Thrombotic external hemorrhoids clinical characteristics

Written by Chen Tian Jing
Colorectal Surgery
Updated on March 14, 2025
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The clinical features of thrombosed external hemorrhoids primarily include acute episodes of localized swelling and pain in the anal area, with thrombosis forming in the local hemorrhoidal tissue. This condition is primarily due to dry stools and excessive straining during bowel movements, leading to congestion and edema in the local hemorrhoidal tissue and subsequent disruption of local blood circulation, resulting in thrombosis. After an attack, the anal hemorrhoidal tissue may display dark red or purplish clots, enclosed by the local skin and mucous membrane. Treatment options include the application of topical medications and hot compresses to promote absorption of the hemorrhoids, as well as local surgical excision. It is important to note that if rupture or bleeding occurs, considering the possibility of local thrombus rupture, it is essential to perform proper local cleaning and disinfection and to promptly proceed with surgical excision to prevent infection.

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Written by Chen Tian Jing
Colorectal Surgery
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Is surgery necessary for thrombosed external hemorrhoids?

Thrombotic external hemorrhoids do not necessarily require surgery during the acute phase of an attack. If the thrombotic external hemorrhoids are mild, Chinese herbal medicine can be used for local topical application to relieve symptoms. Early-stage or mild thrombotic external hemorrhoids may only form small thrombi, and the pain experienced by the patient is not very intense. Therefore, one can opt to use Chinese herbal washes for hot compresses and fumigation, along with the application of hemorrhoid cream to alleviate symptoms. However, it is only recommended to perform excision surgery for thrombotic external hemorrhoids if they are acutely recurring over a long period or repeatedly, severely affecting the patient's life. (Please use medication under the guidance of a professional physician and avoid self-medication.)

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Written by Deng Heng
Colorectal Surgery
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External hemorrhoids are divided into several types.

External hemorrhoids refer to hemorrhoids below the dentate line and are divided into four types. The first type is the connective tissue type of external hemorrhoids, which are formed by the proliferation and bulging of excess skin at the anal margin. The second type is the varicose vein type of external hemorrhoids, formed by the dilation and bending of the venous plexus below the dentate line. The third type is inflammatory external hemorrhoids, which is a state where external hemorrhoids become inflamed. The fourth type is the thrombosed external hemorrhoid, which is formed by bleeding due to the rupture of the subcutaneous veins at the anal margin, resulting in a blood clot.

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Written by Yu Xu Chao
Colorectal Surgery
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How to eliminate a two-centimeter external hemorrhoid?

The external hemorrhoid is about two centimeters in size, which indicates that it's relatively large. This condition can cause feelings of a foreign object in the anus, itching, and even moisture around the anal area, leading to anal eczema. If one wishes to completely eliminate it, it is advisable to go to the hospital's proctology department as soon as possible to have a hemorrhoidectomy. Post-surgery, one should choose anal cleaning solutions or potassium permanganate solution for sitz baths, complemented by external applications of medicines such as Jing Huang Gao or hemorrhoid creams. At the same time, the patient's diet should consist of light and easily digestible food to prevent dry and hard stools, which will aid in the healing of the surgical site. Additionally, patients should develop good bowel habits, maintain smooth bowel movements, and avoid sitting or squatting for long periods. Regularly performing anal lifting exercises can prevent the recurrence of external hemorrhoids. If patients prefer not to undergo surgery, conservative medical treatment can be used to reduce the size of the external hemorrhoids, but it cannot completely eliminate them.

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Written by Yu Xu Chao
Colorectal Surgery
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Does the surgical removal of external hemorrhoids hurt?

Surgical removal of external hemorrhoids generally does not cause significant pain because anesthesia is required for the procedure. There are options for anesthesia, including local infiltration anesthesia, spinal anesthesia, or general anesthesia via intravenous injection, ensuring the patient does not experience notable pain during the surgery. However, post-surgery sensitivity is higher because the external hemorrhoids are innervated by perineal nerves. Therefore, it is crucial to use pain relief medication appropriately when changing dressings to alleviate discomfort. Additionally, it is essential to prevent infection, inflammation, or swelling of the wound to reduce postoperative pain. Patients should also manage their bowel movements to avoid dry, hard stools; smooth bowel movements can somewhat relieve postoperative pain. If the pain is particularly severe, the use of diclofenac sodium suppositories for anal insertion can help reduce inflammation and pain. (Please follow medical advice regarding medication use.)

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Written by Yu Xu Chao
Colorectal Surgery
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Can external hemorrhoids use hemorrhoid suppositories?

In clinical practice, hemorrhoidal suppositories can also be used for external hemorrhoids. Since hemorrhoidal suppositories are mainly administered through the rectum to act locally, they have a certain therapeutic effect on external hemorrhoids, especially for varicose external hemorrhoids and inflammatory external hemorrhoids, helping to alleviate local swelling and pain. Additionally, for external hemorrhoids, it is often recommended to use anal cleansers, or to sit in baths with potassium permanganate or other medicated solutions, combined with the external application of hemorrhoidal cream or golden ointment. If symptoms do not show significant improvement after four to five days of medication treatment, it is advisable to visit a hospital's proctology department for external hemorrhoid surgery as soon as possible, to prevent potential thrombosis or necrosis of the external hemorrhoids. Moreover, patients should develop good bowel habits, avoiding prolonged sitting or excessive straining during bowel movements to prevent worsening of external hemorrhoids. (Medication should be used under the guidance of a doctor)