Hemorrhoids are swollen, enlarged veins that form either inside the rectum (internal) or under the skin around the anus (external). This condition, also known as piles, is extremely common, affecting a large portion of the population, particularly those over the age of 50. While many cases are mild and resolve on their own, delaying treatment for symptomatic hemorrhoids allows the condition to progress, leading to worsening symptoms and potentially severe medical complications.
The Gradual Worsening of Symptoms
The initial symptoms of hemorrhoids, such as occasional bright red bleeding and mild discomfort, often intensify over time without intervention. Internal hemorrhoids typically cause painless bleeding but become more problematic as the vascular cushions enlarge and descend. This descent leads to prolapse, where the tissue begins to push outside the anal opening, especially during a bowel movement. What starts as a temporary protrusion that spontaneously retracts may progress to requiring manual pushing back into the anal canal, or eventually becoming permanently prolapsed. This constant presence outside the anus causes increasing irritation, pain, and discomfort, making simple activities like sitting difficult.
Risk of Acute Thrombosis and Strangulation
The most urgent and painful consequences of untreated hemorrhoids involve the sudden development of a blood clot within the swollen tissue, known as thrombosis. This occurs when blood pools and clots inside the hemorrhoid, most commonly in an external hemorrhoid, leading to a hard, painful lump at the anal margin. The pain is typically sudden and severe because the clot rapidly distends the highly sensitive skin surrounding the anus.
Strangulation is a serious complication that occurs when a prolapsed internal hemorrhoid becomes tightly trapped by the surrounding sphincter muscle. This mechanical entrapment cuts off the hemorrhoid’s blood supply, causing intense swelling and a lack of oxygen to the tissue. Without immediate medical attention, this lack of blood flow can lead to tissue death (necrosis). The resulting severe, constant pain signifies an emergency situation, often requiring surgical intervention to relieve pressure and restore blood flow.
Chronic Health Consequences
Beyond the acute complications, chronic, untreated hemorrhoids can lead to systemic health problems and persistent quality of life issues. Although the bleeding is often minor, the persistent blood loss can eventually deplete the body’s iron stores. This depletion may result in iron deficiency anemia, a condition characterized by a reduced number of healthy red blood cells.
Anemia can manifest as fatigue, weakness, pale skin, and shortness of breath, affecting overall daily function. Furthermore, hemorrhoids, particularly when prolapsed, can lead to chronic skin and hygiene issues around the anus. The constant presence of moisture, mucus discharge, and microscopic stool particles irritates the perianal skin, causing persistent itching known as pruritus ani. This chronic irritation can lead to skin breakdown and increase the risk of secondary infection.