RT Book, Section A1 Holmes, Katherine A1 Balkin, Michael A1 Wang, Hao A2 Reichman, Eric F. SR Print(0) ID 1159799941 T1 External Hemorrhoid Management T2 Reichman's Emergency Medicine Procedures, 3e YR 2018 FD 2018 PB McGraw-Hill Education PP New York, NY SN 9781259861925 LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1159799941 RD 2024/03/29 AB Thrombosed external hemorrhoids consistently cause patient pain and embarrassment. The etiology is still unclear. The mainstay of treatment is excision. It is important to remember that excision is performed to alleviate or palliate pain and shorten the course of the disease. The natural history of an untreated thrombosed external hemorrhoid is to rupture and spontaneously evacuate the clot or to resorb the clot over time. Therefore, treatment should give the maximum amount of pain relief with the least chance of complications. To make this decision, it is important to take a thorough history from the patient and include questions about the time course, severity, improvement or deterioration, and what has worked or failed in the past. It is also important to perform a physical examination to rule out prolapsed grade IV internal hemorrhoids, perianal abscesses, and other perianal masses.