From the Guidelines
Thrombosed hemorrhoids are characterized by painful, swollen, bluish-purple or dark lumps around the anus, often accompanied by significant discomfort and tenderness to touch. They typically form when a blood clot develops in an external hemorrhoid, causing it to become hard and sometimes the size of a grape or marble 1. The skin covering the hemorrhoid often appears stretched and shiny, and the area may be extremely sensitive or painful, especially during bowel movements or when sitting. Unlike regular hemorrhoids which might be pink or flesh-colored, thrombosed hemorrhoids have this distinctive darker coloration due to the clotted blood inside. They can develop suddenly, often after straining during bowel movements or prolonged sitting, and may cause significant discomfort. Some key characteristics of thrombosed hemorrhoids include:
- Painful, swollen lumps around the anus
- Bluish-purple or dark coloration
- Hard and tender to touch
- Skin covering the hemorrhoid appears stretched and shiny
- Area may be extremely sensitive or painful, especially during bowel movements or when sitting While some thrombosed hemorrhoids resolve on their own within 1-2 weeks as the body absorbs the clot, severe cases might require medical intervention such as excision under local anesthesia, as recommended by the American Gastroenterological Association 1. If you suspect you have a thrombosed hemorrhoid, seeking prompt medical attention is advisable, especially if the pain is severe or accompanied by fever, excessive bleeding, or inability to have bowel movements.
From the Research
Thrombosed Hemorrhoids Appearance
Thrombosed hemorrhoids are a common complication of hemorrhoidal disease, and their appearance can be described as follows:
- They are typically characterized by extreme pain, likely resulting from internal anal sphincter hypertonicity, which traps the hemorrhoids below the dentate line, thus leading to congestion and swelling 2.
- The size, thrombosis, and location of the hemorrhoids determine the extent of pain or discomfort, with proximal or distal locations to the dentate line being relevant factors 3.
- Thrombosed external hemorrhoids can appear as swollen, painful lumps on the outside of the anus, and excision of these can greatly reduce pain if performed within the first two to three days of symptoms 3.
Diagnosis and Treatment
The diagnosis and treatment of thrombosed hemorrhoids involve:
- Assessing the history and physical examination to determine the extent of pain or discomfort and to identify risk factors and clinical signs indicating more concerning disease processes 3.
- Considering the degree of discomfort, bleeding, comorbidities, and patient preference when determining the order in which treatments are pursued 3.
- Using medical management, dietary modifications, and behavioral therapies as the mainstays of initial therapy, with office-based treatment of grades I to III internal hemorrhoids with rubber band ligation being a preferred next step if these are unsuccessful 3.
Note that the study 4 is not relevant to the topic of thrombosed hemorrhoids.