Crohn’s disease (CD) is an inflammatory bowel disease (IBD) causing chronic inflammation throughout the digestive tract. Hemorrhoids are swollen veins in the anal canal and rectum, presenting as internal or external lumps. While common generally, hemorrhoids are significantly more frequent and severe in individuals with Crohn’s disease. This increased risk stems directly from the disease process and its associated symptoms affecting the delicate perianal tissue.
How Crohn’s Disease Increases Hemorrhoid Risk
The chronic nature of Crohn’s disease creates an environment highly conducive to hemorrhoid formation. A primary factor is the chronic alteration in bowel habits, frequently involving persistent diarrhea or, less commonly, constipation. Frequent, loose stools irritate the anal lining, and repeated urgency or straining increases pressure on the anal veins.
This sustained pressure leads to venous engorgement and swelling. Systemic inflammation characteristic of active Crohn’s disease also plays a role by weakening the walls of blood vessels and surrounding support tissues. This makes the veins more fragile and susceptible to swelling.
Some medications used to manage CD, such as corticosteroids, may also contribute to tissue fragility and swelling. The overall inflammatory state of the body, coupled with mechanical stress from chronic motility issues, accelerates the development of symptomatic hemorrhoids.
Distinguishing Hemorrhoids from Crohn’s Perianal Complications
Recognizing the difference between a common hemorrhoid and a disease-specific perianal complication is important for proper treatment. Hemorrhoids are varicose veins of the anus that cause pain, itching, or bright red bleeding, especially during bowel movements. These symptoms are often self-limiting or responsive to conservative measures.
Crohn’s disease frequently causes distinct lesions known as perianal Crohn’s disease, which can be mistaken for hemorrhoids. One complication is the anal fissure, a small tear or ulcer in the anal lining. Unlike typical fissures, Crohn’s-related fissures are often multiple, deeper, and located off-midline.
The disease can also cause abscesses, which are painful, pus-filled pockets of infection. These may lead to a fistula, an abnormal tunnel connecting the anal canal or rectum to the skin. These complications are much more serious than hemorrhoids, often involving severe, constant pain, fever, and purulent discharge. Chronic inflammation can also result in hypertrophied skin tags, which may be misidentified as external hemorrhoids.
Treatment Considerations When Crohn’s Disease is Present
The presence of Crohn’s disease significantly changes the approach to treating hemorrhoids and other perianal symptoms. The primary goal is to address the underlying inflammatory condition, as achieving remission of CD often leads to the spontaneous improvement or healing of associated perianal issues. Immunosuppressive and biologic therapies aimed at reducing intestinal inflammation are the most effective long-term treatment.
Standard conservative measures remain beneficial for relieving pressure and soothing symptoms. These include increasing dietary fiber, ensuring adequate hydration, and using warm sitz baths. Topical treatments like over-the-counter creams can be used, but patients should consult their gastroenterologist before starting any new local treatment.
Surgical intervention for hemorrhoids, such as a hemorrhoidectomy or rubber band ligation, is approached with caution in people with active Crohn’s disease. Surgical procedures carry a risk of complications, including poor wound healing, sepsis, and the development of new or complex fistulas. Studies indicate that patients with CD have a complication rate more than double that of other IBD patients following hemorrhoidal surgery, with wound healing extending over 70 days. Therefore, surgery is reserved for severe cases that fail conservative therapy and is ideally performed only when the underlying Crohn’s disease is in clinical remission.