Office-based surgery in which a sudden clot (thrombus) in the external hemorrhoidal veins around the anus is evacuated through a small incision, providing rapid pain relief — most beneficial when performed within the first 72 hours of symptom onset.
Indication
- Acute, severely painful thrombosed external hemorrhoid
- First 48-72 hours after symptom onset (when benefit is highest)
- Inadequate response to local cold application, sitz baths, and pain relievers
- Large swelling that significantly impairs walking, sitting, and bowel habits
- Lesions at high risk of skin necrosis or spontaneous rupture
Preparation
- Diagnosis is confirmed by anal examination and, when needed, anoscopy
- Use of blood thinners is reviewed and managed with physician approval if necessary
- The procedure area is cleaned and the patient is placed in an appropriate position (lateral or reverse Trendelenburg)
- Informed consent is obtained and allergy history is reviewed
- Emptying the bowel before the procedure is recommended
How it's performed
- The skin overlying the clot is numbed with local anesthesia
- The clot is evacuated through a small (usually elliptical) incision
- When possible, the entire clot is removed; if needed, the skin edges are minimally trimmed
- Mild bleeding is controlled with hemostasis; tight sutures are usually not required
- The wound is left open and protected with gauze or a hemorrhoid pad to allow drainage
- The procedure is generally completed within 10-20 minutes
Post-procedure
- Warm sitz baths 2-3 times a day for 10-15 minutes
- High-fiber diet and adequate fluid intake; stool softeners if needed
- Topical anesthetic / antiseptic creams as recommended by the physician
- Pain relievers (paracetamol / NSAIDs) used as needed
- Follow-up examination within 7-14 days; symptoms typically resolve significantly within 1-2 weeks
Risks
- Mild bleeding or discharge after the procedure (usually for a few days)
- Local wound infection (rare)
- Recurrence of the clot or hemorrhoid (especially with underlying hemorrhoidal disease)
- A residual skin tag, which may cause cosmetic concern over time
- Temporary pain or, rarely, allergic reaction to local anesthesia
FAQ
Is there immediate relief after the procedure?
Yes, most patients feel significant relief within hours, because the main cause of pain is the pressure created by the clot. Mild discomfort for 2-7 days is normal and is managed with sitz baths and simple pain relievers.
Could medication be enough instead of the procedure?
For patients presenting within the first 48-72 hours with severe pain, thrombectomy is the most effective treatment. In late presentations or mild cases, warm baths, creams, and pain relievers may be sufficient.
When can I return to normal life?
Most patients go home the same day. Return to office work is usually possible within 1-2 days, and to heavy physical work within 5-7 days. Avoiding prolonged sitting and heavy lifting in the first few days is recommended.
Will hemorrhoids never come back?
Thrombectomy resolves the pain of the current attack but does not cure the underlying hemorrhoidal disease. A high-fiber diet, fluid intake, and improved bowel habits reduce the risk of recurrence; for definitive treatment, band ligation or hemorrhoidectomy may be considered.
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