Acute thrombosed external hemorrhoids.

From 1981 to 1985, 159 patients with acute thrombosed external hemorrhoids were treated by the author. This condition is relatively common in young persons; the mean age of the 159 patients in the series was 36 years. The condition was often preceded by a bout of constipation. The incidence was higher in male than in female patients, the ratio being 2:1. These hemorrhoids were slightly more prevalent on the left side (51%), whereas ordinary internal hemorrhoids tend to develop more on the right side (61%). I have postulated that the stagnation of blood and trauma to the anal vessels due to strain is the common denominator in the development of thrombosis. Therefore a rational approach to the condition is to eliminate stasis, trauma, and excess strain. Since the excess strain during defecation is usually caused by constipation, softening the stool is the key to preventing excessive strain. The condition is usually self-limiting and subsides in a few days to a week. If the condition fails to respond to conservative treatment, complete surgical excision of the thrombus is necessary.