Thrombosed External Hemorrhoid

• Painful swollen, bluish lump at anal orifice

• Within 48 hours BEST for excision

• After 48 hours-symptoms usually improved,

• Incision and drainage of thrombus now not recommended. No evidence

  for surgical therapy (1)

• Management controversial with no specific guidelines (2)

• Non surgical management

• First line dietary: increased fiber and water

• Lifestyle changes: avoid hard, retained stool and straining

• Symptom relief: flavonoids (natural substances found in fruits, vegetables,

  grains, roots, stems, flowers) and phlebotonics (class of drugs consisting of plant extracts)

• Sitz baths, oral pain meds (3)

• Topical muscle relaxant for thrombosed or strangulated hemorrhoids: 0.3% nifedipine and 1.5% lidocaine ointment q 1h for 2 weeks

• Steroid creams used for a maximum of 7 days to avoid thinning of the surrounding

  mucosa

(1) Urgent Care RAP 2022 www. hippoed.com/urgentcare/rap

(2) Picciarello et al (2022) Front Surg 2022 May 3; 898850.doi:          10.3389/fsurg2022.898850 - Search (bing.com)

(3) Alldinger et al (2022) Langenbacks Arch Surg May; 407(3):1251-1256.doi:10.1007/s00423-021-02415-2