Hemorrhoids are swollen veins located in the lower rectum or around the anus, which can cause symptoms such as itching, discomfort, or bleeding. A common question is whether these swollen veins can be “drained” for relief. Drainage depends on the specific type and characteristics of the hemorrhoid. This process is considered for a particular kind of hemorrhoid, not all.
Understanding Hemorrhoid Types
Hemorrhoids are generally classified into two main types: internal and external. Internal hemorrhoids develop inside the rectum, often above a line called the dentate line, and are typically covered by a mucous membrane. These hemorrhoids may bleed but usually cause little to no pain because the area has few pain-sensing nerves. External hemorrhoids form under the skin around the anus, below the dentate line, and are covered by sensitive skin.
External hemorrhoids can become painful if a blood clot forms inside them, called a thrombosed external hemorrhoid. This thrombosis leads to rapid swelling, inflammation, and pain from the clot stretching nerve-rich tissue. This blood clot within an external hemorrhoid is the specific scenario where drainage might be considered. Internal hemorrhoids, by contrast, do not typically thrombose in a way that allows for a similar drainage procedure.
When Draining is an Option
Draining, an incision and evacuation procedure, is an option primarily for thrombosed external hemorrhoids. This procedure is considered when a person experiences severe pain caused by the blood clot. Its goal is to provide rapid relief from the severe discomfort. For optimal results, it is most effective when performed within 72 hours of symptom onset, before the clot resolves naturally or hardens.
Beyond this 72-hour window, the clot may organize, making extraction more difficult and potentially reducing the procedure’s benefit. While still possible, its effectiveness for immediate, complete pain relief may diminish. The decision to proceed with drainage is based on the severity of the pain and the timing of the thrombosis.
The Draining Procedure and Recovery
The procedure for draining a thrombosed external hemorrhoid is called incision and evacuation. During this outpatient procedure, a healthcare provider administers a local anesthetic to numb the area around the thrombosed hemorrhoid. Once the area is numb, a small incision is made directly over the clotted vein. The blood clot is then removed through this incision.
Following the procedure, patients can expect immediate relief from the acute pain caused by the clot’s pressure. Post-procedure care usually involves maintaining good anal hygiene, including gentle cleansing after bowel movements and sitz baths. A sitz bath involves soaking the perineal area in warm water for 15-20 minutes several times a day to promote healing and reduce discomfort. Over-the-counter pain relievers can manage soreness, and complete healing of the incision site occurs within one to two weeks.
Other Treatment Approaches
While incision and evacuation address thrombosed external hemorrhoids, many other treatment approaches exist for various hemorrhoid types and severities. For less severe or non-thrombosed hemorrhoids, conservative management is often the first line of treatment. This includes dietary modifications to increase fiber intake, ensuring adequate hydration, and using over-the-counter topical creams containing witch hazel or hydrocortisone to relieve itching and inflammation. Sitz baths also offer symptomatic relief for general hemorrhoid discomfort.
Beyond conservative measures, several office-based procedures can address persistent or larger hemorrhoids. Rubber band ligation, for example, involves placing a small rubber band around the base of an internal hemorrhoid to cut off its blood supply, causing it to shrink and fall off within a few days. Sclerotherapy involves injecting a chemical solution into the hemorrhoid to scar and shrink it. For severe cases unresponsive to other treatments, surgical hemorrhoidectomy may be recommended to remove the hemorrhoids.