Hemorrhoids, commonly referred to as piles, are swollen veins located in the lower rectum and around the anus. While often resolving within a few days to a week with self-care measures, some cases persist, leading to ongoing discomfort and potential health concerns.
Understanding Persistent Hemorrhoids
Hemorrhoids may persist due to various factors, often stemming from increased pressure in the lower rectal area. Chronic straining during bowel movements, prolonged sitting, and a diet low in fiber are common contributors to this pressure. Genetics can also play a role, as can conditions like chronic constipation or diarrhea, pregnancy, and obesity.
Persistent hemorrhoids can cause continuous symptoms. These include ongoing pain, itching, and swelling around the anal region. Bleeding during bowel movements, which appears as bright red blood, is also a common sign. Internal hemorrhoids, located inside the rectum, may bleed without pain, while external hemorrhoids, under the skin around the anus, typically cause more discomfort due to more nerve endings.
Potential Health Consequences
If hemorrhoids do not resolve, several health complications can arise. Chronic bleeding, particularly from internal hemorrhoids, can lead to iron-deficiency anemia over time. Anemia may present with symptoms such as fatigue, weakness, dizziness, and pale skin.
External hemorrhoids can become thrombosed, meaning a blood clot forms within the swollen vein, causing sudden and severe pain, swelling, and a firm lump. Internal hemorrhoids may prolapse, extending outside the anus. If their blood supply is cut off by the anal muscles, they become “strangulated,” leading to intense pain and tissue damage. Unresolved hemorrhoids can also lead to chronic skin irritation, potentially developing into painful ulcers or anal fissures, which are tears in the anal lining. In rare instances, persistent irritation and open sores can become infected, potentially forming an abscess that requires medical drainage and antibiotics.
Available Treatment Options
For hemorrhoids that do not resolve with initial self-care, various medical interventions are available. Non-surgical approaches are often the first line of treatment. Dietary changes, such as increasing fiber intake to 25 to 38 grams daily, and adequate hydration help soften stools and reduce straining. Over-the-counter topical creams containing hydrocortisone, witch hazel, or lidocaine can alleviate itching, swelling, and pain. Sitz baths, soaking the anal area in warm water, can also soothe symptoms.
Office-based procedures offer more targeted interventions. Rubber band ligation involves placing a small band around the base of an internal hemorrhoid, cutting off its blood supply, causing it to shrink and fall off. Sclerotherapy involves injecting a chemical solution into the hemorrhoid, causing it to shrink and scar. Infrared coagulation uses an infrared light to apply heat, causing the hemorrhoid to shrivel and fall off. Electrocoagulation uses an electric current to achieve a similar effect.
When non-surgical treatments are insufficient, surgical options may be considered, particularly for larger or more severe cases. A hemorrhoidectomy is a surgical procedure where the swollen veins are excised. Another option is stapled hemorrhoidopexy, which involves stapling internal hemorrhoids back into the rectum. Hemorrhoidal artery ligation uses sutures to cut off the blood supply to the hemorrhoids, leading to their shrinkage. These surgical interventions are generally reserved for cases that have not responded to less invasive methods.
Knowing When to Consult a Doctor
Seeking professional medical advice is advisable if hemorrhoid symptoms persist or worsen despite home care. If discomfort, pain, or itching continues for more than a week, a doctor’s evaluation is recommended. Any instance of rectal bleeding, whether before, during, or after bowel movements, warrants a medical consultation to rule out more serious conditions like colon or anal cancer.
A doctor should also be consulted if there are changes in bowel habits, such as a persistent feeling of incomplete evacuation, or if a prolapsed hemorrhoid cannot be easily pushed back inside. Severe pain, significant bleeding, or signs of infection like fever and chills, require prompt medical attention. A healthcare provider can accurately diagnose the condition and recommend the most appropriate course of treatment.