Thrombosed hemorrhoid that won't go away - please help!

[elusionz]

Hi all,

I've been suffering from hemorrhoids for the past 5 years, and finally decided to go see a colo-rectal specialist 6 months ago when I had a very intense flare up of external hemorrhoids that were thrombosed. The pain was so bad that I had to take time off from work and could not sleep at night because of the pulsating pain. During my visit to the specialist, he informed me that my hemorrhoids were not severe enough to warrant a hemorrhoidectomy and that the rubber-band ligation was strictly reserved for internal hems (which I do not have). He advised me to follow a high-fiber diet and everything would be dandy; I wasn't so sure. So, some time went by after my visit and of course the hems have returned. Looking in the mirror, and feeling around the area, I noticed that there is another thrombosed hem forming. It feels like a hard round pebble under the skin (but it is probably HALF the size of a pea this time...very small). I do not know if it will get bigger, but it has been this way for the past few months. I also see the remnants of my previous thrombosed hemorrhoids that do not have hard lumps, but instead show a pale blue color under the skin. My questions to the community:

(1) I've read that thrombosed external hems typically go away on their own after 1-2 weeks. Why then, in my case, do I still have a small hard pebble (clot) under the skin after many months?

(2) I've also read that you must see a doctor within 72 hours to effectively deal with/remove a thrombosed hemorrhoid. Why is that the case? It's been months, and mine is still here. Can the clot still be removed?

(3) I know this might sound silly, but will my anal region ever return to a pink colour all over, or am I plagued with the faint spots of purple under the skin for the rest of my life? It is almost as if hemorrhoids never truly go away...even AFTER a flare up, there is still a slight bulge and pale purple color to the area. Very frustrating.

Thanks in advance. Really looking forward to some feedback.

[elusionz]

Thank you for your response. Can you also attempt to answer my first question? I am concerned as to why there is still a small pebble/clot after many months. I thought when thrombosed hemorrhoids cleared up that the clot would also disappear completely. Is that not true?

[Paderla Anitha, DNB]

Hi, surgical therapy is the best option to prevent recurrence and for resolution of symptoms. Acute pain and thrombosis of an external hemorrhoid within 48-72 hours of onset is an indication for excision. According to studies done, surgical treatment resulted in much faster symptom resolution, as well as a lower frequency of recurrence. In another study, in comparison with simple incision or topically applied 0.2% glycerin trinitrate ointment, thrombosed external hemorrhoid excision improved recurrence rates, symptoms, and residual skin tags at 1-year follow-up. So, for complete resolution consult your doctor for surgical management. Regards.