A thrombosed hemorrhoid is a hemorrhoid with a blood clot inside it, usually just outside the anus, showing up as a sudden, very painful, firm bluish-purple lump. Most go away on their own over two to three weeks. If the pain started within the last 48–72 hours, though, a doctor can remove the clot in the office under local anesthetic, and that gives the fastest relief.
What Is a Thrombosed Hemorrhoid?
Hemorrhoids are normal cushions of blood vessels in the anal canal. Everyone has them, and they help with continence. They only cause trouble when they swell. A thrombosis happens when blood pools in one of these vessels and clots. The clot stretches the tissue around it and triggers inflammation and swelling.
What does a thrombosed hemorrhoid look like?
Picture a round lump at the edge of the anus, roughly the size of a pea to a small grape. The skin over it is tight and shiny, and it looks blue, purple, or almost black because the clotted blood shows through. It feels firm, like a marble under the skin, rather than soft and squashy. There is usually one lump, though several can clot at once. After a few days you may see a small dark spot where the clot is pressing against the skin.
External vs internal thrombosed hemorrhoids
Most thrombosed hemorrhoids are external. They form below the dentate line, where the skin has plenty of pain-sensing nerves, and that is why they hurt so much. Internal hemorrhoids sit higher up, in lining that has very few pain fibers, so they usually bleed without pain.
| Feature | External thrombosed | Internal thrombosed |
|---|---|---|
| Location | Skin at the anal edge | Inside the anal canal, often prolapsed out |
| Pain | Sudden and severe | Severe once prolapsed and swollen |
| Appearance | Single bluish, firm lump | Swollen, dark, sometimes ulcerated tissue that can’t be pushed back |
| Usual care | Excision if early; otherwise conservative | Needs prompt surgical assessment |
An internal hemorrhoid can thrombose too, most often after it prolapses and gets trapped by the anal sphincter muscle (“strangulated”). This is less common than the external kind, but it is more urgent, because the tissue can lose its blood supply. See a doctor the same day.
Causes and Risk Factors
There is rarely one cause. The usual triggers raise the pressure in the anal veins or slow the blood flowing through them:
- Straining on the toilet, the most common trigger
- Constipation or diarrhea
- Sitting on the toilet for a long time
- Pregnancy and childbirth, especially the third trimester and the pushing stage
- Heavy lifting
- A low-fiber diet, which makes stools harder
Can weightlifting or heavy lifting cause one?
Yes, it can. When you hold your breath and bear down to lift something heavy (called the Valsalva maneuver), the pressure in your abdomen and pelvic veins rises sharply, and that pressure travels down into the hemorrhoidal veins. Lifters who already have hemorrhoids are more likely to get a thrombosis. Breathing out during the effort, not holding your breath, and not training while constipated all lower the risk.
Symptoms and Diagnosis
- Anal pain that comes on suddenly and is usually worst in the first 48 hours
- A firm, tender lump at the anal edge
- Pain when sitting, walking, or having a bowel movement
- Some bleeding if the clot wears through the skin
Diagnosis is made by examination. The doctor looks at the area and may do a gentle rectal exam. If they suspect an internal hemorrhoid, a fissure, or another problem, they may use a short scope called an anoscope. A few other conditions can look similar and need to be ruled out, including a perianal abscess, an anal fissure, rectal prolapse, and, rarely, a tumor.
Treatment Options
| Treatment | Best timing | What to expect |
|---|---|---|
| Excision (thrombectomy) | Within 48–72 hours of onset | Quick relief; done in the office; lowest chance of coming back |
| Incision and drainage | Early, when excision isn’t done | Fast relief, but clot can re-form |
| Conservative care | After 72 hours, or milder pain | Gradual improvement over 1–3 weeks |
| Hemorrhoidectomy | Repeated thrombosis or large hemorrhoids | Operating-room surgery; longer recovery |
How do doctors drain a thrombosed hemorrhoid?
Most doctors prefer to remove the whole clot, together with the small area of skin over it, rather than just cutting it and letting it drain, because the clot is less likely to form again. The procedure is done in the office and takes 15–30 minutes:
- You lie on your side and the area is cleaned.
- Local anesthetic is injected around the lump. This stings for a few seconds, then the area goes numb.
- The doctor makes a small oval cut over the lump and lifts out the clot, which is often in several pieces.
- The wound is usually left open to drain or loosely closed, and then covered with a gauze pad.
- You go home the same day. Most people feel the pressure ease right away. After about 72 hours the clot is already breaking down, so home care is preferred instead.
Recovery after excision
Expect some soreness and a little bleeding onto the gauze for a day or two. Swelling gets better over the first few days, and the small wound is mostly healed within about a week. Sit in a warm sitz bath several times a day, and always after bowel movements. Keep your stools soft, and use simple pain relief. Most people are back at work within a day or two.
Home care and topical treatments
- Sitz baths: warm water, 10–15 minutes, several times a day
- Fiber and fluids: about 25–30 g of fiber a day (psyllium is a good choice) and plenty of water
- Stool softener such as docusate, so you don’t have to strain
- Oral pain relief: acetaminophen or an NSAID such as ibuprofen; avoid opioids if you can, because they cause constipation
| Active ingredient | What it does | Note |
|---|---|---|
| Hydrocortisone | Reduces itching and inflammation | Use for no more than about a week unless your doctor advises otherwise |
| Witch hazel | Astringent; soothes itching and burning | Pads or wipes; gentle enough for frequent use |
| Lidocaine | Numbs the area for short-term pain relief | Can irritate the skin in some people |
| Nifedipine with lidocaine | Relaxes the sphincter and numbs | Prescription-only |
What to Expect in the ER
If the pain is too bad to wait for a clinic appointment, going to the emergency department is reasonable. You will be triaged, asked when the pain started, and examined. Depending on local practice, the ER doctor may remove the clot there and then under local anesthetic, especially within the first 72 hours. Otherwise they will control your pain and refer you to a surgeon or colorectal clinic. Either way, you will usually go home the same day with instructions for sitz baths and softening your stools.
Complications
What happens if a thrombosed hemorrhoid bursts?
Sometimes the clot wears through the skin on its own. You will see dark blood or clots on the toilet paper, and the pressure pain usually eases quickly. The bleeding is usually small and stops if you press on it gently. Keep the area clean with warm sitz baths. See a doctor if the bleeding is heavy or won’t stop, or if a pus-filled wound develops.
Infection and abscess
Infection is uncommon. Signs include pain that is getting worse after the first few days, spreading redness, pus, or fever, and these may mean a perianal abscess, which needs draining. Other rare problems are an ulcer that keeps bleeding and, after the swelling settles, a leftover skin tag, which is harmless.
When to See a Doctor
- Severe pain that began within the last 48–72 hours, when excision helps most
- A prolapsed hemorrhoid that is dark, swollen, and can’t be pushed back
- Heavy or ongoing bleeding
- Fever, spreading redness, or pus
- No improvement after two weeks of home care, or repeated episodes
- Any rectal bleeding over age 45 if you have not had a colonoscopy
Frequently Asked Questions
Can a thrombosed hemorrhoid go away on its own?
Yes. The body gradually reabsorbs the clot. Pain usually peaks around day 2–3, eases over the first week, and is gone within two to three weeks. It may leave a painless skin tag.
Can it come back?
Yes, especially if it was drained rather than removed completely, or if constipation continues. Soft stools, keeping toilet visits under about five minutes, not straining, and raising your feet on a footstool all help prevent it.
Key Takeaways
- A thrombosed hemorrhoid is a clot in a hemorrhoid, usually a painful, bluish lump outside the anus.
- Within 48–72 hours of onset, removing the clot in the office gives the fastest relief; after that, home care is standard.
- A burst clot usually bleeds only a little. Fever, pus, or worsening pain need a doctor.
- Internal hemorrhoids can thrombose too, and a trapped, dark prolapse needs to be seen the same day.
