Incision And Drainage Of Thrombosed Hemorrhoid

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Most treatment is local and nonsurgical unless a complication is present. Hot sitz baths for at least 15 min three times a day and after each bowel movement are the most effective way to relieve pain. Following the bath, the anus must be dried gently but thoroughly to avoid maceration of the perianal skin. Iopical analgesics and steroid-containing ointments may provide relief. The patient should not sit for a prolonged period on the commode. Bulk laxatives, such as psyllium seed compounds, or stool softeners should be used after the acute phase is treated. Laxatives causing liquid stool must be avoided; this can result in cryptitis and anal sepsis. The addition of bran or other forms of roughage to the patient's diet should help to prevent future problems.

As a rule, internal hemorrhoids bleed and, if not prolapsed, are not palpable. External hemorrhoids thrombose. Selection of therapy for thrombosed external hemorrhoids depends on the severity of symptoms: if the thrombosis has been present less than 48 h, the swelling is not tense, and the pain is tolerable, the patient may be treated with sitz baths and bulk laxatives. Suppositories, which are placed proximal to the anorectal ring, are of no help. If, on the other hand, thrombosis is acute and recent in origin, significant relief can be provided by excising the clots. With the patient in prone position, the area of the overlying skin to be incised is infiltrated with a local anesthetic using a 30-gauge needle. While applying gentle traction to the skin adjacent to the thrombosed hemorrhoid, an elliptical incision is made in the overlying skin, exposing the thrombosed vein, which is locally excised with the elliptical flap of skin ( Fig 78:3). Because of the multiloculated clots that are invariably present, the technique of unroofing a thrombosed hemorrhoid with an elliptical incision gives far better results than the simple incision and evacuation of a clot. Bleeding is controlled by tucking the corner of a small piece of gauze into the wound and leaving it in place for a few hours. A small pressure dressing may be applied external to the gauze and removed when the patient takes the first sitz bath 6 to 12 h after the drainage procedure. Narcotics may be prescribed, but only judiciously, since they cause constipation and may produce more problems.

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Surgical referral and intervention for hemorrhoids is indicated for continued bleeding; incarceration and/or strangulation; severe, unrelenting pruritus; and intractable pain. Surgical treatment can consist of sclerosing injections, the use of rubber-band ligation, 2 or excision. Up to 5 percent of patients undergoing rubber-band ligation may develop acute thrombosis of external hemorrhoids, and immunocompromised patients so treated may develop pelvic sepsis.

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Constipation Prescription

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  • Mantissa
    How a thrombosed hemmerhoid grts frained?
    10 months ago

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