thrombi, can form in external hemorrhoids, leading to a condition called thrombosed external hemorrhoids 2, 3, 4, 5.
- Thrombosed external hemorrhoids are characterized by painful swelling and can be treated with incision and excision 3, 5.
- The formation of blood clots in hemorrhoids is often caused by increased pressure and straining during defecation, which can lead to stagnation of blood and trauma to the anal vessels 5.
- Thrombosis can also occur in internal hemorrhoids, but this is less common and typically requires more aggressive treatment, such as surgical hemorrhoidectomy 2, 3, 6, 4.
Treatment of Thrombosed Hemorrhoids
- Conservative treatment, such as stool softeners, analgesics, and warm soaks, can be effective in managing thrombosed external hemorrhoids 2, 5.
- If conservative treatment fails, surgical excision of the thrombus may be necessary 2, 3, 5.
- For internal hemorrhoids, treatment options include rubber band ligation, infrared coagulation, and surgical hemorrhoidectomy 2, 3, 6, 4.
Complications of Thrombosed Hemorrhoids
- Thrombosed external hemorrhoids can lead to complications such as abscesses, fistulas, and anal stenosis if left untreated or if treatment is delayed 3.
- Internal hemorrhoids can also lead to complications, such as bleeding, prolapse, and anal incontinence, if left untreated or if treatment is inadequate 2, 3, 6, 4.