Hemorrhoids left alone can follow several paths, from resolving quietly on their own to escalating into painful, sometimes dangerous complications. Mild cases often stay mild for years, but without any changes to the habits that caused them, hemorrhoids tend to progress rather than disappear. The range of potential outcomes includes blood clots, chronic blood loss severe enough to cause anemia, tissue that becomes trapped and loses its blood supply, and a subtler but serious risk: assuming that rectal bleeding is “just hemorrhoids” when it could signal something far worse.
Blood Clots in External Hemorrhoids
One of the most common acute complications is a thrombosed external hemorrhoid, where a blood clot forms inside a swollen vein near the anal opening. This produces a hard, intensely painful lump that can make sitting, walking, or having a bowel movement miserable. The pain typically peaks in the first 48 to 72 hours and then gradually fades over one to two weeks as the clot is reabsorbed. A systematic review comparing surgery with conservative management for thrombosed external hemorrhoids found that surgical removal cut the risk of the problem coming back roughly in half, though both approaches carried similar rates of bleeding afterward.1PubMed. Operative versus nonoperative treatment of thrombosed external hemorrhoids: a systematic review and meta-analysis People who ride out the episode without treatment may recover, but the stretched skin left behind often forms a permanent skin tag around the anus, which can be annoying to keep clean and sometimes gets mistaken for a new hemorrhoid.
How Hemorrhoids Get Worse Over Time
Internal hemorrhoids are graded on a four-point scale based on how far the tissue bulges out of the anal canal. In the earliest stage, swollen cushions bleed during a bowel movement but never protrude. At the second grade, tissue slides out during straining and then retracts on its own. Third-grade hemorrhoids prolapse and have to be pushed back in manually, and fourth-grade hemorrhoids stay permanently outside the anus.2PubMed Central. A New Classification for Hemorrhoidal Disease: The Creation of the “BPRST” Staging and Its Application in Clinical Practice Without intervention, progression from one grade to the next is common, though the timeline varies widely from person to person. The cushions weaken further each time they swell and prolapse, making the next episode more likely.
The most alarming stage of this progression is strangulation. When prolapsed hemorrhoids become trapped outside the anal sphincter and their blood supply gets cut off, the tissue swells, turns dusky, and can become gangrenous. This is a surgical emergency. If strangulated hemorrhoids are not treated promptly, the dying tissue can become infected, potentially leading to a dangerous pelvic infection.3Surgical Clinics of North America. Diagnosis and management of anorectal disease frequently seen in the emergency room Strangulation is rare among people with early-stage hemorrhoids, but it becomes a real concern for anyone with chronically prolapsing tissue who puts off treatment for years.
Chronic Bleeding and Anemia
A small streak of bright red blood on the toilet paper after a bowel movement might seem trivial, but hemorrhoids that bleed repeatedly over months or years can drain enough blood to cause iron deficiency anemia. You might not connect the dots because each individual episode seems minor. A study evaluating the causes of iron deficiency anemia found that hemorrhoids were the single most common lower-GI source, accounting for roughly 45% of cases in men and 30% in women among the patients examined.4PubMed Central. Study to evaluate the etiology of iron deficiency anemia at a teaching hospital in northeastern part of India Separately, a colonoscopy-based study of patients who already had confirmed iron deficiency anemia identified severely bleeding hemorrhoids as one of the notable lower-GI findings.5PubMed. Prospective evaluation of gastrointestinal tract in patients with iron-deficiency anemia
The symptoms of iron deficiency anemia are easy to write off as stress or poor sleep: fatigue, weakness, pale skin, brittle nails, shortness of breath during ordinary activity. Some people live with these symptoms for so long that they forget what normal energy feels like. If you have hemorrhoids that bleed with most bowel movements and you’ve been feeling unusually tired, a simple blood test can check your iron levels and hemoglobin count. Treating the hemorrhoids stops the blood loss; treating the anemia replenishes your stores. Ignoring both can leave you increasingly debilitated.
When “Just Hemorrhoids” Masks Something Else
Perhaps the most consequential risk of leaving hemorrhoids unexamined is not what the hemorrhoids themselves do, but what they hide. Rectal bleeding, changes in bowel habits, and discomfort around the anus are symptoms shared by hemorrhoids and colorectal cancer, and the overlap is close enough to fool both patients and doctors. The American Society of Colon and Rectal Surgeons has explicitly warned that rectal bleeding attributed to hemorrhoids represents the most commonly missed opportunity to catch a cancer diagnosis.6Diseases of the Colon & Rectum. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids
A systematic review of the clinical overlap between hemorrhoidal disease and rectal cancer confirmed that the similarity in symptoms leads to frequent misdiagnosis.7PubMed Central. Hemorrhoids and Rectal Cancer: A Systematic Review of Clinical Overlap, Diagnostic Misclassification, and Early Detection Strategies for Primary Care And patients themselves contribute to the delay: a study of people eventually diagnosed with rectal cancer found that more than half had initially attributed their symptoms to hemorrhoids.8PubMed Central. Delayed treatment for rectal cancer The reasoning is understandable. Hemorrhoids are common and cancer is comparatively rare, so bleeding feels like a familiar nuisance rather than a warning. But this is exactly the logic that lets tumors grow while people wait for symptoms to go away on their own.
This doesn’t mean that every person with hemorrhoids needs to panic about cancer. It means that new rectal bleeding, a change in the character of bleeding you’ve had for years, or any bleeding accompanied by unexplained weight loss, persistent changes in stool caliber, or a feeling of incomplete evacuation should be evaluated by a doctor rather than managed at home with over-the-counter creams.
How Untreated Hemorrhoids Affect Daily Life
Even when hemorrhoids don’t produce a dramatic complication, leaving them untreated can grind down your quality of life in ways that are hard to quantify but easy to feel. Research measuring health-related quality of life in people with hemorrhoidal disease found that patients with a high symptom load scored meaningfully lower on physical health measures compared to the general population.9PubMed Central. Quality of life in patients with hemorrhoidal disease What stands out in that research is that the severity you feel matters more than what a surgeon sees during an exam. How much symptoms disrupt your day predicts your quality of life better than the anatomical grade of the hemorrhoids themselves.
This tracks with what people living with untreated hemorrhoids describe: avoiding exercise because bouncing or straining triggers a flare-up, dreading business trips because sitting for hours on a plane worsens the swelling, or skipping social events because the discomfort is too distracting. The same study found that quality of life improved after surgical treatment, which suggests that the burden is genuinely tied to the hemorrhoids rather than to some unrelated factor.9PubMed Central. Quality of life in patients with hemorrhoidal disease
Embarrassment, Avoidance, and the Psychological Toll
A reason hemorrhoids so often go untreated is that many people are too embarrassed to bring them up with a doctor. The persistent pain and social stigma associated with anorectal disorders frequently contribute to depressive symptoms and anxiety, and this is made worse by patients’ reluctance to seek help due to shame.10PubMed Central. Depression and anxiety symptom networks in hemorrhoid patients: evidence from the UK biobank The result is a feedback loop: hemorrhoids cause discomfort and worry, the worry and embarrassment prevent treatment, the lack of treatment allows progression, and progression causes more discomfort and worry. Breaking this cycle usually requires accepting that hemorrhoids are one of the most common conditions doctors see, and that a brief, straightforward examination is all that is typically needed to get a treatment plan started.
Hemorrhoids During Pregnancy
Pregnancy deserves special mention because it accelerates nearly every factor that causes hemorrhoids to worsen. Rising progesterone relaxes blood vessel walls, the expanding uterus compresses pelvic veins, constipation becomes more common, and delivery itself involves prolonged straining. A study of pregnant women found that half developed perineal disease, with about two-thirds of those cases appearing in the third trimester. Among affected patients, roughly 72% had hemorrhoids alone, and constipation and prolonged straining during delivery were identified as key risk factors.11Journal of Pharmaceutical Research International. Occurrence of Hemorrhoids and Anal Fissures through Pregnancy and Postpartum
Many pregnancy-related hemorrhoids do improve postpartum as the mechanical pressures resolve. But women who already had hemorrhoids before becoming pregnant often find that pregnancy pushes them to a higher grade, and the tissue doesn’t fully recover afterward. Managing constipation aggressively during pregnancy, with adequate fluid, fiber, and safe stool softeners if needed, is one of the more effective ways to keep hemorrhoids from escalating during this period.
The Constipation Connection
Constipation and hemorrhoids are tangled together in a way that matters for anyone thinking about whether to treat or wait. A meta-analysis found that the prevalence of functional constipation is roughly twice as high in people with hemorrhoids compared to those without, and that people with hemorrhoids also tend to have higher resting pressures in the anal canal.12European Journal of Gastroenterology & Hepatology. Functional constipation in patients with hemorrhoids: a systematic review and meta-analysis The relationship runs in both directions: constipation promotes hemorrhoid formation by forcing prolonged straining, and hemorrhoids may worsen constipation by making bowel movements painful enough that people delay or avoid them.
Interestingly, a study on smartphone use in the bathroom found that the total time spent sitting on the toilet may matter more than how hard you strain. Prolonged sitting, possibly encouraged by scrolling through a phone, was independently associated with hemorrhoids even after accounting for straining and diagnosed constipation.13PLoS One. Smartphone use on the toilet and the risk of hemorrhoids The practical takeaway is straightforward: get off the toilet when you’re done. If nothing is happening after a few minutes, stand up and try again later rather than sitting there waiting.
What Treatment Looks Like When You’ve Waited Too Long
Early-stage hemorrhoids have easy treatment options. Dietary changes, fiber supplements, topical treatments, and sitz baths are usually enough for grade I and grade II hemorrhoids. When those measures fail, rubber band ligation is a quick office-based procedure that remains the preferred approach for minor hemorrhoids that don’t respond to conservative care.14PubMed Central. Still a Case of “No Pain, No Gain”? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020
But people who wait until their hemorrhoids have reached grade III or IV are generally looking at surgery. Conventional hemorrhoidectomy, where the tissue is excised entirely, produces the lowest recurrence rates but is notorious for postoperative pain.15PubMed Central. Minimally Invasive Treatment for Advanced Hemorrhoids Newer alternatives, including stapled hemorrhoidopexy and transanal hemorrhoidal dearterialization, offer less pain and fewer complications like anal narrowing, but a network meta-analysis found that both come with higher recurrence rates compared to conventional excision.16PubMed. Comparison of surgical procedures implemented in recent years for patients with grade III and IV hemorrhoids: a network meta-analysis In other words, the trade-off for a gentler surgery is a greater chance you’ll need another procedure down the line.
A randomized trial of 200 patients with grade III and IV hemorrhoids compared a newer tissue-preserving technique to the standard Milligan-Morgan procedure. The tissue-preserving approach produced less anal narrowing, fewer residual skin tags, and no relapses over six months of follow-up, compared to four relapses in the conventional group.17PubMed Central. A NEW MIXED SURGICAL TREATMENT FOR GRADES III AND IV HEMORRHOIDS: MODIFIED SELECTIVE HEMORRHOIDECTOMY COMBINED WITH COMPLETE ANAL EPITHELIAL RETENTION Surgical techniques continue to evolve, but the fundamental point remains: treating hemorrhoids early, when office-based procedures still work, avoids a recovery that involves significant pain and time off from work. Every year spent ignoring worsening symptoms is time moving closer to a surgical intervention that could have been avoided.
The Financial Side of Delay
There’s also a practical financial argument for not waiting. An analysis of U.S. insurance claims estimated that about 1.4 million people in the employer-insured population sought care for hemorrhoids in a single year, with a total annual cost of roughly $770 million across physician visits, outpatient facility charges, and prescriptions.18PubMed. Burden and Cost of Outpatient Hemorrhoids in the United States Employer-Insured Population, 2014 Those costs are heavily weighted toward people who need procedures rather than people managing symptoms with diet and fiber. Catching hemorrhoids early and addressing the lifestyle factors behind them is substantially cheaper than treating the complications that emerge after years of neglect. The pattern with hemorrhoids is the same as with most chronic conditions: the longer you wait, the more invasive, painful, and expensive the solution becomes.