What is included in emergency department (ED) care of hemorrhoids?

Updated: Sep 24, 2019
  • Author: Kyle R Perry, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

Acutely thrombosed external hemorrhoids may be safely excised in the emergency department in patients who present within 48-72 hours of symptom onset. (See Thrombosed External Hemorrhoid Excision)

Infiltration of a local anesthetic containing epinephrine is followed by elliptical incision and excision of the thrombosed hemorrhoid, its accompanying vein, and overlying skin.

Note: Simple incision and clot evacuation is inadequate therapy and should not be performed.

The incision should not extend beyond the anal verge or deeper than the cutaneous layer. A pressure dressing is applied for several hours, after which time the wound is left to heal by secondary intention.

In patients presenting after 72 hours from the start of symptoms, conservative medical therapy is preferable. (See Conservative Management.)


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