An anal thrombosis is a blocked vein in the anus. It occurs due to a blood clot blocking the vein. It often causes severe pain and itching at the exit of the anal canal. Surgery is only necessary in rare cases. Around five percent of patients who consult a proctologist are affected by anal thrombosis. Men are affected slightly more often than women.
Here you will find further information and selected doctors for anal thrombosis.
The correct term for anal thrombosis would be anal vein thrombosis, but the common abbreviation among doctors is anal thrombosis.
There are blood vessels at the anus (medically the anal canal) through which the used blood is transported back to the heart.
Like the veins in the legs, these are often dilated and form varicose veins. If blood accumulates in these vascular sacs, a blood clot (thrombus) can form and block the vein. The accumulated blood causes swelling within minutes to a few hours. The nodule-like swelling can be the size of a pea or a plum and can be very painful.
Doctors refer to this as anal thrombosis (also known as perianal or anal vein thrombosis).
Both anal thrombosis and hemorrhoids have in common that they are both diseases of the anal canal. Anal thrombosis is often confused with haemorrhoids, but has nothing to do with them.
Hemorrhoids are mucosal protrusions of the anal canal, while anal thromboses are clot formations in anal canal veins. If haemorrhoids cause an obstruction to the outflow of blood in the anal canal veins, there is a risk of anal thrombosis developing. Conversely, if the anal thrombosis causes the mucous membrane to bulge and protrude, this can lead to the development of hemorrhoids.
The following factors also promote the development of anal thrombosis:
Unlike deep vein thrombosis, anal thrombosis originates from superficial veins. They are therefore harmless. The most dangerous thing about deep vein thrombosis is pulmonary embolism, which can be fatal. Thromboses of the superficial veins, e.g. varicose veins in the legs, but also anal vein thrombosis, do not usually result in pulmonary embolisms. Anal thrombosis is therefore a harmless condition, even if it can sometimes be extremely painful.
Anal thrombosis (blue dotted line) © Armin Kübelbeck, CC-BY-SA, Wikimedia Commons
An anal thrombosis is mainly characterized by
In addition, those affected often suffer from
in the anus.
Anal thrombosis can usually be diagnosed by physical examination. The bulging, elastic, bluish-colored lump(s) are clearly visible on the outside and painful to the touch. Anal thrombosis, as with most other diseases of the anal area, is a visual diagnosis. However, the recommendation to rule out additional diseases also applies here.
If the pain is tolerable, a palpation examination of the anus can also be carried out to detect or rule out internal hemorrhoids.
As a malignant tumor can also "hide" behind every discharge of blood from the bowel, a colonoscopy should also be carried out once the pain has subsided and the swelling has subsided.
Although anal thromboses are harmless, they are usually extremely painful. You can use a cold pack to relieve the pain and reduce the swelling.
Ointments such as milking fat or Vaseline can also be used to give the skin elasticity.
Harmless thromboses usually heal on their own after two to three weeks. You can promote the healing process:
Ensure soft (not liquid) bowel movements by, for example
for example. Take one to two tablespoons with plenty of water. Laxatives, on the other hand, impair bowel function and are therefore more likely to do harm!
Clean the anus with water after a bowel movement. You can do this by showering the anus and then dabbing it dry with a soft towel. Rubbing the affected area can further irritate the swelling.
Avoid exertion that leads to a build-up of pressure in the lower abdomen. This includes, in particular, heavy lifting and pressing hard when going to the toilet.
Conservative (without surgery) and surgical measures are available for the treatment of anal thrombosis. The aims of conservative methods are
Conservative procedures can be used as the sole therapeutic measure, but can also be used in addition to surgery. In particular, pain therapy with medication and the use of ointments are part of the post-operative follow-up treatment.
The application of ointments is the main component of conservative treatment. This is also known as "local" therapy, which means "on the spot". Ointments with a local anaesthetic agent such as lidocaine help with anal thrombosis. They relieve the pain and thus accelerate the breakdown of the clot.
Pain-relieving and anti-inflammatory ointments can also be used. These include in particular ointments containing diclofenac (non-steroidal anti-inflammatory drug). Ointments containing heparin are also often prescribed to speed up the breakdown of the clot.
Ointments containing a corticosteroid (cortisone) also relieve the pain. They also reduce swelling. However, long-term use can damage the sensitive anal canal skin. They should therefore only be used on a short-term basis .
In the case of extremely painful anal thromboses, "systemic" therapy is recommended and often necessary in addition to the application of ointments. Systemic, as opposed to local, means that the therapy acts throughout the entire body and is administered as a tablet or infusion. Analgesic, anti-inflammatory and clot-dissolving medications are preferred here. The ingredients are similar to locally applied ointments, i.e. non-steroidal anti-inflammatory drugs such as ibuprofen, cortisone and heparin.
In exceptional cases, removal of the anal thrombosis under local anesthesia may be considered. Surgery may be necessaryfor very large, extremely painful anal thromboses.
The procedure is performed on an outpatient basis by a proctologist or surgeon. There are two options available:
Many people find the wound healing pain much more bearable than the pain caused by thrombosis. The pain, which is usually mild, can be controlled very well with painkillers.
The wound requires special care for about a week after the operation. It must be showered with water after every bowel movement and before going to bed. If this is not possible, a moist dressing containing a disinfectant and ointment should be applied.
Many patients can return to work just one day after the procedure. The wound should be completely closed and healed after two to three weeks.
In general, no major complications are to be expected after the surgical removal of an anal thrombosis.
In some cases there is bleeding from the wounds. Slight post-operative bleeding usually stops on its own. If this is not the case, another operation may be necessary. In this case, the bleeding vessel must be closed again with electricity or, if necessary, sutured. If the wound becomes infected and an abscess with an accumulation of pus develops, it may be necessary to surgically open the accumulation of pus, and antibiotic therapy is then often also necessary.
In extremely rare cases, the wound heals poorly, resulting in the development of a chronic anal fissure. This can be very painful and must be treated accordingly.
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