Hemorrhoids can absolutely persist for years, and for many people they do. Once the tissue changes that define hemorrhoidal disease set in, the swollen cushions do not always shrink back on their own. A study of postpartum women found that about half who had hemorrhoid problems three weeks after giving birth still had them a year and a half later.1Sexual & Reproductive Healthcare. Haemorrhoids – A neglected problem faced by women after birth That pattern holds more broadly: without changes to the conditions that caused them, hemorrhoids tend to stick around or come back.
What Makes Hemorrhoids a Chronic Problem
Hemorrhoids are not a temporary swelling that simply goes away like a bruise. The underlying issue involves structural damage to the tissue inside and around the anal canal. The vascular cushions that everyone has in that area become abnormally dilated and distorted, and the connective tissue that normally holds them in place breaks down.2PubMed Central. Hemorrhoids: from basic pathophysiology to clinical management Think of it like a hammock whose ropes have stretched out: the cushion sags downward because the supporting structure can no longer keep it taut. That connective tissue does not regenerate well on its own, which is why hemorrhoids can linger indefinitely once they reach a certain point.
The disease tends to progress through stages. Early on, the problem is mostly vascular congestion, where blood pools in the cushions and they swell. Over time, the connective tissue anchoring those cushions weakens further, and the hemorrhoids begin to prolapse, meaning they slide downward and may protrude from the anus.3Quality in Sport. Etiology Based and Stage-Adapted Management of Hemorrhoidal Disease: Clinical Outcomes, Functional Impact, and Quality of Life — A Narrative Review Internal hemorrhoids are classified in four grades based on how much they prolapse: grade I stays inside the canal, grade II pokes out during straining but retracts on its own, grade III requires you to push it back in manually, and grade IV stays out permanently.4JAMA. Hemorrhoidal Disease: A Review Someone with a grade I hemorrhoid may barely notice it for years. Someone with a grade III or IV is living with a daily physical nuisance that does not resolve without intervention.
Why They Keep Coming Back or Never Leave
The habits and conditions that cause hemorrhoids in the first place are usually still present after the hemorrhoids develop, which is why the problem becomes self-sustaining. Constipation is one of the biggest drivers. People who strain regularly during bowel movements face dramatically higher odds of developing hemorrhoidal disease, and that straining creates a vicious cycle: the pressure damages tissue, the damaged tissue makes bowel movements more uncomfortable, and discomfort leads to more straining or avoidance.5Frontiers in Surgery. Toilet behaviors and lifestyle factors in anorectal diseases: a cross-sectional analysis Functional constipation and abnormal patterns of pelvic floor coordination are more common in people with hemorrhoids than in the general population, and addressing those underlying issues may be key to breaking the cycle.6European Journal of Gastroenterology & Hepatology. Functional constipation in patients with hemorrhoids: a systematic review and meta-analysis
Time spent sitting on the toilet is another factor that often gets overlooked. Research has found a strong linear relationship between the amount of time people spend sitting on the toilet and the severity of their hemorrhoids.7PubMed. Relationship between haemorrhoidal grade and toilet habits Scrolling through your phone for 15 minutes while sitting there creates sustained downward pressure on the anal cushions. Combined with hard stools and frequent straining, these habits make it nearly inevitable that hemorrhoids will persist or worsen over the years.8PubMed Central. Recovery from hemorrhoids and anal fissure without surgery
The Genetic Side of the Equation
If hemorrhoids seem to run in your family, there is real biology behind that impression. A massive genetic analysis of nearly a million people identified over 100 distinct regions of the genome associated with hemorrhoidal disease. The genes involved were concentrated in pathways related to smooth muscle function, blood vessel development, and connective tissue integrity.9Gut. Genome-wide analysis of 944 133 individuals provides insights into the etiology of haemorrhoidal disease In other words, some people are born with vascular and connective tissue that is inherently more vulnerable to the mechanical stresses that cause hemorrhoids. If you have that genetic predisposition and also sit on the toilet too long or eat a low-fiber diet, your hemorrhoids are more likely to develop earlier and persist longer than someone with more resilient tissue.
This genetic component helps explain a frustrating reality many people face: they do “everything right” in terms of diet and toilet habits and still cannot get rid of their hemorrhoids. The tissue itself may simply be prone to stretching and not recovering. It does not mean treatment is futile, but it means that for some people, managing hemorrhoids is a long-term project rather than a one-time fix.
Can a Hemorrhoid That Has Been There for Years Become Dangerous
For most people, a hemorrhoid that has been present for years is more of a chronic annoyance than a medical emergency. But there are real complications worth knowing about. The most clinically significant one is anemia from chronic bleeding. A study in Olmsted County tracked hemorrhoid-related anemia over 15 years and found it was rare, roughly 0.5 cases per 100,000 people per year, but the patients who did develop it had average hemoglobin levels well below normal.10PubMed. Evaluation of anemia caused by hemorrhoidal bleeding Almost all of them had grade II or III internal hemorrhoids. If you have been bleeding with every bowel movement for months or years and feel increasingly tired or lightheaded, that is worth a blood test.
Skin tags are another consequence of long-standing hemorrhoids. These are small flaps of excess skin around the anus left behind after a hemorrhoid has repeatedly swollen and deflated over time. They are not dangerous, but they can be annoying, difficult to keep clean, and are sometimes mistaken for active hemorrhoids. Even after surgical treatment, skin tags are a common leftover.11PubMed Central. Residual skin tags following procedure for prolapse and hemorrhoids: differentiation from recurrence
When It Might Not Be a Hemorrhoid at All
Here is where things get serious. If you have been assuming that the bleeding or lump you have had for years is “just hemorrhoids,” you may be right, but you also may not be. Hemorrhoidal disease and rectal cancer share several overlapping symptoms, including rectal bleeding, changes in bowel habits, and general anorectal discomfort. That overlap leads to cases where rectal cancer gets misdiagnosed as hemorrhoids, sometimes for months or years.12PubMed Central. Hemorrhoids and Rectal Cancer: A Systematic Review of Clinical Overlap, Diagnostic Misclassification, and Early Detection Strategies for Primary Care Case reports describe patients whose cancers initially presented in ways that looked like hemorrhoids or rectal prolapse, delaying the correct diagnosis.13New Nigerian Journal of Clinical Research. Rare Case of Rectal Cancer Presenting as a Nidus for a Rectal Prolapse: A Case Report
This does not mean you should panic if you have had hemorrhoids for a few years. The point is that a self-diagnosis made years ago deserves an actual medical evaluation, especially if your symptoms have changed, gotten worse, or if you have never had a proper examination. Bleeding that was always bright red and is now darker, unexplained weight loss, a new feeling of incomplete evacuation, or any symptoms in someone over 45 who has never had a colonoscopy are all reasons to get checked. A hemorrhoid you have lived with for years is probably still a hemorrhoid, but “probably” is not good enough when it comes to ruling out something more serious.
Treatment Options and How Well They Last
Early-stage hemorrhoids (grade I and II) can often be managed without procedures. Lifestyle changes, fiber supplements, topical treatments, and medications that improve vein tone are the standard first approach.14PubMed. Pharmacological treatment of hemorrhoids: a narrative review For someone who has had low-grade hemorrhoids for years but has never tried these consistently, there is a real chance of improvement. The caveat is that these measures work best as ongoing habits, not one-time fixes. If you eat more fiber for a month, see improvement, and then go back to your old diet, the hemorrhoids come right back.
For hemorrhoids that do not respond to conservative treatment, or for grade III and IV disease, procedural interventions are the next step. Rubber band ligation is the most commonly used office procedure. A band is placed around the base of the hemorrhoid to cut off its blood supply, and the tissue dies and falls off within days. One review found that this approach resolved symptoms in about 70% of patients, and when treatment of recurrent symptoms was included, the cumulative success rate reached roughly 80%.15Diseases of the Colon & Rectum. Long-Term Outcome of Rubber Band Ligation for Symptomatic Primary and Recurrent Internal Hemorrhoids A separate study found that banding was more effective for grade II hemorrhoids than grade III, with recurrence rates of about 15% for lower grades but closer to a third for grade III.16PubMed. Comparison of the long-term efficacy and safety of multiple endoscopic rubber band ligations in a single session for varying grades of internal hemorrhoids
A JAMA review noted that rubber band ligation resolves symptoms in about 89% of patients, though up to 20% need repeated banding sessions. Sclerotherapy, which involves injecting a solution to shrink the hemorrhoid, works for 70 to 85% of patients in the short term, but only about a third maintain long-term remission. Infrared coagulation, which uses heat, achieves 70 to 80% success in reducing bleeding and prolapse.4JAMA. Hemorrhoidal Disease: A Review The range of numbers across these procedures tells a consistent story: office-based treatments work reasonably well but are not permanent cures for everyone. Many people need repeat treatments over the years.
For the most advanced cases, surgery remains the most durable option. Traditional excisional hemorrhoidectomy has the lowest recurrence rates, though it comes with more pain and longer recovery. Stapled hemorrhoidopexy is less painful but trades that for a significantly higher recurrence rate. A Cochrane review found that patients who had the stapled procedure were about three times as likely to have recurrent hemorrhoids compared to those who had conventional excision.17Cochrane Database of Systematic Reviews. Stapled hemorrhoidopexy versus conventional excisional hemorrhoidectomy for hemorrhoids If you have had hemorrhoids for years and are considering surgery, this tradeoff between short-term comfort and long-term durability is worth discussing with your surgeon.
The Emotional Weight of Chronic Hemorrhoids
Something that rarely gets mentioned is the psychological toll of living with hemorrhoids for years. It is not a glamorous condition to discuss, and many people suffer in silence out of embarrassment. Research using data from the UK Biobank found that hemorrhoidal disease is associated with meaningful psychological distress, and that patients assessed more than 20 years after their hemorrhoid diagnosis still showed elevated patterns of depression and anxiety symptoms compared to controls.18PubMed Central. Depression and anxiety symptom networks in hemorrhoid patients: evidence from the UK biobank The discomfort, the bleeding, the worry about whether something more serious is going on, the difficulty sitting for long periods, and the sheer awkwardness of the topic all compound over time.
Chronic hemorrhoids also affect everyday decisions in ways that people without them might not appreciate. Choosing a seat at a restaurant, dreading a long flight, avoiding exercise that puts pressure on the pelvic floor, or simply dealing with itching and wetness throughout the workday are real quality-of-life issues. If you have been living with this for years and telling yourself it is “not a big enough deal” to see a doctor about, the psychological burden alone is a good reason to get it evaluated and treated.
Pregnancy and Postpartum Persistence
Pregnancy is one of the most common triggers for hemorrhoids, and for many women, the problem does not resolve after delivery. The combination of increased blood volume, hormonal changes that relax vein walls, the physical pressure of a growing uterus, and the strain of labor and delivery creates a perfect storm for hemorrhoidal disease. As mentioned earlier, about half of women who develop hemorrhoid problems around birth still have them 18 months later.1Sexual & Reproductive Healthcare. Haemorrhoids – A neglected problem faced by women after birth The researchers who documented this called hemorrhoids a “neglected problem” in postpartum care, and that label feels earned. Many new mothers are told the hemorrhoids will go away on their own. Sometimes they do. Often, they do not.
If you developed hemorrhoids during pregnancy and they are still present a year or more later, that is not unusual, but it also does not mean you have to keep waiting. The connective tissue changes that happened during pregnancy may not fully reverse, especially if you went through multiple pregnancies. Treatment options are the same as for anyone else, and the earlier you address persistent postpartum hemorrhoids, the less likely they are to progress to a higher grade.
The Gut Microbiome Connection
An emerging and somewhat surprising area of research involves the relationship between gut bacteria and hemorrhoidal disease. A genetic analysis technique that uses inherited variations in gut microbiome composition to test for cause-and-effect relationships found that certain bacterial families appear to have a protective effect against hemorrhoids, while others seem to increase risk.19PubMed Central. Causal associations between human gut microbiota and hemorrhoidal disease: A two-sample Mendelian randomization study The effect sizes are small, and this research is still early-stage, so nobody is prescribing specific probiotics for hemorrhoids yet. But the finding fits with what we know about how the microbiome influences bowel habits, stool consistency, and local inflammation, all of which directly affect hemorrhoid development and persistence. It is a thread worth watching.
For practical purposes, this research reinforces what is already good advice for managing chronic hemorrhoids: a diverse, fiber-rich diet that supports healthy gut bacteria is likely beneficial not just because it softens stool, but because it may influence the inflammatory environment in the lower gut. The specifics are still being worked out, but the direction of the evidence is clear enough to act on.
Practical Steps if You Have Had Hemorrhoids for Years
If you have been living with hemorrhoids for a long time and have not seen a doctor about them, the single most useful thing you can do is get a proper evaluation. A clinician can confirm the diagnosis, rule out anything more concerning, and determine the grade. Knowing the grade matters because it changes the treatment approach entirely. Grade I hemorrhoids are managed very differently from grade IV.
Beyond that, the evidence points to a few concrete changes that are supported by research rather than folklore:
- Limit toilet time: Get off the toilet as soon as you are done. Sitting there longer than about five minutes contributes to the problem. Leave your phone outside the bathroom if you have to.
- Address constipation seriously: If you strain regularly, the hemorrhoids will not improve regardless of what else you do. Fiber supplementation, adequate water intake, and in some cases, medical evaluation for pelvic floor coordination problems are all reasonable steps.
- Do not assume the problem is cosmetic: Chronic bleeding that you have been ignoring deserves at minimum a blood count to check for anemia, especially if you feel fatigued.
- Consider procedural treatment sooner rather than later: Many people tolerate hemorrhoid symptoms for years before seeking treatment, only to find that a relatively simple office procedure could have resolved the issue. Rubber band ligation, for instance, takes minutes and has good long-term success for grade II and III hemorrhoids.
Hemorrhoids are one of those conditions where the gap between how much people suffer and how available effective treatment is can be enormous. A hemorrhoid you have had for years is unlikely to resolve on its own, but it is also very likely to respond to appropriate treatment once you actually pursue it.