Thrombosed External Hemorrhoid

Aka: Thrombosed External Hemorrhoid, Thrombosed Hemorrhoid

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II. Pathophysiology

  1. Complication of External Hemorrhoid
  2. May follow sudden episode of increased anal pressure
    1. Coughing, sneezing, lifting or Defecation

III. Symptoms

  1. Severe Anorectal Pain
  2. Exascerbated by sitting, standing, or defecating

IV. Signs

  1. Tender and inflammed External Hemorrhoid
  2. Hemorrhoid is tense, firm with underlying bluish clot

V. 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

VI. Course

  1. Resolves in days to weeks regardless of surgery
  2. Surgical excision within 72 hours shortens course

VII. 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]

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