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Thrombosed Internal Hemorrhoid: Causes, Symptoms, Treatment

Updated on August 26, 2017
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Hitting the gym too much resulted in such an unpleasant condition as thrombosed hemorrhoids. I want to share what I learned about the issue.


I was am an eager gym-goer, but I made a mistake many working out people do – I exercised with excessive weights. After a couple of months of such a regime, I noticed symptoms of hemorrhoids, and as they became more severe, my way has begun.

The first thing I did after visiting a specialist was learning more about the condition, its causes and treatment. I’m such a guy that wants to know everything about the issues I face.

What Is Thrombosed Internal Hemorrhoid?

A thrombosed internal hemorrhoid develops when a blood clot forms in a weakened “venous cushion” – a normal structure. The condition is usually not dangerous for your health, but very painful. Acute pain and bluish or blackish color are the main symptomatic differences between a normal hemorrhoid and a type in which thrombosis has occurred.

Thrombosis is a general term referring to the blockage of blood flow in an area due to a clot obstructing a vein or artery, which can occur in piless, causing the painful condition which is generally simply called “hemorrhoids”. A thrombosed hemorrhoid is rarely internal, and if such a condition develops, the piles usually prolapse. This means it swells to the extent that it moves out and may be visible through the anus. A regular internal type may turn into a thrombosed one when prolapsing, as the blood flow gets blocked even more.

About 10 million Americans get this condition every year, yet only a small percentage of them gets thrombosed type.

Internal Vs. External Thrombosed Hemorrhoid

Thrombosed piles are most often external. Even if the condition starts internally, when thrombosis develops, the bump usually becomes almost as accessible as the external as it prolapses.

External piles develop under the skin around the anus, while the internal type develops deeper into the rectum. The external type aches constantly, while the internal may only bleed and cause minor discomfort. However, the factors leading to both conditions are the same.

Causes of Thrombosed Internal Hemorrhoids

The causes include:

  • Improper diet.
    Lack of fiber and fluids in your diet may cause of constipation and difficulties in bowel movement. This creates excessive strain on the muscles and the cushions themselves, which may partially block blood flow in the area.
  • Constipation.
    Constipation itself causes strain on hemorrhoid tissue, which can cause blockage. Constipation can also be caused by a lack of physical activity or certain medical conditions affecting the digestive and excretory tract.
  • Excessive exercise.
    In contrast to hemorrhoids caused by inactivity, too much exercise with heavy weights and improper techniques may put excessive strain on the muscles and blood vessels. Prolonged pressure may cause one or several of the cushions to swell, prolapse, or clot.
  • Pregnancy.
    During pregnancy, the fetus puts much pressure on the vena cava (or the large vein draining the intestinal veins). In addition, increased amounts of progesterone in pregnancy relax the vein walls, making them more vulnerable to swelling. Moreover, many women suffer from constipations when pregnant, which is a known reason for hemorrhoids.
  • Aging.
    As a person ages, all the tissues become weaker, including the vascular cushions. Loosened vessels are more prone to swelling and clotting. So, the weaker the tissues are, the higher the possibility of developing thrombosis in an internal hemorrhoid becomes.
  • Genetics.
    A predisposition to piles may also be inherited. In such cases, the condition may develop as a chronic one, which needs persistent attention.
  • Complications from treating regular hemorrhoids.
    Some patients suffer from the condition after rubber band ligation – a popular treatment for the regular 1-2 grade type of piles. Natural treatments like increased fiber intake or Sitz baths usually don’t result in such complication.

Symptoms of Thrombosed Internal Hemorrhoids

The symptoms include:

  • Acute pain.
    The first noticeable symptom is acute pain that continues during the first 48-72 hours of blood clot formation. By the fourth day the pain starts to wear away, however, by that time many people are already treating the condition as prescribed by a specialist.
  • Bleeding.
    Bleeding with or without defecation is one of the most common and recognizable symptom of a hemorrhoid. If a patient is anemic, there will be reduced or no bleeding, so the diagnosis should be done according to other symptoms.
  • Swelling.
    Excessive swelling is a sign of piles. However, if the swollen pad is internal, the affected tissues may not be immediately noticeable.
  • Irritation.
    As the pain gets weaker or just starts to build up, the patient may also feel strong irritation due to the processes going on within the condition.
  • Feeling of incomplete defecation.
    Thrombosed internal hemorrhoids can cause a feeling of incomplete defecation because the swollen area is in the rectal cavity. It’s important to be careful in this case, as more strain may cause complications or worsen the condition.
  • Bluish or blackish color.
    A prolapse of the internal pile will result in the appearance of a bump on the outside of the anus. The color of a thrombosed hemorrhoid is noticeably darker than normal.
  • Difficulties standing, walking, or sitting.
    Due to swelling, itching, and pain, it may be uncomfortable to stand, sit, or walk. Lying down becomes the best option before the treatment is applied.
  • Difficulties urinating.
    Some people also experience difficulties with urinating, or dysuria, due to discomfort associated with the muscular stress of urination.

However, if the swollen pad is internal, the affected tissues may not be immediately noticeable.

Complications of Thrombosed Internal Hemorrhoid

If you don’t pay attention to the condition, you may get an infection or experience tissue necrosis. In case the blood clot doesn’t block the flow completely, the area may still get oxygen and maintain bloodflow. It may interact with the clot that may have become stale by that time, developing infections. The percentage of patients who get an infection is very small, though.

In case there’s not enough oxygen, ulceration may develop. Ulceration is a condition in which tissue breaks down and builds up toxins. This increases the pain and may also cause septicemia – blood poisoning.

Complicated cases of thrombosed internal hemorrhoids may cause tissue necrosis in the area of the blocked blood vessel. Gangrene, which is a life-threatening condition, may develop as a result. The affected piles may bleed as the result, relieving from pain due to the decompression of the swollen area. However, it’s crucial to visit a doctor if this happens, as the tissues may need to be excised and the blood clot evacuated if it’s still there.

While all these complications appear rarely, they primarily result from a lack of attention to the condition. So, it’s highly recommended to consult a specialist once you notice such symptoms.

Treatment of Thrombosed Internal Hemorrhoid

Most clots in thrombosed hemorrhoids reabsorb back into the blood flow on their own, relieving the pain and decreasing the symptoms. So, they can be treated in a non-surgical way with the help of consultation from a colon or rectal surgeon. However, some patients prefer surgical intervention to get faster relief from the pain and discomfort.

Some patients who prefer non-operative treatment need about three weeks to fully recover from the condition. Those who prefer surgery usually recover from the condition in less than a week assuming no complications arise. Nevertheless, some surgeons recommend the non-surgical treatment for patients without severe cases. The point is that the pain after the excision may last much longer and be even more severe than the pain from the hemorrhoid itself.

Non-Surgical Treatments

Here are some of the ways to relieve pain, decrease the symptoms, and treat the condition:

  • Pain relievers.
    Try using an over-the-counter medication that includes ibuprofen or acetaminophen. You might want to ask your doctor first to know what will work best in your case. Pain relief will help you handle all the necessary procedures.
  • Creams and/or ointments.
    Special medicine may help reduce swelling and itching, as well as help soften the blood clot and allow it to reabsorb faster.
  • Sitz baths.
    Pour several inches of water in a tub and sit there for 10-15 minutes two-three times a day. This will improve blood circulation and help relieve pain. You can get a special plastic tub for the procedure or use your regular bath tub.
  • Cold compresses
    If your doctor approves, try to apply cold compresses or ice on the affected area. This will help reduce swelling.
  • Change your diet.
    Add some fiber and liquids to your diet – they will help avoid constipation. Potato juice is a good laxative, should you become constipated, but you should consume it carefully not to cause diarrhea.
  • Reduce straining.
    During the treatment and afterwards, make sure you reduce straining during bowel movements and by avoiding carrying heavy weights. The condition can recur if you don’t eliminate the reasons why it has developed in the first place. Instead, strengthen your abdominal and lower pelvic muscles to avoid the recurrence.

Surgical Treatments

Surgical treatments for thrombosed internal hemorrhoid include hemorrhoidectomy and external thrombectomy.

Hemorrhoidectomy is excision of the whole affected area that is performed by a surgeon with a scalpel or a laser. The patient may request a full or local anesthetic. It’s the best to perform the surgery within the first 48-72 hours after the initial development of the condition, as this will lead to a faster recovery.

External thrombectomy is the draining of the clot. A small incision is made in the pile, through which the clot is removed. The operation is usually performed while the patient is under local anesthetic. The best time to go for such a surgery is 24-72 hours after the onset of primary symptoms. Such a procedure provides quick pain relief, but the clot may form again in the same place later on. Also, in some cases, the clot may be only partially removed, which may not be enough to restore sufficient blood flow in the area.

After any of the procedures it best to continue treatment with Sitz baths and any prescribed medication.

Preventing Thrombosed Internal Hemorrhoids

If you don’t suffer from the condition and want to prevent it, you can do the following things:

  • Enrich your diet with fiber.
    Adding more fiber to your diet helps to prevent the condition. Consume about 25 g (for women) or 38 g (for men) of fiber every day as fruit, vegetables, and whole grains. If you can’t add more fiber through fiber-rich foods, discuss the possibility of fiber supplements with your doctor, and let them help you pick out the one that will help you the most.
  • Drink 8 glasses of water a day.
    Plenty of fluids, especially water, helps digest food, soften stool, making bowel movement easier as a result.
  • Don’t hold for too long.
    Relieve yourself as soon as you have the need to, or the stool might become dry. This will make it more difficult to pass, which will create strain – the main cause of the condition.
  • Avoid sitting too much.
    Whether you sit on a chair or on the toilet, make breaks to relieve the veins in the anus of the pressure such a position creates.

through fiber-rich foods, discuss the possibility of fiber supplements with your doctor, and let them help you pick out the one that will help you the most.

Grading of Internal Hemorrhoids

As an important note, not all piles are thrombosed or dangerous. There are four grades of the severity of the condition according to the degree of prolapse, as proposed by Banov L.Jr. in 1985:

  • Grade I.
    The affected hemorrhoid is mildly swollen and bleeding but not prolapsing.
  • Grade II.
    The affected pile partially prolapses with strain but spontaneously reduces.
  • Grade III.
    The affected hemorrhoid prolapses with strain and needs to be manually replaced back in to the rectum.
  • Grade IV.
    The affected pile prolapses and can hardly be manually reduced.

Most frequently, thrombosed internal hemorrhoids develop as the grade IV condition, where it also has some of the symptoms of the external condition. These include a visible bump and increasing acute pain. Additionally, since the cushion is in the rectum, it may not ache a lot as there are almost no pain nerve endings.

As soon as you understand something is wrong, it’s critical that you seek help to prevent thrombosis and/or complications resulting from improper or inadequate treatment. Also, don’t repeat my mistakes and do everything you can to prevent the condition, as it may become chronic.

Also, don’t repeat my mistakes and do everything you can to prevent the condition, as it may become chronic.


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