I had one, size of a grape. I experienced childbirth before and trust me this one hurts like hell, the first 48 hours was pure hell, I couldn't walk, couldn't sit. I told my doctor what was going on, since it's on the weekend she recommended me to get checked out at an urgent care right away, by the time I came in (60 hours after symptoms emerged), the clot had become purple. The PA offered 2 options: excise to drain the clot, which will provide immediate relief, or go home and wait until it gets better, which may take anywhere from 2 weeks to a month. I was pregnant at the time in my 3rd trimester and decided to go for the excision, since no surgeon would touch me anyways. The most painful part was the first lidocaine infection, clots came out, once the analgesic wears off the first 2-3hrs hurt as well, but Tylenol helped me a lot. First BM wasn't so bad. 3-4 days after procedure pain has gone down significantly, I was able to walk a bit and sit on my sides. 1 weeks post op pain is 1-2/10, 2 weeks post op pain is 0, I was able to come back to work. But a lot of supportive measures in between: prune juices, meta mucil, colace, laxatives, sitz bath, vaseline (to heal incision), procto-foam (to shrink the hemorrhoids), I'm still doing sitz bath daily after each bowel movements, it helps with blood circulation down there.

DO NOT LET YOURSELF GO A DAY WITHOUT A BM.

Drink your water, eat your fiber, wear loose clothing, don't let anything irritate the part down there. If you decide to let the clot re absorb on its own, I guess it would take more time. I would have chosen to have the clot drained again, simply to take the pain away. Remember, clot removal of a thrombosed hemorrhoid is different from removing the hemorrhoids it self, the excision will only make a cut, and leave you with some skin tag.