At a glance
A thrombosed hemorrhoid is an external hemorrhoid in which a blood clot has formed. It typically shows up suddenly — often overnight or after straining — as a firm, painful lump near the anus. The lump may appear blue or purple under the skin.
This is one of the more alarming hemorrhoid experiences people describe. The pain can be intense, but it is treatable and does resolve.
This page covers what people commonly experience, the typical timeline, and when to seek care.
What happens
A blood clot forms inside an external hemorrhoid, causing it to swell rapidly. This often happens:
- After a period of straining or constipation
- After heavy lifting
- During or after pregnancy
- Sometimes with no obvious trigger at all
People frequently describe waking up with a sudden, painful lump they have never noticed before. The surprise is part of what makes it distressing.
Common patterns people report
- A sudden, firm lump near the anus that was not there the day before
- Intense pain that makes sitting, walking, and bowel movements difficult
- The lump may feel hard and be tender to touch
- Skin over the lump may appear blue, purple, or dark
- Pain is often most severe in the first 48 to 72 hours
- Some people describe gradual improvement after the initial peak
- The clot may eventually be reabsorbed by the body over days to weeks
- A skin tag may remain after the swelling resolves
The pain timeline
Based on what people commonly describe:
- Day 1 to 3 — the most intense period. Pain may be constant and severe. Sitting is often very uncomfortable.
- Day 3 to 7 — many people notice gradual improvement. Pain begins to shift from sharp and constant to a dull ache.
- Week 2 to 3 — swelling and discomfort continue to decrease. The lump softens and shrinks.
- Week 3 and beyond — most people report significant improvement. A residual skin tag is common and usually painless.
These timelines vary. Some people recover faster, some slower.
What tends to help
- Warm sitz baths — 10 to 15 minutes, several times a day. People consistently report this as one of the most soothing measures.
- Ice packs — brief cold application (wrapped in cloth) in the first day or two may help reduce swelling for some people.
- Pain relief — over-the-counter pain relief may help. Talk to your doctor or pharmacist about what is appropriate for you.
- Stool softening — fiber, hydration, and avoiding straining to prevent worsening during recovery.
- Gentle cleaning — water or unscented wipes rather than dry toilet paper.
- Rest — avoiding heavy lifting and prolonged sitting during the acute phase.
When it may need intervention
A doctor may recommend a procedure to remove the clot if:
- Pain is severe and not improving
- You seek care within the first 48 to 72 hours (the window when excision tends to be most helpful)
- The clot is very large
This is a brief in-office procedure. After that window, the clot is often already beginning to resolve, and doctors may recommend conservative care instead.