Hemorrhoids are swollen, inflamed blood vessels located in the lower rectum and anus. The condition is common, often causing bleeding, itching, or discomfort. While most single, acute episodes of swelling resolve with conservative care, the underlying vascular tissue remains. This means the condition itself can become chronic or frequently recurring if not properly managed.
Defining Acute Flare-ups Versus Chronic Conditions
The question of “permanence” depends heavily on distinguishing between an acute flare-up and a persistent, chronic condition. An acute hemorrhoidal episode is a sudden swelling often triggered by a specific event like a bout of constipation or diarrhea, which typically subsides within a few days to a couple of weeks with rest and home remedies. These swellings occur when excess pressure causes the vascular cushions to become engorged with blood.
A condition is considered chronic when symptoms are recurrent or persistent over an extended period. Medical professionals use a four-grade classification system to describe the severity of internal hemorrhoids, which relates to the likelihood of the condition becoming permanent without intervention. Grades I and II describe hemorrhoids that may prolapse (protrude) during a bowel movement but either do not prolapse at all or spontaneously retract back inside the anal canal.
The issue of permanence becomes apparent with Grades III and IV internal hemorrhoids. A Grade III hemorrhoid prolapses and requires manual repositioning back inside the anal canal, indicating structural damage that will not heal on its own. A Grade IV hemorrhoid is permanently prolapsed and cannot be manually pushed back in. This permanently prolapsed tissue, along with persistent external hemorrhoids that leave behind residual skin tags, represents a hemorrhoid that will not resolve without definitive medical treatment.
Lifestyle Factors Contributing to Persistence
The primary reason a hemorrhoidal issue transitions from an acute event to a chronic one is the failure to address the underlying causes of sustained pressure. Chronic constipation and the resulting straining during bowel movements are significant factors, as this action dramatically increases hydrostatic pressure within the hemorrhoidal veins. This repeated, forceful exertion weakens the supporting tissues that anchor the vessels, making the cushions more susceptible to persistent enlargement and prolapse.
A low-fiber diet and inadequate fluid intake contribute to the cycle by producing hard, difficult-to-pass stools, necessitating greater straining and prolonging time spent on the toilet. Spending excessive time sitting on the toilet, even without straining, also maintains pressure on the anal and rectal veins, obstructing blood flow and encouraging the vascular cushions to swell. This habit is known to prevent the veins from fully decongesting after a bowel movement, contributing to chronic inflammation.
Other lifestyle elements that maintain high abdominal pressure include frequent heavy lifting and pregnancy and childbirth. Pregnancy pressure can severely impede the return of blood from the lower body, leading to the development or worsening of hemorrhoids. Even after an acute episode resolves, if a person continues with these behaviors, the likelihood of a rapid and sustained recurrence remains high.
Definitive Medical Procedures for Resolution
When lifestyle modifications are insufficient to resolve a chronic hemorrhoidal condition, particularly those classified as Grade II, III, or IV, definitive medical procedures are necessary to achieve resolution. These interventions are designed to either shrink, remove, or fix the prolapsed tissue, preventing the issue from remaining permanent. Minimally invasive office procedures are often the first line of treatment for Grade I to Grade III internal hemorrhoids.
Rubber band ligation (RBL) involves placing a small elastic band around the base of the internal hemorrhoid. This action cuts off the blood supply to the tissue, causing the hemorrhoid to wither and fall off within a week, leaving behind a scar that anchors the remaining tissue. Similarly, injection sclerotherapy involves injecting a chemical solution into the hemorrhoid tissue, which irritates the vein walls and causes them to scar and shrink, a process known as fibrosis.
Infrared coagulation (IRC) uses a focused beam of infrared light to generate heat, which causes the tissue to coagulate and shrivel. This procedure is used for smaller, bleeding Grade I and II internal hemorrhoids. These office-based methods work by inducing an inflammatory reaction that destroys the excess tissue and re-secures the remaining cushion to the rectal wall, resolving the prolapse.
For larger, permanently prolapsed Grade IV hemorrhoids or cases unresponsive to less invasive methods, surgical excision, known as a hemorrhoidectomy, provides the most definitive resolution. Although associated with a longer recovery period, a hemorrhoidectomy offers the lowest long-term recurrence rates and is the most reliable method for treating a condition that has become structurally permanent.