anatomy of anorectal diseases

External hemorrhoids

Treatment of external hemorrhoids

Thrombosed external hemorrhoids are in a category of their own. Acute thrombosis is usually triggered by constipation, diarrhea or excessive straining. Patients will complain from a hard (bluish) lump next to the anus and severe anal pain. The peak of the pain is in the first three days. Timing is very important as excisional hemorrhoidectomy could be performed only in the first 3-4 days after the flare up.

The procedure is done under local anesthesia. The surgeon will make an incision over the mass and then the thrombus shall be removed. The wound is closed with absorbable suture. Pain relief is immediate. Postoperative care includes analgesics in the first 24 h, warm sitz baths for 10-15 min., keeping the area clean.

Generally thrombosed external hemorrhoid could resolve on its own in two weeks. Nonoperative treatment is aimed at pain relief and prevention. Nifedipine gel can be used to aid the treatment. You should stick to a high-fiber diet and drink plenty of fluids. Supplements, such as psyllium, can be useful in moderate amounts. You should be careful to avoid constipation, staining, and diarrhea. Bathing with warm water (or sitting in sitz-baths) could ease the pain. You should try to avoid prolonged sitting and some physical activities (such as cycling). However, conservative management could lead to recurrence of the external hemorrhoid. Complete excision of the underlying vascular formation will solve the problem in the long-term.

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