HAEMORRHOIDAL THROMBUS

Do you experience intense pain in the anus, either when you go to the toilet or when you make simple movements, or even when you cough?

Has this pain popped up suddenly, and is it making your life extremely complicated, so much so that you can hardly move?

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Hemorrhoidal thrombus is the most disabling complication of pathological hemorrhoids, which can occur in any individual with even mild hemorrhoidal prolapse.

Often, the pain is so severe that the emergency room is urgently needed, so the condition cannot be neglected.

Read this page to find out what a hemorrhoidal thrombus is, why it is generated, and how it can be treated.

What are hemorrhoids?

Hemorrhoids are anatomical plexuses that are physiologically present in our anal canal, resembling the shape of soft pads.

They are formed by both veins and arteries, seamlessly joined together in what, in medical jargon, is called anastomosis.

Physiologically, we have two types of hemorrhoidal plexuses: the main ones, which are three (right anterior, right posterior, and left lateral) and two secondary ones, smaller, outermost toward the anal orifice.

The main task of hemorrhoids is to adequately flush the anal canal, and to participate secondarily in fecal continence.

In the absence of problems and pathology, hemorrhoids are not even felt, and remain in place vascularizing the entire anus.

If problems occur, however, the hemorrhoids can swell and become congested, giving rise to what is called hemorrhoidal disease, of which hemorrhoidal thrombus is a painful complication.

What is hemorrhoidal prolapse?

Hemorrhoidal prolapse, or otherwise referred to as hemorrhoidal prolapse, is a slow but progressive prolapse of hemorrhoids that, from their original location in the anal canal, slide downward, slowly extruding out of the anus itself.

The causes of this prolapse are not yet well known, but two main theories are speculated:

• The hemodynamic theory, which assumes a slow but steady exhaustion of the tissue inside the hemorrhoids, worsened by triggers such as childbirth, excessive and prolonged pouching during defecation, as well as certain types of sports and strenuous work, which increase intraabdominal pressure;
• The mechanical theory, which assumes inevitable aging of tissues with loss of fundamental collagen, which lumps pathological hemorrhoids with chronic venous disease, which in turn is based on familial inheritance

It should necessarily be noted that the two hypotheses are not in conflict with each other, and can still coexist, both being the cause of the onset of hemoroid prolapse.

What are the symptoms of hemorrhoidal prolapse?

Hemorrhoidal prolapse from symptoms often overlooked by patients for a long time, until the condition begins to become particularly disabling, causing a marked deterioration in quality of life.

The symptomatology of hemorrhoids is quite broad, but the most common symptoms are:

• Anal bleeding during or shortly after evacuation (called hematochezia), either on stool or toilet paper;
  
• Pain and burning during the act of defecation;
  
• Anal itching and mucus discharge;
  
• Tenesmus, that is, the feeling of not having emptied completely during evacuation;
  
• Proctitis and anitis, which are inflammations of the anus and rectum that generate itching and heat of the area;
  
• In case of hemorrhoidal thrombus, pain (often called unbearable) both during evacuation and throughout the day

Especially, hemorrhoidal thrombus is perhaps the most painful complication of pathological hemorrhoids, as well as the one that almost always makes the patient urgently ask for medical support.

What is a hemorrhoidal thrombus?

A hemorrhoidal thrombus is the most painful and common complication of hemorrhoidal disease.

It manifests symptomatically as a sharp pain, often defined as unbearable, that prevents both normal defecation and even trivial gestures and movements, such as walking.

The pain is caused by the formation of a thrombus, that is, a blood clot, in one of the external hemorrhoidal plexuses.

Not having continence valves inside (such as those found in veins, for example), stagnant blood from prolapsed hemorrhoids can easily clot, thus becoming a painful thrombus.

The pain is accompanied by the formation of a bluish-colored lesion in the perianal area, just at the gavage of the thrombosed hemorrhoid.

This pain, as mentioned earlier, in acute crises is difficult to bear, and creates great prostration for the patient, so much so that he or she urgently seeks medical care.

Although hemorrhoidal thrombus can also occur in internal hemorrhoids, the little innervation of internal hemorrhoids does not make it as painful and prostrating as that which can affect external hemorrhoids.

How is hemorrhoidal thrombus diagnosed?

A specialist proctological examination is necessary and sufficient for the diagnosis of a hemorrhoidal thrombus.

During the examination, it is relatively easy for an experienced proctologist to detect the presence of a hemorrhoidal thrombus, ruling out the potential presence of other lesions (such as anal fissures) that could cause similar symptoms.

What is the therapy for hemorrhoidal thrombus?

Therapy for hemorrhoidal thrombus depends in good part on its degree of pain and tolerability, not necessarily dictated by the volume of the hemorrhoidal prolapse that generated it.

There are large thrombi that are not painful or even felt by the patient and small thrombi that are extremely painful.

Conservative thrombus treatment is based on the observation that, over time, the hemorrhoidal thrombus (like any other venous thrombus) reabsorbs spontaneously, thus causing the inflammation to wane and then end.

However, this takes time, which can be reduced (within limits) with adjuvant medical therapy, such as:

• Relaxing tepid semicups, especially after defecation;
  
• Strict control of the diet, providing the right amount of fiber and the necessary hydration;
  
• Daily mobility, avoiding long sedentary periods;
  
• The use of local flavonoids, with soothing and inflammatory action;
  
• The use of painkillers as needed;
  
• Proper detention of the anus, with nonaggressive and soothing cleansers

Non-surgical medical therapy of thrombus takes many days, sometimes weeks, to give its effects.

Essentially, conservative therapy is only supportive of what, normally, our metabolism is inclined to do anyway (i.e., reabsorb the thrombus).

In the case of pain that is unbearable, so much so that it causes continuous torment to the patient and does not allow normal daily living, thrombectomy surgery is imperative and cannot be postponed.

What is thrombectomy?

Thrombectomy is the procedure of incision of the hemorrhoidal gavage that gave rise to the thrombus, to allow its exit and thus bring immediate comfort to the patient.

It is a minimally invasive surgical procedure that is performed on an outpatient basis by a Vascular Surgeon experienced in Proctology, using a small local anesthesia with lidocanine and adrenaline.

The incision is very small, and once the thrombus is purged, it is not sutured but simply medicated.

Healing occurs in a few weeks, while the disappearance of pain is almost immediate: the patient, already finished with the minor surgery, is immediately well, as the source of his pain, namely the thrombus, has been removed.

There may remain for a few days a slight inflammation of the operated area (entirely physiological) and the formation of a small inflammatory skin papilla, which is benign in nature and tends to reabsorb itself over time.

Although thrombectomy is immediately effective, it is not a cure for hemorrhoidal prolapse, but a symptomatic treatment of the thrombus.

That is, it does not prevent hypothetical new thrombotic formation in the future, and therefore, once healed from the minor surgery, the patient is still required to initiate appropriate therapy for hemorrhoidal disease.

I have crazy pain in my anus and I think I am suffering from hemorrhoidal thrombus, who can I contact?

The specialist physician who can help you and give you immediate relief for hemorrhoidal thrombus is the Vascular Surgeon perfected in Proctology, often referred to simply as a Proctologist.

He is the one who can diagnose your possible thrombus, and he is always the one who can intervene directly, even surgically, to make you feel better.

Remember that hemorrhoidal thrombus also has symptomatic elements common to other proctologic conditions, such as anal fissure, perianal abscess, and anal fistula.

This is why you should never start 'do-it-yourself' therapies, but should always visit an experienced and trained Proctologist Doctor.

Do you suffer from a hemorrhoidal thrombus, or think you do? Get immediate help from Dr. Luisella Troyer

Dr. Luisella Troyer is a Vascular Surgeon experienced in Proctology, who can help you with painful hemorrhoidal thrombus.

At her clinic in Dubai, Dr. Troyer can give you quick support to resolve the hemorrhoidal thrombus that is plaguing you, possibly including emergency surgical access and thrombectomy.