- Clinical science
A thrombosed external hemorrhoid is a localized thrombosis of the inferior hemorrhoidal venous plexus that results in severe, acute anal pain. Perianal clinical examination reveals a bulging, purplish nodule that is very tender to palpation. It may be treated conservatively with analgesic creams and steroids or be surgically excised for immediate pain relief.
- Acute onset of severe pain
- Pain with defecation
- May ulcerate and bleed
- Thrombosed hemorrhoid detectable on rectal exam: palpable, bulging, dark red to purplish nodule at the outer rim of the anal canal; very tender to palpation
- Indications: small thromboses , thromboses older than 72 hours, current pregnancy
- Thromboses usually resolve or improve within 2–3 days. Surgery is rarely required.
- Excision of external hemorrhoid
- Alternatively, incision and evacuation of the thrombus
- Complications (rare): recurrence requiring further surgery, local swelling, minor bleeding, perianal fistula or abscess