Hemorrhoids are swollen veins in the lower rectum and anus. Close to three out of four adults will have hemorrhoids from time to time. Hemorrhoids have a number of causes, but often the cause is unknown. However, swollen hemorrhoids can be painful, irritating, and cause rectal bleeding, making bowel movements uncomfortable. There are two kinds of hemorrhoids – External and Thrombosed hemorrhoids.
- Thrombosed internal hemorrhoids located inside your rectum are usually not seen or felt, and rarely cause discomfort. There might be bleeding during bowel movements, but it is usually not painful. At times, the hemorrhoids might push through the anal opening resulting in excessive pain.
- External hemorrhoids are around the anus and causes irritation, pain, bleeding and swelling around the anus. These are the most commonly occurring hemorrhoids, and are caused due to continuous straining during bowel movements, which happens due to constipation or diarrhea, leading to the enlargement of the vessels in that area.
Thrombosed hemorrhoids are also known as perianal thrombosis or acute hemorrhoidal disease, and appear as a single lump or circle of lumps. It occurs when there is a blood clot inside a hemorrhoidal vein, blocking the blood flow causing severe pain due to the swelling of the anal tissues. Most of the time, the blood clot is reabsorbed by the body resulting in no symptoms of the condition. In most cases, thrombosed hemorrhoids are not dangerous but may require treatments to relieve pain and discomfort. Pregnant women are at greater risk of developing hemorrhoids due to the uterus’ excess pressure on these veins.
What causes thrombosed hemorrhoids?
A hemorrhoid is caused when the blood vessels lining the anal canal becomes swollen. If blood pools in an external hemorrhoid and forms a clot (thrombus), it can result in:
- Severe pain
- A hard lump near your anus
A hemorrhoid is the result of increased pressure on the veins of the rectum, which could be triggered by:
- Pressure caused by the baby during pregnancy
- Strenuous activities causing exertion
- Unusual or irregular bowel movements
- Continuous sitting
- Anal intercourse
- Weakening of the supportive connective tissues
- Decreased blood flow to the perianal area
Even though hemorrhoids are common, leaving hemorrhoids that causes irritation, discomfort and pain untreated over a period of time can develop into severe pain with bleeding. The lack of fibre in diets and certain medical conditions can also cause hemorrhoids.
What are the symptoms of thrombosed hemorrhoids?
Thrombosed hemorrhoids that appear as a small lump outside the anus. Acutely thrombosed external hemorrhoids appear as a dark bluish lump at the edge of the anal canal and is painful. The blood clot inside the lump causes a dark bluish colour. External hemorrhoid that is not thrombosed are more rubbery lumps that are usually not bluish.
Some of the symptoms of thrombosed hemorrhoids include:
- Pain during bowel movements, sitting, walking and other strenuous activities
- Bleeding during bowel movements
- Itching around the anus
- Lumps or swelling around the anus
How is it diagnosed?
If you are experiencing the above-mentioned symptoms, such as itching around the anus or bleeding during bowel movements for over 48 hours, you should visit a doctor. At times, the blood clot will get slowly reabsorbed, and the pain will subside.
The diagnosis would include the examination of the symptoms and medical history. A digital rectal exam is carried out to feel any lumps or growths. If you are at risk of colon cancer, a sigmoidoscopy or colonoscopy may be conducted to examine the colon for any precancerous growth or other changes.
What is the treatment for thrombosed hemorrhoids?
For hemorrhoids, over-the-counter medications are usually prescribed. Thrombosed hemorrhoid treatments include external thrombectomy. This procedure involves making a small incision the lump to drain it. Local anaesthesia is given to avoid any pain during the procedure. This procedure is effective when it is carried out within three days of the appearance of the lump. You may experience some pain post-surgery which would subside in few days.
If you’re experiencing fever along with a thrombosed hemorrhoid, it could be a sign of an infection that can cause a perianal abscess, a pocket of pus in the top tissue layer of the anus. Perianal abscesses are painful and should be drained as soon as possible as an untreated perianal abscess can lead to an anal fistula, which may require surgery.
Most thrombosed hemorrhoids disappear within 2-3 weeks through self-care. Below are some ways to take care of yourself if you have a thrombosed hemorrhoid.
- Take sitz baths
- Include fiber in the diet and drink plenty of fluids to keep the stool soft
- Avoid straining during bowel movements
Topical treatments like ointments and creams, can be used for hemorrhoids. However, surgery might be advised if the symptoms do not subside with self-care and if the hemorrhoid is very large in size. Some of the surgeries for hemorrhoids are as follows:
- Hemorrhoidectomy: You will be given general anaesthesia or spinal block to remove hemorrhoids along with the clot and blood vessels. This surgery takes longer than external thrombectomy but has reduced chances of hemorrhoids returning.
- Rubber band ligation: This procedure involves placing a small elastic band at the base of hemorrhoid, and within a few weeks, the hemorrhoid will shrink.
- Stapled hemorrhoidopexy: This procedure is carried out under general anaesthesia using a stapling instrument to push back and hold hemorrhoids in place.
How long does the recovery take?
Without surgery, the pain from a thrombosed hemorrhoid might reduce in 7-10 days, and regular hemorrhoids will shrink within a week. But, it may take a couple of weeks for the lump to go down completely. Apart from pain and bleeding, thrombosed hemorrhoids do not cause any complications, and you will be able to resume normal activities soon after.
How can hemorrhoids be prevented in the future?
Following tips can reduce the risk of hemorrhoids in the future:
- Include more fiber in your diet in the form of fruits, vegetables and whole grains. This will help soften the stools, reducing the need for straining at the time of bowel movements
- Drink plenty of water to avoid constipation and straining
- Get regular exercises to keep your bowels moving