Quick answer: a thrombosed haemorrhoid is a blood clot inside an external haemorrhoid. It causes a hard, painful, purple lump next to the anus. If the thrombosis is external, the haemorrhoid can be excised with a procedure during the first 72 hours, which improves symptoms and stops that same haemorrhoid from becoming inflamed again. After that time, excision gives no advantage for how the episode evolves, and it is managed with pain relief and local measures. If the episode is internal, treatment is always medical and excision is not recommended. Removing only the clot (thrombectomy) is not recommended.
What is a thrombosed haemorrhoid?
It is a blood clot that forms inside an external haemorrhoid. It appears suddenly and, unlike ordinary haemorrhoids, it usually hurts from the start. It often coincides with straining, constipation, diarrhoea, pregnancy or long hours of sitting, although sometimes there is no clear trigger.
Symptoms
- A hard lump next to the anus that appears quickly
- Purple or bluish colour
- Severe pain, especially when sitting, walking or passing a stool
- Itching, irritation or a feeling of tightness in the area
- Sometimes a little bleeding if the skin breaks
Not every lump at the anus is a thrombosed haemorrhoid. An abscess, a fissure or a skin tag can look similar, and less often there are more serious causes. That is why it is worth having it seen by a specialist.
What can you do at home in the meantime?
- Take an ordinary painkiller if you need one
- Avoid straining and do not spend long on the toilet
- Eat fibre and drink water regularly to keep stools soft
- Do not prick or try to open the lump at home
- If you take blood thinners, do not stop them on your own; speak to a doctor
Treatment: it depends on whether the episode is external or internal
External haemorrhoidal episode
When the thrombosis is external, the haemorrhoid can be excised with a procedure during the first 72 hours. At that point excision improves symptoms and stops that same haemorrhoid from becoming inflamed again in the future.
After 72 hours, excising the external haemorrhoid no longer brings an advantage for how the episode evolves. In that case it is usually managed with pain relief and local measures while the clot is reabsorbed.
Internal haemorrhoidal episode
In an internal episode, treatment is always medical and excision of the haemorrhoid is not recommended.
Removing only the clot (thrombectomy)
It is currently not recommended for haemorrhoidal episodes. When an external thrombosis is treated within the first 72 hours, what is done is to excise the haemorrhoid, not to take out the clot alone.
That is why it is worth seeking advice as soon as possible and not waiting for it to go away on its own. More information: when is surgery necessary for haemorrhoids? and our haemorrhoid treatment page.
⚠️ Go to the emergency department or contact the clinic immediately if the pain is very severe and getting worse, there is heavy bleeding with clots, fever, or you cannot pass urine.
Frequently asked questions
How long does a thrombosed haemorrhoid last?
Pain is usually worst in the first 48 to 72 hours and then gradually improves. The lump can take longer to disappear completely.
Does it go away on its own?
It often improves with time, but waiting means days of pain. If it is external and assessed within the first 72 hours, the haemorrhoid can be excised and the discomfort settles sooner.
Is it dangerous?
In itself it is not usually dangerous, but it is very painful and can be mistaken for other problems. A specialist should assess it to confirm the diagnosis.
Can it come back?
If the thrombosed haemorrhoid is excised in time, that same haemorrhoid does not become inflamed again. Others can appear, so it is worth preventing constipation, eating fibre and drinking water.
What if the haemorrhoidal episode is internal?
In an internal episode, treatment is always medical and excision of the haemorrhoid is not recommended.
Can the clot be removed on its own?
It is not recommended. Removing only the clot (thrombectomy) is currently not recommended for haemorrhoidal episodes. In an external thrombosis within the first 72 hours, the haemorrhoid is excised.
¿Tienes síntomas o dudas sobre tu caso?
Consulta con el Dr. Jaime Jorge Cerrudo. Diagnóstico y tratamiento en el mismo acto en la Clínica de San Pío, Almería.
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- van Tol RR, Kleijnen J, Watson AJM, et al. European Society of ColoProctology: guideline for haemorrhoidal disease. Colorectal Dis. 2020;22(6):650-662. ESCP
- Gallo G, Martellucci J, Sturiale A, et al. Consensus statement of the Italian Society of Colorectal Surgery (SICCR): management and treatment of hemorrhoidal disease. Tech Coloproctol. 2020;24(2):145-164. PubMed Central