From the Guidelines
Thrombosed hemorrhoids should be treated with early surgical excision, as it provides more rapid symptom resolution, lower incidence of recurrence, and longer remission intervals, as suggested by the most recent and highest quality study 1.
Treatment Options
When it comes to treating thrombosed hemorrhoids, the goal is to alleviate symptoms, reduce the risk of complications, and improve quality of life. The treatment approach may involve a combination of home remedies, medical interventions, and surgical procedures.
- For immediate relief, patients can apply over-the-counter hemorrhoid creams containing hydrocortisone or use witch hazel pads to reduce pain and swelling.
- Taking warm sitz baths for 15-20 minutes, 2-3 times daily, can help improve blood flow and reduce discomfort.
- Over-the-counter pain relievers like acetaminophen or ibuprofen can help manage pain.
Surgical Intervention
For severe cases, seeing a doctor within 72 hours of onset is crucial for possible external hemorrhoid thrombectomy, a minor procedure where the clot is removed under local anesthesia.
- A study published in the World Journal of Emergency Surgery 1 suggests that early surgical excision can provide more rapid symptom resolution, lower incidence of recurrence, and longer remission intervals.
- The decision between non-operative management and early surgical excision should be based on local expertise and patient preference, as recommended by the WSES-AAST guidelines 1.
Lifestyle Modifications
In addition to medical and surgical interventions, lifestyle modifications can help alleviate symptoms and prevent recurrence.
- Increasing fiber intake to 25-30 grams daily through foods or supplements like psyllium or methylcellulose can help soften stool.
- Drinking 6-8 glasses of water daily can help reduce the risk of constipation and straining during bowel movements.
- Avoiding straining during bowel movements and limiting sitting on the toilet for extended periods can also help reduce pressure on the anal veins and improve blood circulation.
From the Research
Treatment Options for Thrombosed Hemorrhoids
- Excision is the most effective treatment for thrombosed external hemorrhoids, as it can greatly reduce pain if performed within the first two to three days of symptoms 2, 3, 4, 5
- For prolapsed internal hemorrhoids, the best definitive treatment is traditional hemorrhoidectomy, while rubber band ligation produces the lowest rate of recurrence among nonoperative techniques 2
- Medical management, including stool softeners, topical over-the-counter preparations, and topical nitroglycerine, is often the initial therapy for hemorrhoids, with dietary modifications and behavioral therapies also playing a role 3, 6
- Office-based treatment of grades I to III internal hemorrhoids with rubber band ligation is the preferred next step if initial therapy is unsuccessful, due to its lower failure rate compared to infrared photocoagulation 3
Surgical Treatment
- Open or closed (conventional) excisional hemorrhoidectomy leads to greater surgical success rates but also incurs more pain and a prolonged recovery than office-based procedures, and should be reserved for recurrent or higher-grade disease 3
- Closed hemorrhoidectomy with diathermic or ultrasonic cutting devices may decrease bleeding and pain, while stapled hemorrhoidopexy can elevate grade III or IV hemorrhoids to their normal anatomic position but has potential postoperative complications 3
- Hemorrhoidal artery ligation may be useful in grade II or III hemorrhoids, as patients may experience less pain and recover more quickly 3
Conservative Management
- Conservative treatment, including wait and see, mixture of flavonoids, mix of lidocaine and nifedipine, botulinum toxin injection, and topical application of 0.2% glyceryl trinitrate, is often considered the first-line approach for external hemorrhoidal thrombosis 4
- Conservative management can result in symptom resolution, but excision of thrombosed external hemorrhoids may lead to more rapid symptom resolution, lower incidence of recurrence, and longer remission intervals 5