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What is Anal Hematoma, How Does it Form, and What is the Treatment?

Anal: Pertaining to the anus; Hematoma: Accumulation of blood clot. It is Turkishized as the accumulation of clot inside or next to the rectum.

It is a disease that suddenly appears next to the rectum, with a purple color, ranging in size from as small as a lentil to as large as an orange, and causing intense pain (1).

Similarly, it is confused with thrombosed hemorrhoid (2), also known as strangulated piles disease. The most important difference is that strangulated piles have a history of existing hemorrhoidal disease for years before the onset.

How to Recognize Anal Hematoma and What are Its Symptoms?

When examined by a proctology specialist or a general surgery expert experienced in this field and through detailed questioning, a diagnosis can be made.

From the patient’s perspective, the presence of the following signs and symptoms suggests the accumulation of blood clot in the rectum:

  • Sudden swelling in the rectum; there is invariably a history of severe straining, with the cause being an event such as constipation, severe diarrhea, or childbirth.
  • The swelling is firm, round, and painful to touch.
  • Similar issues related to straining have occurred in the past.
  • There is no history of hemorrhoid complaints in oneself or in the family’s past.
  • Persistent urge for bowel movements may accompany the condition.
  • If the swelling bursts, it can lead to fresh red bleeding as well as small clots resembling currants.

Treatment of Anal Hematoma

The choice of treatment is based on the patient’s complaint, specifically the time elapsed since the onset of the condition until the patient seeks medical attention.

If the patient comes for examination within the first 2-3 days, and the severity of pain significantly affects the patient’s quality of life and social activities, a simple surgical procedure is performed to drain the clot beneath the skin and provide relief to the patient.

If 4-5 days have passed, and the pain has substantially decreased, with an expectation that it will continue to diminish, spontaneous healing without intervention can be anticipated. In such cases, there is a 100% likelihood of self-recovery.

Hemorrhoid medications such as Daflon Tablets, Doxium Tablets, Proctolog Cream, commonly used in hemorrhoid treatment, may not be effective for the patient’s symptoms. Topical anesthetic creams with muscle-relaxing effects, such as Anuflex Ointment, contribute to reducing pain complaints.

Surgery for Anal Hematoma

If the patient seeks medical attention in the first few days, the pain during this period becomes unbearable, and the patient wants relief as soon as possible.

The area is anesthetized with a small injection, and the clot is drained through a minor surgical procedure. The patient experiences significant relief as soon as the clot is drained. The reduction in pressure is a crucial factor in providing relief. As the surgery is minor, recovery occurs quickly.

Is There Herbal Treatment?

Since it is a sudden onset subcutaneous bleeding, herbal treatment is not possible. The swelling persists until the clot is absorbed, but the pain rapidly decreases after the 4th – 5th day. Meanwhile, if herbs are used, the symptoms that would already resolve on their own may be perceived as if they have improved due to the herbs.

How to Alleviate Anal Hematoma at Home?

Warm sitz baths can be taken to alleviate pain.

During the initial days, Anuflex Ointment is applied to reduce pain caused by significant swelling.

Applying leeches on the swelling can decrease pressure by absorbing the internal clot, thus reducing pain. The sole reason for leech therapy in hemorrhoids is this; individuals who mistakenly believe they have hemorrhoids and find relief with leeches might think their hemorrhoids have improved due to leech therapy, but this is a complete misconception.

Apart from these, there is no effective treatment.

Before attempting treatment with the above-mentioned medications, a medical examination should be performed for a definitive diagnosis. This is because an anal abscess, which requires prompt drainage and the use of different medications, can produce similar symptoms to anal hematoma.

Is There Medication Available at the Pharmacy for Anal Hematoma?

There is no curative medication specifically for it. Although doctors may prescribe medications such as Kortos, Proktoglivenol, Hedensa, Daflon, none of them have any effect. Relief can be achieved with local anesthetic drugs such as Anuflex or Anestol ointment.

What Are the Differences Between Anal Hematoma and Hemorrhoids?

It is often confused not with hemorrhoids but with thrombosed hemorrhoids, which is the aggravated form of hemorrhoids. In fact, many general surgeons mistakenly diagnose the accumulation of blood clot in the rectum as thrombosed hemorrhoids (3).

With careful examination and evaluation of answers to specific questions, a correct diagnosis can be made.

The differences are as follows:

  • Thrombosed hemorrhoids emerge with the swelling of pre-existing hemorrhoids; the patient describes it as ‘there were bumps’ or ‘the bumps used to come out with every bowel movement, but this time they won’t go back in.’ The patient with anal hematoma has not experienced any rectal issues until the day before.
  • Thrombosis is not clearly defined, but hematoma is distinctly shaped like a walnut or hazelnut.
  • Hemorrhoids are generally softer, while anal hematoma is very firm.
  • Hemorrhoids are usually larger, while hematoma is generally smaller.
  • When hemorrhoids swell, they persist, but when anal hematoma resolves, there are no remaining symptoms or complaints.

Does Anal Hematoma Cause Inflammatory Discharge?

No, inflammatory discharge occurs after a rectal abscess, whereas in the case of blood clot accumulation, there may be either no discharge or the discharge may consist of blood. Although the symptoms may resemble each other before bursting or drainage, these are two very different conditions.

How Long Does Anal Hematoma Take to Heal?

The healing time is entirely related to the amount of clot accumulated beneath the skin.

The healing process is as follows:

  • The first three days are characterized by intense and severe pain, often too sensitive to touch, and the swelling is very firm.
  • By the 4th day, the pain starts to decrease.
  • On the 5th day, the clot begins to soften as the serum inside is absorbed.
  • By the 8th – 9th day, a significant reduction in size is observed, and if the hematoma is initially very large, it may take up to 2 weeks.

As the clot is absorbed, the symptoms diminish, and the complete absorption of the clot varies between 4 to 8 weeks depending on its size.

When the healing is complete, there are no remaining signs of the previous illness.


1- Arthur, K. E. (1990). Anal hematoma (coagulated venous saccule or peri-anal thrombosis). Revista Medica de Panama15(1), 31-34.

2- Ganchrow, M. I., Bowman, H. E., & Clark, J. F. (1971). Thrombosed hemorrhoids: a clinicopathologic study. Diseases of the Colon & Rectum14(5), 331-340.

3- Delaini, G. G., Bortolasi, L., Falezza, G., & Barbosa, A. (1995). Hemorrhoidal thrombosis and perianal hematoma: diagnosis and treatment. Annali Italiani di Chirurgia66(6), 783-785.

About Op. Dr. Canan ERDEM

Merhabalar, ben Op. Dr. Canan ERDEM, 1967 doğumluyum 1984 yılında Etiler Anadolu Lisesinden mezun olduktan sonra Cerrahpaşa Tıp Fakültesi’ne girdim ve 1990 yılında mezun oldum. 1991 yılında Erzurum’da mecburi hizmetimi tamamlayarak 2000 yılında Kartal Eğitim Araştırma Hastanesinde Genel Cerrahi Uzmanlığı İhtisasımı tamamladım.