Remove 1 wk old thrombosed hemorrhoid?

[cja369]

I am 20 wks pregnant and got a thrombosed hemorrhoid one wk ago tomorrow. I went to a colorectal surgeon that day who said that based on my lack of acute pain and the smaller size of the hemorrhoid, he recommended not doing surgery and letting it reabsorb in a few weeks. Since then I've had some discomfort but not lots of pain. I would love to have this go away and not deal with it for several more weeks. However, I've had thrombosed hemorrhoids before and I remember how horribly painful the surgery and recovery have been. Based on my reading, it seems like if I was going to do the surgery, it should have been done right away, not after a week. So, my questions are this:
1) since I'm having discomfort (which sometimes causes lower back pain too) but not lots of pain, should I have it removed?
2) is it too late to have it removed? I read that if not done within 72 hrs, the pain of surgery can be worse than the pain of "riding it out"
3) is there any harm to letting it reabsorb into my body?
4) how long will it take to be reaborsed into my body?
One other thing of note... I currently have 3 other regular external hemorrhoids. I know that regular hem. will be a problem throughout my pregnancy and delivery and have talked with the colorectal Dr about looking into getting rid of those 3 months after delivery.

Thank you!

[Dr. Safaa Mahmoud]

Hello,

A thrombosed hemorrhoid (hemorrhoid with a clot) causes pain that may be tolerable or severe. If it is not sever many surgeons start with medical treatment like hot baths, local ointments and diet modifications. Since recurrence is not uncommon surgeons usually prefer conservative measures till clear indication for surgery is there especially in a pregnant woman.

If the pain is not tolerable or the swelling is getting bigger (prolapsed hemorrhoids) and cannot be pushed back into place, or causing severe rectal itching, surgery is needed.

Unfortunately, you are correct that hemorrhoids worsen during pregnancy. Moreover they may have an effect on delivery, for example if surgery is done late in pregnancy your doctor may chose to go for cesarean section to avoid worsening a complicated hemorrhoid (thrombosed or prolapsed).

However, if they resolve after conservative treatment, it is better to wait and consider their removal before you get pregnant again.

So, I advise you to follow up with your doctor and to update him with your symptoms. Discuss with him all your concerns to be more reassured.

Please keep us updated.
Best regards.