Rectum

Thrombosed External Hemorrhoid

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Thrombosed External Hemorrhoid, Thrombosed Hemorrhoid

  • See Also
  1. Hemorrhoid
  2. External Hemorrhoid
  3. Thrombosed Hemorrhoidectomy
  • Pathophysiology
  1. Complication of External Hemorrhoid
  2. May follow sudden episode of increased anal pressure
    1. Coughing, sneezing, lifting or Defecation
  • Symptoms
  1. Severe Anorectal Pain
  2. Exascerbated by sitting, standing, or defecating
  • Signs
  1. Tender and inflammed External Hemorrhoid
  2. Hemorrhoid is tense, firm with underlying bluish clot
  • Management
  1. General measures
    1. See Hemorrhoid Management
    2. Sitz baths
    3. Keep stool soft
    4. Topical Nifedipine 0.3% and Lidocaine 1.5% ointment
      1. Apply twice daily for 1-2 weeks for analgesia
    5. Topical Nitroglycerin 0.4% ointment (Glyceryl Trinitrate)
  2. Thrombosed Hemorrhoidectomy
    1. Indicated if thrombosed for <72 hours (not effective if longer duration)
    2. See Thrombosed Hemorrhoidectomy
  • Course
  1. Resolves in days to weeks regardless of surgery
  2. Surgical excision within 72 hours shortens course
  • References
  1. Pickard in Dornbrand (1992) Ambulatory Care, p. 226
  2. Hulme-Moir (2001) Gastroenterol Clin North Am 30:183-97 [PubMed]
  3. Hussain (1999) Prim Care 26(1):35-51 [PubMed]
  4. Mott (2018) Am Fam Physician 97(3): 172-9 [PubMed]