Hemorrhoids are swollen, inflamed veins located in the rectum or anus. While minor cases may resolve with simple lifestyle changes, failing to treat persistent hemorrhoids often leads to a predictable progression of worsening symptoms. Understanding the potential consequences of non-treatment is important, as the risks extend beyond discomfort and can lead to acute medical emergencies and systemic health issues.
Escalation of Chronic Discomfort and Prolapse
Untreated internal hemorrhoids are classified by a four-grade scale based on their tendency to prolapse, or protrude, outside the anus. A Grade I hemorrhoid remains internal, while a Grade II prolapses during a bowel movement but spontaneously retracts. If lifestyle factors like chronic constipation or straining are not addressed, the condition may worsen, increasing the frequency and severity of this protrusion.
Progression to Grade III means the hemorrhoid prolapses and requires manual manipulation to be pushed back inside. A further escalation to Grade IV results in a permanently prolapsed mass that cannot be manually reduced. This causes significant and constant pain, swelling, and interferes with sitting and daily activities. Persistent irritation from the protrusion and discharge can also lead to chronic inflammation and intense, localized itching known as pruritus ani.
Risk of Acute Complications: Thrombosis and Strangulation
Leaving hemorrhoids untreated significantly increases the risk of two distinct acute complications that require immediate medical attention. The first is hemorrhoidal thrombosis, which occurs when a blood clot forms within an external hemorrhoid. This event is characterized by the sudden onset of severe, constant pain, often described as throbbing, due to the pressure and inflammation.
The thrombosed hemorrhoid typically appears as a firm, bluish-purple lump near the anal opening, with intense pain most severe within the first 48 to 72 hours. The second, more dangerous complication is strangulation, which happens when a prolapsed internal hemorrhoid becomes trapped by the anal sphincter muscles. This constriction cuts off the blood supply to the trapped tissue, leading to extreme pain and a risk of tissue death, or necrosis. Strangulation most often occurs with Grade IV hemorrhoids, where the tissue is permanently outside and cannot be reduced.
Secondary Systemic Effects: Anemia from Chronic Bleeding
A frequent symptom of internal hemorrhoids is painless bright red bleeding during or after a bowel movement. While the amount of blood lost during a single event may seem minor, chronic bleeding over a long period can lead to iron deficiency anemia. The continuous loss of blood depletes the body’s iron stores, which are necessary for producing hemoglobin.
This gradual depletion can cause symptoms of anemia, including generalized weakness, fatigue, and pallor (pale skin). In severe cases, patients may experience lightheadedness or shortness of breath. While severe anemia from hemorrhoids is not common, it is a documented consequence of ignoring chronic blood loss.
The Danger of Delayed Medical Review
The most significant risk of self-treating or ignoring symptoms attributed to hemorrhoids is the missed opportunity for a professional diagnosis. Rectal bleeding, pain, and changes in bowel habits are not unique to hemorrhoids; they are also common signs of several serious gastrointestinal conditions. Delayed medical review prevents a differential diagnosis, which is the process of ruling out other potential causes.
Conditions that can mimic hemorrhoids include anal fissures, inflammatory bowel disease, and colorectal cancer. A tumor low in the rectum can cause bright red bleeding similar to hemorrhoids, which can easily be mistaken for a benign condition. Assuming the symptoms are merely hemorrhoids and avoiding a consultation risks significantly delaying the detection and treatment of a potentially life-threatening disease.