What Thrombosed Hemorrhoids Are and How to Identify Them

Thrombosed hemorrhoids are the most severe complication of hemorrhoidal disease. The patient who suffers from them has continuous pain and cannot even sit up.
What Thrombosed Hemorrhoids Are and How to Identify Them

Last update: 04 March, 2021

Hemorrhoidal disease is the most frequent proctological illness and one of the main reasons for medical consultation. 5% of the world population has symptoms associated with it and, after the age of 50, there is a 50% prevalence. Thrombosed hemorrhoids are the most serious form of this disease.

Although hemorrhoids are very common in adulthood, the thrombosed form requires immediate medical attention. The pain is so severe and stabbing that, in some cases, the patient can’t even sit up. If you’d like to get to know more about it, keep reading.

What are thrombosed hemorrhoids?

According to the National Library of Medicine of the United States, hemorrhoids are inflamed or swollen veins around the anus or the lower part of the rectum. Based on their location and symptoms, they’re differentiated into internal and external.

In general, the external ones cause more discomfort, but in both there’s superficial bleeding with the stools. As indicated by the Proctological Clinic , there are different degrees of hemorrhoids, from mild to thrombosed. Its characteristics are as follows:

  • Grade I: Hemorrhoids are completely internal. The varicose dilations located under the mucosa of the rectum grow, but protrude out of it. This is the typical thickening of the veins.
  • Grade II: Inflammation progresses and the veins protrude outside the anal canal, almost always after bowel movements, leading to a visible prolapse. Shortly after efforts of defecation, the prolapse disappears and the structures return to their correct place by themselves.
  • Grade III: The prolapse is continuous, that is, the hemorrhoids are visible from the outside at all times, but you can push them inwards manually.
  • Grade IV: Due to poor circulation in the prolapsed vein, a clot occurs. This is what happens in the case of thrombosed hemorrhoids, and you can’t push the prolapse inwards even manually.

Thus, a thrombosed hemorrhoid is one in which a blood clot has formed that prevents proper flow in the affected area. Faced with this medical condition, the only option is to seek professional help quickly.

Blood clot blocking a thrombosed hemorrhoid.
The formation of clots within the hemorrhoid is the most serious clinical form, since circulation is interrupted.

Main symptoms

According to the Colorectal Surgery portal, with thrombosed hemorrhoids, the patient suffers intense, continuous, stabbing pain. This discomfort is no longer related to defecation and the person who suffers from it can’t even sit up.

Before reaching this point, it’s possible to detect the disease based on other clinical signs, according to whether they have internal or external hemorrhoids. Some of them are the following:

  • Itching or irritation in the anal area (when there are external hemorrhoids)
  • Pain or discomfort
  • Swelling around the anus (on the outside, too)
  • Bleeding: Bright red, as if it were a newly opened wound. Unlike ulcers and other events that occur in the upper gastric tract; these cause the defecation of blackish stools, because the blood has been partially digested.

It’s advisable to see a doctor for any of these symptoms in order to avoid hemorrhoidal thrombosis. Rectal bleeding may be due to hemorrhoids or something even more serious.

What causes thrombosed hemorrhoids?

According to sources already cited, hemorrhoids occur when there’s too much pressure on the veins around the anus. The Mayo Clinic indicates that some of the causes are straining to try to empty the intestines, sitting for long periods on the toilet, being obese, and having a diet low in fiber.

On the other hand, relatively frequent events, such as hypertension or spending too much time sitting down at work, can be triggers. Hemorrhoids don’t arise from any one specific cause; in most cases they’re due to a set of simultaneous events.

Fat intake, sedentary lifestyle, and obesity greatly favor the appearance of hemorrhoids.

How are thrombosed hemorrhoids diagnosed?

As indicated by the Health Library, the professional proctologist will examine the patient’s anus and rectum using a proctoscope. This device is a short metal tube (6 inches long) that’s lubricated and inserted into the rectum.

Thanks to it, a doctor can detect mild, thrombosed hemorrhoids, and anal polyps. In order for the patient not to feel uncomfortable, a doctor can apply local anesthesia in the area that they will analyze. Sometimes this isn’t necessary, however, as a manual examination (inserting a finger into the anus) is sufficient in many cases.

Available treatments

The approach can be surgical and non-surgical. We review each of the possible options in the following lines.

Non surgical

As indicated by the aforementioned portals, milder cases require a conservative approach. If the clot has formed more than 72 hours ago, the doctor will prescribe self-care for the patient in their own home. This consists of:

  • The use of anti-inflammatory creams and suppositories to relieve pain.
  • Baths with lukewarm water for 10 to 15 minutes, 4-5 times a day, to avoid the most acute episodes.
  • Painkillers to relieve pain.
  • Modification of diet, especially in obese patients or pregnant people.

Surgical

The surgical approach is divided into two: thrombectomy and hemorrhoidectomy. The first of the procedures consists of draining the thrombus of the external hemorrhoid. A surgeon will carry this out through an incision under local anesthesia, on an outpatient basis.

The chances of relapse are high. In a hemorrhoidectomy, the surgeon will remove the hemorrhoids. It can be carried out on an outpatient basis or require hospital admission, always under local anesthesia and with medical assistance. This is the most indicated and appropriate treatment in most cases, as it effectively ends the problem.

Hemorrhoidectomy in a woman.
The removal of hemorrhoids is the surgical procedure of choice in the case of thrombi.

Prevention

In many cases, preventing hemorrhoids is simply not possible. Human beings are quite sedentary nowadays, as many jobs involve prolonged activities (more than 7 hours) in the same position in front of a computer. Whatever the case, you can follow certain tips to avoid a thrombosed hemorrhoid or, failing that, its appearance. Some of them are the following:

  • Eat foods rich in fiber and take dietary supplements, always indicated by a medical or nutritional professional. The fiber content in the diet should amount to 30 grams (1.2 oz) per day.
  • Drink plenty of fluids. This can soften the stool and thus reduce the strain during defecation.
  • Exercise and avoiding a sedentary lifestyle. A healthy lifestyle doesn’t only prevent thrombosed hemorrhoids, but also prevents high blood pressure and diabetes.

Pay attention to blood in the stools

Thrombosed hemorrhoids are a rare complication, as this condition remains in a mild, yer bothersome, form most of the time. However, in the event of any symptoms, it’s best to see a doctor promptly. If you have reddish blood with your stools or you need a lot of effort in order to defecate, then we recommend that you go to a nutritionist. Only then can you avoid complications.

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