A thrombosed external hemorrhoid is a painful swelling of the anal tissue caused by a blood clot (or "thrombus") in one or more venules of the anal skin. It can occur in association with prolonged sitting or constipation, but it can also occur spontaneously for no apparent reason. The swollen tissue is very soft and painful, often with the characteristic bluish color due to the underlying blood clot. Although very painful, the condition is not serious and can recover for a few days to a week or two without specific treatment. No further special evaluation or treatment is required.
Rarely, doctors may remove part of a blood clot under local anesthesia if the hemorrhoids are very large. This is called "incision and drainage" for thrombotic hemorrhoids. However, this area remains painful after this treatment. It is unclear if this treatment will help in any way. There is no fever with thrombotic hemorrhoids. If you have pain, swelling, and fever, you are more likely to have a perianal abscess.
How can Thrombosed External Hemorrhoids be treated?
Conservative management consists of increasing dietary water and dietary fiber, taking anti-inflammatory analgesics such as Tylenol, ibuprofen and naproxen, and avoiding constipation by reducing activity. A sit bath (such as soaking in warm water) can also help increase comfort. Local pain and swelling begin to subside after a few days, but it may take a few weeks for the lumps to completely disappear.
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