Hemorrhoids are a common condition defined by the swelling of vascular structures located in the anal canal and lower rectum. These cushions of blood vessels, connective tissue, and muscle can become enlarged due to increased pressure, often from straining during bowel movements or prolonged sitting. The question of how long hemorrhoids last if left untreated does not have a single answer, as the duration of symptoms is highly variable. This persistence or resolution depends entirely on the specific type, the degree of severity, and the individual’s underlying habits.
Classification and Expected Duration
Hemorrhoids are categorized into two main types: external and internal, each having a distinct typical course. External hemorrhoids develop under the skin around the anus, where sensitive nerves are present, causing noticeable pain and swelling. An acute flare-up of an external hemorrhoid, often triggered by a bout of constipation or diarrhea, frequently resolves on its own within a few days to one week with conservative measures like fiber intake and warm baths.
A more severe presentation occurs when a blood clot forms within an external hemorrhoid, creating a thrombosed external hemorrhoid. This condition causes sudden, intense pain and swelling, and while the clot may eventually be reabsorbed, this natural process can take approximately two to three weeks. Although the pain will subside as the swelling reduces, the residual tissue or skin tag may persist indefinitely even after the acute symptoms resolve.
Internal hemorrhoids form inside the rectum, above a line where pain-sensing nerves are less dense, meaning they are painless unless they prolapse. The severity of internal hemorrhoids is classified using a four-grade system based on the extent of their protrusion. Grade I hemorrhoids, which bleed but do not prolapse outside the anus, and Grade II hemorrhoids, which prolapse upon straining but retract spontaneously, may respond to basic lifestyle changes and diminish within days to weeks.
However, Grades III and IV represent structural changes that will not disappear without medical intervention. Grade III hemorrhoids prolapse and require manual repositioning back inside the anal canal, while Grade IV hemorrhoids are permanently prolapsed. Since these higher grades involve significant displacement and deterioration of the supportive tissue, they are considered chronic structural problems that will persist indefinitely if left unaddressed. These advanced hemorrhoids will require specific treatments, such as rubber band ligation or surgery, for lasting resolution.
Progression of Untreated Hemorrhoidal Disease
Untreated hemorrhoidal disease can progress, leading to increasingly severe and complicated symptoms. For internal hemorrhoids, this progression is characterized by the worsening of the prolapse over time. A Grade II hemorrhoid, which initially retracts on its own, can eventually weaken the supporting structures to the point where it becomes a persistent Grade III or even a permanently prolapsed Grade IV.
Untreated hemorrhoids can also lead to the development of iron deficiency anemia due to persistent, low-grade blood loss. While the amount of blood visible after a single bowel movement may seem insignificant, the cumulative effect of daily bleeding over months or years can deplete the body’s iron stores. This can manifest as symptoms like fatigue, weakness, and paleness.
The most severe consequence of untreated prolapse is the risk of strangulation. This occurs when a prolapsed internal hemorrhoid is tightly constricted by the anal sphincter muscles, effectively cutting off its blood supply. Strangulation causes excruciating pain and can lead to tissue death, which necessitates immediate medical intervention.
Long-term issues include chronic discomfort, irritation, and the development of perianal skin tags. The constant moisture and friction associated with persistent prolapsed tissue can create a cycle of itching and inflammation. Chronic irritation and trauma can also lead to the formation of anal fissures, which are small tears in the lining that cause sharp pain during and after bowel movements.
Warning Signs Requiring Medical Attention
While many hemorrhoidal symptoms are manageable at home, certain warning signs indicate the need for prompt consultation. Sudden, severe, and unrelenting pain in the anal area is a red flag, often signaling an acute complication. This level of pain can be a symptom of a thrombosed external hemorrhoid or, more seriously, a strangulated internal hemorrhoid, both of which require timely assessment.
Any instance of significant or massive rectal bleeding necessitates immediate medical attention. If the bleeding is profuse, or if it causes dizziness, lightheadedness, or fainting, it suggests a substantial blood loss. Signs of infection, such as fever, chills, purulent drainage, or rapidly worsening swelling, also require immediate care to prevent complications like an abscess.
It is important to have any instance of rectal bleeding evaluated by a physician, even if hemorrhoids are suspected. Symptoms like bleeding and discomfort can also be indicative of more serious underlying gastrointestinal conditions, including inflammatory bowel disease or colorectal cancer. A physician must perform an examination to establish an accurate diagnosis and rule out serious conditions.