External hemorrhoid excision

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  • Acute (<48 hours) thrombosed hemorrhoid
  • Pain/discomfort affects daily life


  • Immunocompromised patient
  • Pediatric patient
  • Pregnant patient
  • Portal hypertension
  • Coagulopathy

Equipment Needed

  • Scalpel
  • Local anesthetic


  1. Place patient in side-lying or prone position
  2. Apply EMLA 1 hr prior to procedure
    • Apply tape to each buttock with force directed laterally for better visualization
  3. Inject local anesthetic (e.g. bupivacaine 0.5% with epi) with 30-gauge needle directly into dome of hemorrhoid as a single injection
  4. Make elliptical incision in overlying skin to expose the thrombosis
    • Remove the clot and the overlying skin through the incision site
  5. Control bleeding by tucking corner of a small piece of gauze into the wound and tape buttocks together
    • Leave in place for a few hours
  6. Apply pressure dressing have patient remove 6-12 hr later when takes first stiz bath
  7. Patient may apply soothing ointments (preparation H, Anusol HC, Lidocaine ointment) after dressing is removed
  8. Provide follow up in 24-48hr


  • Continued bleeding
  • Recurrence
  • Infection
  • Fistula
  • Abscess
  • Skin tags

See Also