Hemorrhoid thrombosis or Thrombosed hemorrhoids are hemorrhoids containing blood, which can then clot and become painful. They usually occur in external haemorrhoids.

Acute thrombosed haemorrhoids often look like blue or purple-colored, hard swellings around the rectal area. They are usually extremely painful, with the pain being compared almost to childbirth. They may bleed red-colored blood, as there are some connections between the hemorrhoids, which develop from veins, and the nearby arteries.

The pain usually peaks at two days and subsides after 4 days, although without surgery haemorrhoids may take several weeks to heal. Creams and other treatments applied to the skin can be effective, but you will probably need to take medications by mouth as the pain is due to internal swelling. Sometimes, hydrocortisone steroid cream may dampen down the clot.

Ulcerated thrombosis
Sometimes, hemorrhoids can lead to pressure sores which can then ulcerate and bleed. This has the advantage of reducing your pain levels as the blood drains and pressure reduces. However, they will still require treatment, as the bleeding is likely to continue if left untreated.

Hemorrhoid thrombosis Causes
Thrombosed hemorrhoids are caused blood pooling in dilated, twisted veins around the rectal area. They are not thought to be caused by a clotting disorder or an infection. The most common groups of people that get thrombosed external hemorrhoids are pregnant women and young adults. Sometimes, there is a trigger such as heavy lifting, straining at stool or intense athletic exercise. Other times, there is no obvious cause. At the moment there is no evidence that spicy foods or alcohol intake affect the riks of thrombosed haemorrhoids.

Treatments of hemorrhoid thrombosis
Conservative treatment
If your symptoms are not severe or the thrombosis is normal, your doctor may recommend waiting to see whether the haemorrhoids will heal with non-surgical treatments, such as sitz baths (sitting in one to two inches of hot water), towel-covered ice packs and pain relief. This is known as conservative management. It may also be recommended if your thrombosis is already healing and the worst symptoms are over.

After the clots have healed, you may be advised to take prevention measures such as drinking plenty of water, eating a high-fiber diet and moderate exercise. Painkillers that will help you include ibuprofen and, to a certain extent, acetaminophen. Codeine and other morphine-based medications are not usually recommended because they can cause constipation.

It tends to take longer for the hemorrhoids to heal with this method (around two to four weeks), but is effective if the thrombosis is reabsorbed or bleeds out via the skin. However, there is a risk of further clots forming.

A herbal preparation called Emospid® (a combination of flavonoids and natural steroid-based triterpene acids) has been trialled in the treatment of acute, painful hemorrhoids. It was effective in reducing symptoms, reducing the grade/severity of the hemorrhoids, pain scores and bleeding. Others come from Hemrhoid Harry™ (see the YouTube video below), containing ginger and cayenne.

Surgery
If the pain or other symptoms are severe, surgery will be required. Ideally, this should be done in the first two to three days. Usually, you will receive local anaesthetic and then the thrombosis will be cut out with a scalpel in an ‘I’ shape. This removes the clot but not the haemorrhoid itself. Alternatively you may receive a full hemorrhoidectomy (scalpel or laser). This is more invasive and your doctor will explain the risks and benefits to you before proceeding.

Occasionally, stapling of the haemorrhoids further up the anal canal can be helpful. This is a smaller operation but only effective in some people. A further operation is a combination of clot removal and full hemorrhoidectomy, where the clot and some of the surrounding muscle is removed. It can be done under local anaesthetic.

New procedures such as transanal hemorrhoidal dearterialization, which cuts off the arteries supplying the hemorrhoids, are also being developed. These sometimes include the use of Doppler to guide the procedure, and may involve stapling as the second part of the operation if the hemorrhoids are more severe.

A few clinical studies have looked into the use of medications during surgery to boost the immune system, which can be affected by hemorrhoidectomy. For instance, the antioxidant thiotacide has been shown to increase the antioxidant defense system, decrease the peroxidation of lipids and the inflammatory process, and a decreased number of complications in a study of 45 patients.

Leeches
Surgeons at an Indian hospital have investigated the use of leeches (Hirudina medicanalis) in treating thrombosed hemorrhoids. They found the treatment reduced pain and mucous discharge in patients receiving leech therapy and improved quality of life. This is thought to be due to the antibiotic effects of leeches and their actions in breaking down mucus.