At a glance
A thrombosed hemorrhoid is a sudden, painful lump caused by a blood clot forming in an external hemorrhoid. The first 72 hours are the most painful and also the window during which a minor procedure (excision) can provide rapid relief. This guide covers what to do during this critical period.
What has happened
A blood clot has formed inside an external hemorrhoid. This causes:
- Sudden onset — the lump appears quickly, sometimes within hours
- Significant pain — often described as the worst pain people have experienced from a hemorrhoid
- A firm, tender lump — usually blue or purple, clearly visible and palpable
- Swelling around the area
The first 24 hours
Immediate self-care
- Sitz baths — warm water for 10 to 15 minutes, as often as practical. This provides the most consistent relief.
- Pain medication — over-the-counter anti-inflammatory medication (ibuprofen) if you can take it, combined with paracetamol. The anti-inflammatory effect is particularly helpful.
- Ice packs — wrapped in a cloth, applied for 10 to 15 minutes at a time. Some people alternate warm baths with cold packs.
- Stool softeners — start immediately if not already taking them. A hard bowel movement will make things significantly worse.
- Rest — avoid prolonged sitting if possible. Lying on your side reduces pressure on the area.
The decision: wait or see a doctor now?
This is the key decision point. Within the first 48 to 72 hours, a doctor can perform a simple excision — cutting a small incision and removing the clot. This provides rapid pain relief for many people.
Consider seeing a doctor promptly if:
- The pain is severe and not controlled by over-the-counter medication
- You want the option of excision before the 72-hour window closes
- The lump is very large
- You are unsure whether it is a thrombosed hemorrhoid or something else
Conservative management is reasonable if:
- The pain is manageable with medication and sitz baths
- You are past the 72-hour window
- The lump is small
- You prefer to let it resolve naturally
The excision procedure
If done within 72 hours:
- A local anaesthetic is injected around the area
- A small incision is made in the hemorrhoid
- The clot is removed
- The wound may be left open to drain
- Pain relief is often immediate and dramatic
- Done in a clinic or emergency department — no hospital stay required
After 72 hours, excision is less commonly offered because the body is already beginning to resolve the clot and the procedure provides less benefit.
Hours 24 to 72
If managing conservatively:
- Continue sitz baths (three to four times daily)
- Continue pain medication on a regular schedule (not just when pain is bad)
- Keep stools soft — fibre, water, softeners
- Avoid sitting for long periods — use a cushion when you must sit
- Monitor for signs that require urgent attention (see below)
The pain typically peaks during this period and then begins to gradually improve.
After 72 hours
From day three onwards, most people describe:
- Gradual reduction in pain
- The lump beginning to soften
- Returning to daily activities, though with some discomfort
- Full resolution over one to three weeks
The lump may leave a residual skin tag after the clot resolves. This is common and not harmful, though some people find it bothersome.
When to seek urgent care
- Heavy bleeding that does not stop with pressure
- Fever or signs of infection (increasing redness, warmth, discharge)
- Pain that is getting worse after the first 48 hours rather than improving
- Inability to urinate
- Multiple thrombosed hemorrhoids or significant surrounding swelling