Hemorrhoids are a common condition involving swollen veins in the rectum or anus. While often resolving within a few days or weeks with self-care, hemorrhoids can persist for extended periods, sometimes for years. This persistence can significantly impact an individual’s comfort and daily life.
Understanding Persistent Hemorrhoids
Hemorrhoids are vascular structures in the anal canal that become swollen and inflamed. They are categorized into two main types: internal and external. Internal hemorrhoids develop inside the rectum and typically do not cause pain unless they prolapse, meaning they bulge outside the anus. External hemorrhoids form under the skin around the anus and are often more painful due to the presence of more nerve endings in that area.
The term “persistent” in the context of hemorrhoids refers to chronic symptoms, frequent recurrence, or an ongoing presence of the swollen veins. While mild cases might clear up within a week or two, more severe or unmanaged hemorrhoids can become chronic, lasting for months or even years. This can include thrombosed hemorrhoids, where a blood clot forms within the swollen vein, causing intense pain and swelling that can last for several weeks.
Factors Contributing to Chronicity
Several factors can contribute to hemorrhoids becoming long-lasting or recurring frequently. Chronic constipation or diarrhea are common culprits, as both involve increased pressure and straining during bowel movements, which can engorge the veins. Prolonged sitting, especially on the toilet, can also put sustained pressure on the anal area, hindering proper venous return and leading to enlarged hemorrhoids.
A low-fiber diet often leads to harder, drier stools, necessitating more straining and exacerbating hemorrhoid formation. Other contributing factors include heavy lifting, which increases intra-abdominal pressure, and pregnancy, due to increased pelvic pressure and hormonal changes. Obesity also adds strain on rectal veins, making individuals more prone to developing persistent hemorrhoids.
Managing Long-Term Hemorrhoids
Managing persistent hemorrhoids involves a combination of lifestyle adjustments and, when necessary, medical interventions. Increasing dietary fiber intake to 25-38 grams daily, through fruits, vegetables, and whole grains or fiber supplements like psyllium, can soften stools and reduce straining. Adequate hydration by drinking plenty of water also helps maintain softer stool consistency.
Regular physical activity promotes healthy bowel movements and can prevent constipation. At-home remedies include warm sitz baths for 15 minutes a few times a day to soothe irritation, and topical creams containing hydrocortisone or witch hazel to relieve pain and swelling. If symptoms persist for more than a week or worsen, medical consultation is advised.
For hemorrhoids that do not respond to conservative measures, medical procedures include:
- Rubber band ligation involves banding an internal hemorrhoid to cut off its blood supply, causing it to shrink and fall off.
- Sclerotherapy injects a solution to shrink the hemorrhoid.
- Electrocoagulation and infrared photocoagulation use heat or electric current for similar effects.
- Surgical options like hemorrhoidectomy (for large external or prolapsed internal hemorrhoids) or hemorrhoidopexy (stapling) may be recommended for severe cases.
Potential Complications of Untreated Hemorrhoids
Leaving chronic hemorrhoids unaddressed can lead to several complications:
- Persistent bleeding, especially from internal hemorrhoids, can cause chronic blood loss and lead to anemia (fatigue, weakness).
- External hemorrhoids can develop a blood clot (thrombosis), causing sudden, severe pain and swelling.
- Internal hemorrhoids may prolapse outside the anus and become strangulated if their blood supply is cut off, leading to tissue damage and intense pain.
- Untreated hemorrhoids can become infected, potentially forming abscesses requiring drainage and antibiotics.
- Continuous irritation can also lead to skin tags or painful anal fissures.