✅ Setting

• OPD (Outpatient) if lesion is small, pain tolerable, no complications.
• IPD (Inpatient) only if severe pain, large thrombosis, recurrent bleeding, or associated perianal abscess.

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1. Definitive Treatment

• Excision of thrombosed external hemorrhoid if:
  • Onset <48–72 hours
  • Severe pain
  • Large, tense, bluish perianal swelling
• If >72 hours or lesion is small → conservative management is acceptable.

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2. Pharmacologic Management (Exam-Style Prescription)

• Venoactive drug (Daflon® = Diosmin + Hesperidin, MPFF)
  • Daflon 1000 mg po tid × 4 days (3,000 mg/day), then
  • Daflon 1000 mg po bid × 3 days (2,000 mg/day).
  • Rationale: Improves venous tone, reduces inflammation/edema (ASCRS, Thai CPG).
• Pain Relief
  • Paracetamol (500 mg) 1×3 po pc × 5 days.
  • Or Ibuprofen (400 mg) 1×3 po pc × 5 days (if no GI/renal risk).
• Topical Agents
  • Lidocaine 5% ointment, apply tid prn (pain relief).
  • Hydrocortisone acetate suppository 25 mg PR bid × 5–7 days (short course).
  • Witch hazel pads prn (soothing).
• Stool Softener
  • Docusate sodium (100 mg) tid po (max 300 mg/day) until stool soft.
  • Alternative: Lactulose syrup 15–30 mL po hs prn.

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3. Non-Pharmacologic Support

• Sitz bath: Warm water soak 10–15 min, 2–3×/day.
• High-fiber diet (20–30 g/day) + 2–3 L/day hydration.
• Avoid prolonged sitting, straining, or heavy lifting.

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4. Monitoring & Complications

• Monitor for: increasing pain, fever, spreading perianal swelling → suspect abscess.
• Complications: recurrence, ulceration, secondary infection, scarring.

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5. Follow-Up

• Re-evaluate in 5–7 days: check pain relief, lesion regression, bowel habits.
• If worsening or persistent severe pain → consider surgical excision.
• Long-term: lifestyle + fiber to prevent recurrence.

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🧑‍⚕️ Patient Education

• Benign condition, commonly due to constipation/straining.
• Avoid hard stools: fiber, fluids, stool softeners.
• Sitz bath + topical creams for relief.
• Return immediately if sudden bleeding, fever, or worsening pain/swelling.

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✅ Summary (High-Yield for Exams)

• Acute thrombosed external hemorrhoid (<72h, severe pain) → surgical excision.
• Small / >72h / mild pain → conservative management.
• Daflon (Diosmin) improves pain, edema, bleeding, and speeds recovery.
• Chronic management = lifestyle + fiber + Daflon maintenance (1000 mg/day).