Anal thrombosis by itself cannot cause pulmonary embolism. This differs from leg vein thrombosis. However, large perianal thromboses can become painful, inflamed, rupture and then bleed. Although the bleeding itself is not large, it is alarming and should be stopped. Ruptured thrombosis in the anus can then become inflamed. If left untreated, a lump remains, which appears as a skin tag – a skin tag on the rectum. Skin tags then disturb the cleanliness, and hygiene of the rectum is often undesirable from an aesthetic point of view.

Examination at the proctologist

Country doctors and general practitioners only diagnose the thrombosis by visual diagnosis because the painful lump in front of the rectum is clearly visible. However, a modern proctologist can now also visualize the depth of the pelvic floor using ultrasound and obtain an exact picture of the extent of the thrombosis, the extent to which the thrombosis is affected and the development of the internal hemorrhoids and also other possible anal and perianal diseases that may exist at the same time (fistulas, abscesses, prolapse, tumours, polyps, neighboring switching organs) and thus to make a complete diagnosis by imaging the entire small pelvis, including the hemorrhoidal cushion, without pain and with little effort. The complete and the differential diagnosis is important in order not to overlook any other important concomitant disease, for example. A therapy plan is correct only considering all diseases in the area. 

The treatment of anal thrombosis

The laser therapy 

Diseased tissue, haemorrhoids and thrombosis can be removed most quickly and gently with the laser beam of the 1470 nm diode laser, without cuts and without pain. The tissue, the thrombosis is vaporized, i.e. heated and converted into steam. What remains is just a kind of "ash", that is, pulverized tissue residue. This tissue powder can be sucked off at the end of the laser procedure, so that only a mini stitch remains from the thrombosis knot, which already looks healing the next day and hardly hurts. It is important that the laser can also be used to treat and seal other perianal veins not yet affected by thrombosis, as well as haemorrhoids and skin tags. This is extremely important because perianal thrombosis is not a disease in its own right and it is not a disease that affects only one point in the anal entrance. As a rule, there are other severely stretched perianal veins at the edge of the anal, which are inevitable for later thrombosis. In addition, the perianal veins are only the "tip of the iceberg", which present themselves as a continuation of internal hemorrhoids. See picture above. That means: the inner hemorrhoids are the ones that give rise to the perianal veins, the "varicose veins" of the anal edge. It is about the anorectal erectile tissue according to Stelzner's teachings, which swells from the abdomen pumped with strong arteries, to which a venous vessel part connects at the anal edge, which in the English-speaking world is referred to as "external - external - hemorrhoids". Without (internal) hemorrhoids, there are no “external” hemorrhoids, no perianal veins and their thrombosis. Consequently, the appropriate logical treatment is only that which covers all components of the vascular bundle, the anal cavernous body: internal + external hemorrhoids, not only the external hemorrhoids that are already in the phase of thrombosis, but also the perianal veins and hemorrhoids that are not yet thrombotic but will most likely cause further complications and discomfort in the future. During a session of the Laser Hemorrhoids Plastic Surgery (LHPC)  all possible components of hemorrhoids and thrombosis are removed without any noticeable additional burden for the patient, as if "erased" and all the side effects or pain that are hardly noticeable.

LHPC eliminates both hemorrhoids and anal thrombosis in one session. However, after the procedure, those treated can sit, walk and carry on with their normal activities immediately. No other procedure is known in proctology, with which both the thrombosis, as well as the other pathologically stretched out perianal veins and still  Hemorrhoids could be removed in a laser session without an incision and afterwards without a wound, without pain and suffering. This outstanding exceptional service is provided without a hospital stay, just through a 1-1,5 hour outpatient surgery. including outpatient mini anesthesia. Our before and after pictures of hemorrhoids laser plastic surgery (LHPC) and laser perianal thrombosis surgery in our clinic testify to the maximum success without major side effects. 

The piercing 

Fresh anal thrombosis can be pierced under local anesthesia and the clot pushed out. Relief follows immediately. In the past, all thromboses were treated by piercing at the country doctor's house doctor's. However, there is a risk of infection because the wound remains open. The open puncture wound weeps and smears with blood, can become inflamed. Healing takes about 7-10 days with some pain. However, this treatment is only justified for smaller – up to the size of a pea – thrombosis. With all other, larger thromboses, one gets impaired wound healing and later permanent lumps in the anal entrance if a larger thrombosis was only punctured and only partially removed. 

Plastic surgical peeling

This method is common with us because we can offer minimally invasive plastic surgical removal with 40 years of experience, even in the case of very large thromboses, with only minor side effects and symptoms. The patient decides whether to use local anesthesia or twilight sedation. In any case, we can carry out the local anesthetic without much pain so that the procedure itself is completely painless. The advantage of plastic surgical peeling is the complete removal of all inflamed tissue damaged by thrombosis. Only healthy tissue remains, from which the anal entrance is completely reconstructed from a small access with sunken, invisible plastic sutures. There is hardly any pain afterwards, at most 1-2 days, which can be well controlled with minor analgesics. Wound healing is usually much better and faster than after puncturing a thrombosis. If there are haemorrhoids with prolapse or prolapse, then simultaneous minimally invasive ligature treatment with HAL, RAR or ligature excision is possible. This saves the patient another hemorrhoid operation because the hemorrhoids, which caused the perianal veins and thrombosis, are also removed. In our practice, which specializes in proctology, plastic surgical peeling alone or in combination with laser vaporization has proven to be a well-established method for all anal thromboses.

Treatment with hemorrhoid ointment? 

Smaller anal and perianal thromboses can recede, while larger thromboses would burst after several painful days. Ointments such as Faktu-Akut or even cortisone and lidocaine ointments help in the short term to reduce the swelling of smaller hemorrhoids. Heparin ointments can slow down the spread of thrombosis. Nevertheless, even after the swelling has gone down, a knot or skin tag almost always remains. Everyone must now decide for themselves whether they should spend their whole life with skin tags, which can increase and disturb hygiene in the long run. Anal thrombosis with throbbing, increasing pain and swelling require urgent medical help, preferably from a proctologist, who can also carry out minor interventions immediately on an outpatient basis. 

After laser treatment of anal thrombosis with or without hemorrhoid laser treatment, healing is extremely fast. In the entrance to the ana there is only a 3-5 mm small puncture wound, through which the "powder" was sucked out after vaporization of the thrombosis. Otherwise no wound at all, neither in the rectum nor perianally at the anal edge. If no wound, then no wound healing disorder. However, the laser beam occasionally has its own side effects, because vaporization occurs through heating, through "burning out" hemorrhoidal tissue. The art of LHPC laser therapy lies in the fact that the sensitive mucous membrane is left undamaged, while the hemorrhoids and thrombosis underneath are completely burned out, so that you do not see or feel any traces of the large-scale internal destruction of the thrombosis and hemorrhoids. The combination of tissue protection and effectiveness has been perfected by the LHPC process: that of Dr. Haffner further developed the LHP procedure, which works on different principles and with a different laser light guide and with a different surgical technique than the original LHP procedure. The before and after pictures of the hemorrhoids laser therapy, laser therapy of anal vein thrombosis, as well as the fast and complication-free healing phase prove the high effectiveness and optimized tissue protection of the LHPC procedure.

The healing phase after plastic surgical removal of a thrombosis is a few days longer, but usually hardly painful. However, the plastic surgical removal of the anal vein thrombosis is always carried out when it comes to huge thromboses - larger than a plum - which occupy half of the rectum, which therefore requires a very experienced and plastic surgically trained surgeon. In the hands of the experienced, however, such large findings are also the norm and are carried out without problems as a norm operation. The healing phase now lasts around 7-10 days for large findings, which means that only slight symptoms are to be expected. 

Prevention of perianal thrombosis

Prevention only works if you are aware of the cause of perianal thrombosis, which are: hemorrhoids, high pressure area congestion caused by hemorrhoids, spread of perianal "varicose veins", i.e. pent-up external hemorrhoids.

In other words: if the proctologist - or family doctor - sees perianal veins during a proctological examination, then he must also think about haemorrhoids and take care of their early, precautionary elimination. Likewise, the perianal veins, which are visibly full and look like varicose veins, should be removed as a precautionary measure before a thrombosis occurs. This philosophy is new and represents the unique selling point of the HeumarktClinic. According to old - but still valid - teachings and guidelines of proctology, you do not need to do anything with the perianal veins or only if a thrombosis has developed there. According to our new philosophy, everyone should think about their health as a precaution and have the preliminary stages of a thrombosis, the perianal "varicose veins" removed before the thrombosis sets in, together with the triggering haemorrhoids. The legitimacy of this new preventive therapy for hemorrhoids and perianal veins arises from the introduction of laser therapy and the LHPC procedure by Dr. Haffner. Because a wide-area radical preventive operation involving the inside and outside of the rectum using the old methods of knife and scissors is contraindicated, is out of the question because it would be so traumatizing.

However, laser therapy makes it possible to prevent the complications of hemorrhoids - including anal thrombosis - through laser precautions.

Practical procedure: If the doctor finds perianal veins or hemorrhoids from stage 2, then perform a precautionary laser sclerotherapy of both the hemorrhoids and all perianal veins. This prevents thrombosis and the progression of hemorrhoids, saves visits to the doctor, major operations even in the hospital, you also save costs, you protect yourself against future thrombosis, tears, weeping rectum, eczema, itching, burning and anal insufficiency with stool smearing.

In our individual opinion, patients should not let themselves be left to the fate of deterioration and wait for the formation of thrombosis and only go to the doctor when the thrombosis is already forcing it. Earlier is better, earlier is easier.

The Laser therapy with LHPC makes the prevention of thrombosis and haemorrhoids possible without any side effects worth mentioning.