From the Guidelines
Thrombosed hemorrhoids may increase in size during treatment due to continued blood clot formation and inflammatory response, and the decision between non-operative management and early surgical excision should be based on local expertise and patient’s preference, as suggested by the most recent guidelines 1. When a hemorrhoid becomes thrombosed, a blood clot forms inside the hemorrhoidal tissue, causing pain, swelling, and discomfort. During initial treatment, which typically includes sitz baths, topical medications like hydrocortisone cream, and oral pain relievers such as acetaminophen or ibuprofen, the inflammatory process may temporarily worsen before improving. The increased blood flow to the area as part of the healing process can contribute to additional swelling. Some key points to consider in the management of thrombosed hemorrhoids include:
- Non-operative management is recommended as first-line therapy, with dietary and lifestyle changes, such as increased fiber and water intake, and adequate bathroom habits 1.
- The use of topical muscle relaxants may be suggested for symptomatic relief, although the evidence is based on low-quality studies 1.
- Surgical excision may be considered in selected patients, based on local expertise and patient preference, although the evidence is scarce and of low quality 1.
- Incision and drainage of the thrombus is not recommended due to the higher incidence of bleeding and relapse of symptoms 1. It is essential to weigh the potential benefits and risks of each approach, considering the individual patient's circumstances and preferences, to optimize outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Thrombosed Hemorrhoid Size Increase with Treatment
- The provided studies do not directly address why thrombosed hemorrhoid size increases with treatment 2, 3, 4, 5, 6.
- However, it can be inferred that the increase in size may be due to the body's natural response to injury or inflammation, which can cause swelling and enlargement of the affected area.
- The studies discuss various treatment options for hemorrhoids, including excision, rubber band ligation, sclerotherapy, and hemorrhoidectomy, but do not specifically address the issue of thrombosed hemorrhoid size increase with treatment 2, 3, 4, 5.
- One study mentions that excision of thrombosed external hemorrhoids can greatly reduce pain if performed within the first two to three days of symptoms, but does not discuss the effect on size 4.
- Another study discusses the management of acutely thrombosed external hemorrhoids, but notes that there is low quality evidence for this topic 6.
Treatment Options for Hemorrhoids
- The studies discuss various treatment options for hemorrhoids, including:
- Medical management (e.g., stool softeners, topical over-the-counter preparations, topical nitroglycerine) 4
- Dietary modifications (e.g., increased fiber and water intake) 4
- Behavioral therapies (e.g., sitz baths) 4
- Office-based treatment of grades I to III internal hemorrhoids with rubber band ligation 4
- Open or closed (conventional) excisional hemorrhoidectomy 4
- Stapled hemorrhoidopexy 4
- Hemorrhoidal artery ligation 4
- The choice of treatment depends on the severity of the hemorrhoids, patient preferences, and other factors 4, 6.