A painful lump appears outside the anus, sometimes overnight. The pain can be frankly intense in the first few hours. How long does it last? The answer is more nuanced than most medical websites indicate.
What really happens during an external hemorrhoid
External hemorrhoids are located under the skin of the anal margin, an area very richly innervated. Unlike internal hemorrhoids, they hurt. Sometimes a lot.
What people call an "external hemorrhoid" is almost always a thrombosed hemorrhoid: a small blood clot that has formed in an external hemorrhoidal vein. The area swells, hardens, sometimes turns bluish. The pain appears suddenly, often after exertion, lifting a heavy load, straining during bowel movements, or childbirth.
The actual duration
Here's what the data from the French National Society of Coloproctology says: the edema around the clot subsides in three to four days. This is when the pain most frankly decreases. The clot itself is much slower to disappear: two to six weeks depending on its size.
This delay is important to understand. The most intense pain generally lasts a week. Residual discomfort and swelling can persist for several weeks afterward. Some people retain a skin tag at the location of the clot, called a marisca, which remains permanent even once the thrombosis has resolved.
Without treatment, complete spontaneous healing can therefore take two to six weeks.
What shortens the duration
Anti-inflammatories and venotonics reduce edema and alleviate pain faster. The most painful phase can pass in three to five days instead of a week. However, the clot still takes several weeks to resorb.
If the thrombosis is still recent, less than 48 to 72 hours, and very painful, a doctor may suggest an incision or excision under local anesthesia in consultation. The procedure takes a few minutes. The wound heals in three to six days. It is often an almost immediate relief.
Reducing the duration of an external thrombosis requires active support of the venous tissue, not just pain relief. This is what Sérenia does with horse chestnut aescin and black seed oil.
Relieve an external hemorrhoid quickly with SéreniaWhat prolongs the situation
A large thrombosis takes longer to resolve. A small, less painful thrombosis can resolve in ten days. A large one with extensive edema can stretch over a month.
Managing transit during the crisis also matters. Each straining effort during bowel movements mechanically worsens the situation. An adapted diet, fiber, water, mild laxatives if needed, allows you to get through the period without aggravating the inflammation with each stool.
A point few people know: a thrombosis can sphacelate, meaning the skin covering it turns black and ulcerates. Small clots spontaneously evacuate with some bleeding. This is spectacular but not dangerous in the vast majority of cases.
What you need to know for the future
A healing thrombosis is not a guarantee that the problem is resolved. The venous tissue remains weakened. Recurrences often occur in the following months, sometimes more intensely than the first time. The underlying causes, sedentary lifestyle, low-fiber diet, chronic constipation, continue to act.
Recurrent external hemorrhoids, when they occur several times a year, often eventually require scheduled surgical treatment.