Thrombosed External Hemorrhoids
Anne D. Walling
(Australia–Australian Family Physician, January 2001, p. 29.) External hemorrhoids arise from the vessels in the dermis of the lower anal canal distal to the dentate line. Pathologically, hemorrhoidal tissue has the appearance of dilated vascular channels with longstanding inflammatory changes. While many symptoms of external hemorrhoids are minor, thrombosis can produce moderate to severe pain, a worrying mass and, occasionally, dark red bleeding. If symptoms are mild, the first episode of thrombosed external hemorrhoid may respond to a conservative treatment strategy of sitz baths (immersion in warm water for 15 to 20 minutes twice daily), stool softening and oral analgesia. Patients with severe or prolonged symptoms generally require excision of thrombosed hemorrhoidal tissue under local anesthetic. The thrombosed hemorrhoidal vein and overlying skin are excised using elliptical excision, but care must be taken to avoid damaging the anal verge. Sutures may not be required because most excisions heal well using the conservative measures described above. Simple incision and clot evacuation are not recommended because of the high recurrence rate of thrombosis.
COPYRIGHT 2001 American Academy of Family Physicians
COPYRIGHT 2001 Gale Group