External hemorrhoids usually affect the dentate line in a distal way. They occur due to distention and swelling of the external hemorrhoidal venous system. Though an external thrombosed hemorrhoid is considered to be one of the most usual health disorders among people, it has not been properly studied yet.
Hemorrhoids are not a disease but vascular structures where the disease occurs. Initially, they work as cushions, helping the body control stool. However, as they swell and an inflammation starts, there comes the hemorrhoids as the illness. There are different types of the condition, but the most unpleasant and painful is thrombosed hemorrhoid.
Overall, 50-66% of people have issues with different types of the condition, both male and female. In most cases, these are the people of the 45-65-year old group, yet the disease can occur in any age. It lasts for several days, maybe more if the case is severe and a patient undergoes a surgery. Otherwise, there are lots of different surgical, non-surgical, and natural treatments, and the outcomes are usually good.
What is a Thrombosed Hemorrhoid?
Thrombosed Hemorrhoids is a type of hemorrhoid with a clot that partially or fully blocks blood flow. Additionally, inflammation starts, making the swelling worse and the condition more painful.
As a hemorrhoid becomes compacted with blood and a serious strain occurs, it can develop a blood clot. It’s a natural response of the platelets, the type of cells inhabiting our blood. When a vessel is damaged or blood “sits” there for too long, it starts to coagulate, creating clots.
It’s important that you act as soon as possible if you suspect you have the disease. The reason is that if the skin around is blood-deprived, the cells may start to die within 12 hours. In case the cells are completely blocked from blood flow (oxygen-deprived), necrosis in the area can start within minutes.
Pain builds up for 48 hours, reaching its peak, and during another 48 hours, it goes away gradually. 1-4 weeks may pass until the clot bleeds through the skin or becomes reabsorbed. However, not all cases are so fortunate, so it’s still recommended to consult your doctor when you notice the symptoms. The most appropriate time to visit a specialist and perform all necessary procedures is during the first 48-72 hours since the pain occurred.
Clotted hemorrhoid is usually diagnosed by sight, as it is accompanied with severe swelling, blueish, reddish, or blackish color, and inflammation.
Thrombosed Hemorrhoids Types
There are two types of such a thrombosis:
External thrombosed hemorrhoid is the most frequent type, when an affected blood vessel is outside the rectal canal. It is also the most painful type, described in some medical papers as “exquisite”, meaning sharp.
Internal thrombosed hemorrhoid doesn’t occur as often as the external type. However, blood clots can develop anywhere, and the vessels inside the rectal canal are not an exception. It is accompanied with severe inflammation and swelling, so the affected area usually comes out from the canal partially.
Symptoms of Thrombosed Hemorrhoid
The external type usually causes the following symptoms:
- Itching around the anal area.
Usually occurs within the first hours of clogging, when the pain only starts to build up.
- Severe pain.
Itching is then substituted with severe sharp pain in the area that becomes stronger to the peak.
As a result of blood vessel and skin damage, some bleeding may be present. This may also be a sign of a breakout that can ease pain to some extent by letting excess blood release.
- A swollen bulb visible at sight.
The bulb builds up very rapidly, as the blood fills the hemorrhoid and is trapped there due to the clog. Skin color changes due to its stretching and blood that is underneath.
- Difficulties with walking, staying, or sitting.
Pain and swelling may cause difficulties in performing primitive tasks and moves.
- Difficulties with stool passage.
If the bulb is large enough to block the rectal canal, stool passage becomes difficult, painful, often impossible.
The internal type is more difficult to diagnose, as the painful symptoms appear later. Nevertheless, one may have the following signs:
- Rectal bleeding.
Internal thrombosed hemorrhoid are easier to break, so some bleeding from the damage may be visible almost at once. The blood loss may become severe, so it’s important that the bleeding is noticed as soon as it begins. You can usually detect it after defecation.
During the first stages, pain is present only during bowel movement. However, if one doesn’t pay attention to it, the further inflammation and swelling will develop severe pain.
- Foreign body feeling.
One of the most distinguished symptoms of the internal type is the feeling of a foreign body in the lower part of the rectum.
- Burning and itching.
Due to the swelling and inflammation, the intestinal mucosa may produce a discharge that causes unpleasant itching and burning sensations.
- Fecal leakage.
As the muscles become weaker due to the aforementioned symptoms, rectal incontinence is frequent.
In severe cases, the bulge swells too much and expands through the anus, becoming visible at sight. Sometimes, surgery is needed for such cases.
- Difficulty in standing, walking, sitting, and urination.
While the first three difficulties are understandable, some people also experience difficulties with urinating. It usually happens due to excessive swelling.
Causes of External and Internal Thrombosed Hemorrhoid
The major causes are:
- Severe straining during bowel movements.
This usually occurs due to constipation or diarrhea that affect both the muscles and blood vessels within the rectal canal.
- Lack of standing.
If a person sits too much due to work or other difficulties (including problems with defecation), the blood flow in the area may become blocked. Therefore, it is very important to spend some time standing or walking during the day.
- Lack of exercise.
Sometimes, walking is not enough for clogged hemorrhoids prevention. All muscles in the body have to be toned, and it is only possible with workouts, even simple ones.
- Low fiber diet.
If a diet contains low amounts of fiber, the possibility of constipation is more frequent. As soft stools are one of the main helping factors in preventing thrombosed hemorrhoid, the amount of fiber becomes quite important.
Obese people have more pressure put on all their systems, including cardiovascular system. Blood vessels get a lot of strain in this case, often causing clogged hemorrhoids.
- Pregnancy and difficult childbirth.
As the fetus grows, excess pressure is put on blood vessels, sometimes damaging them, which may cause clogged hemorrhoids. Difficulties during childbirth make these potential causes worse, increasing the possibility of getting the condition.
With age, all tissues become weaker, making the risk of getting hemorrhoids bigger. As the tissues stretch and weaken, it’s easier to exceed their strain limit.
By now, specialists can’t fully explain the straight causes of the condition. However, the risk factors mentioned above are usually taken as causes.
Treatment Options for Both Types of Thrombosed Hemorrhoid
There are three types of treatment one may need:
- Non-surgical yet medicated.
For clogged hemorrhoids, four main surgeries are available:
This is a minor surgery that will relieve acute pain. It is usually performed right at the office, as no special conditions are needed. A doze of Lidocaine is injected in the affected hemorrhoid; a small incision is made when anesthetic comes into effect. The clot is then removed, so the main cause for the pain is eliminated. After such a surgery, swelling may be present for several weeks, but there will be no sharp pain.
- External hemorrhoid excision.
In case the symptoms are treated and the condition still comes into a recess, a full excision of the affected hemorrhoid is recommended. The medical office conditions may be sufficient for this kind of operation, yet it is only performed if the troublesome bulb is external. Some severe cases may need special conditions, so one will need to be hospitalized. Again, a doctor injects Lidocaine into the hemorrhoid and excises all of it, elimination the possibility of a recess. The recovery from such a surgery usually lasts from 3 to 7 days.
- Stapled hemorrhoidectomy.
For some cases, a stapled approach is the best treatment. It is the newest fully developed technology that doesn’t mean removal of the hemorrhoids. The approach tightens the stretched supporting tissue, preventing the condition to prolapse. Such a surgery is performed for about 30 minutes, and the period of recovery takes only a couple of days. The pain relief happens immediately after the main recovery.
- Rubber band ligation.
This approach helps with the internal type, and the procedure can be performed at a medical office. A doctor places special rubber bands around the base of the vein with an affected area. As a result, minor bleeding may occur and some discomfort may be present during 1-2 days after the operation. However, the treatment can help the hemorrhoid to decrease in size.
95% of thrombosed hemorrhoid can be treated without surgery. The non-surgical ways of treatment include:
- Laser therapy.
The affected hemorrhoid can be treated with a laser. During such a procedure, internal hemorrhoids hardens and scars, providing relief. As a result, the natural healing of thrombosed hemorrhoid goes faster.
This method can’t be described as a fully on-surgical one, as it requires injections. A chemical is injected into the affected hemorrhoid, causing the same effects as laser treatment. The bulb decreases in size, the inflammation disappears, and the hemorrhoid scars.
- Over-the-counter medications.
Different ointments and creams can be used to relieve pain and ease the symptoms. However, this approach has to be combined with some other treatment options, as it doesn’t cure the disease.
Solar therapy is also one of the best treatments of internal hemorrhoid. One should ask a doctor for a piece of advice before attempting to treat thrombosed hemorrhoid with such a technique.
A number of natural types of treatment are available:
- Warm Sitz baths.
Pour some warm water (the height of a few inches) into the bath and sit there for 15-20 minutes 3 times a day. Such baths will help decrease inflammation, but it’s important to clean the anal area dry after every bath. This will prevent further itching and irritation.
- More fluid consumption.
Dietary changes that will help treat and prevent hemorrhoids include adding more liquids to your everyday ration. This will help you avoid constipations that are one of the main reasons for hemorrhoids developing.
- More fiber consumption.
Another dietary change is increasing the amount of fiber in meals. This will also prevent constipations, making the stool soft enough not to irritate or strain the muscles and vessels.
- Stool softeners.
Aside from fiber, there are other natural stool softeners, including vegetables and fruits. Potato juice before 3 meals can also help improve a hemorrhoid-treating diet. If one needs an additional softener, a doctor may help by prescribing dietary supplements.
After consulting with a proctologist, one should implement certain simple exercises in the daily life. Sitting on air is one of the best exercises to treat and prevent hemorrhoids. A rubber donut can also be used – you can get one at any pharmacy.
- Natural defecating.
Some people tend to postpone bowel movements for extended periods of time. This is highly dangerous for an existing condition or a treated one that can come to a recess.
Things to Know When You Notice Bleeding and Pain
While calling a doctor and planning an appointment is the first priority, there are some things to do when you notice any of the symptoms.
- Try to stop the blood.
This is a basic symptom of hemorrhoids, even though other conditions may be the reason. The main thing to do is to stop the bleeding to prevent any infection, without panic.
- If there is no bleeding, take a warm bath.
In case you feel sharp pain, take a warm bath for 15-20 minutes. You can add Epsom salt for better treatment, and make sure you take the bath 3 times a day if you don’t visit a doctor during this time.
- Consider using moist towelettes.
Regular toilet paper can be too irritating to your skin in such a condition, so softer methods of cleaning may be needed. Besides, such towelettes often include calming substances like aloe, which can help decrease inflammation.
- Apply special creams.
It’s better to consult your doctor before using any creams, but they can help treat certain stages of thrombosed hemorrhoid. Some of them can help stop bleeding, other’s will reduce inflammation and irritation.
If there are no complications, thrombosed hemorrhoid bleeding can stop by itself in 2-3 days. However, if you decided not to visit your doctor at once and the symptoms continue for a week, it’s imperative that you consult a specialist about your condition. Self-treating without sufficient knowledge of the severity of your condition can make things much worse.
Dangerous Complications of Thrombosed Hemorrhoid
Gangrene is caused by complete blood flow blocking that in its turn causes oxygen and nutrient deprivation. It isn’t the case if small capillaries are not blocked along with the main blood vessel. These capillaries are present in every system of a human body, ensuring even minor blood flow everywhere. When they become blocked, gangrene develops pretty fast if the vessels are not unclogged in time.
Septicemia is blood poisoning, usually caused by bacteria or excessive intoxication. Some of the symptoms are high fever, nausea, pain in the abdomen, anxiety, difficulties with breathing, and tachycardia. During hemorrhoids bleeding, bacteria can get into the blood, causing a dangerous complication.
- Clot migration.
This is not completely a complication if the clot migrates back to the blood stream, dissolving there. However, if it doesn’t, it can cause the same troubles in another part of the body.
Hemorrhoids Can Be Dangerous
Simple hemorrhoids is a regular condition that is usually easily treated. Such a disease occurs due to excessive strain and blood flow difficulties inside the rectal canal and around the anal area. However, when it becomes thrombosed, severe problems may occur due to worsening of the main cause. Thrombosis is a blood clot that blocks the flow partially and completely, causing more dangerous consequences.
It is highly important that a person pays attention to the symptoms of hemorrhoids and consults a specialist as soon as possible. Fortunately, thrombosed hemorrhoid is usually quire easy to detect, so the treatment can be given in short time.
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