Hemorrhoids are swollen veins in the rectum or around the anus, similar to varicose veins. While often temporary, causing pain, itching, or bleeding, some can become a persistent issue. Understanding their types and contributing factors helps explain why some individuals experience ongoing problems.
Hemorrhoid Types and Their Typical Duration
Hemorrhoids are categorized into internal and external types, each with a distinct course. Internal hemorrhoids form inside the rectum and are usually not visible or painful due to fewer pain-sensing nerves. They often present with painless, bright red bleeding during or after bowel movements.
While they can remain asymptomatic, some may prolapse, or protrude, through the anal opening, potentially causing discomfort or discharge. If internal hemorrhoids prolapse, they might go back inside on their own or can be gently pushed back.
External hemorrhoids develop under the skin around the anus, where many pain-sensing nerves make them quite painful. They appear as swollen lumps and can cause discomfort, irritation, and darker bleeding. Mild external hemorrhoids often resolve within a few days to a week with home care. More severe cases, especially thrombosed hemorrhoids (those involving a blood clot), can take several weeks to heal, often lasting two to three weeks. The most intense pain usually subsides within 48 hours as the body begins to reabsorb the clot.
Factors Leading to Persistent Hemorrhoids
Several factors can contribute to hemorrhoids becoming persistent. Repeated or prolonged pressure on rectal and anal veins is a common cause. Chronic constipation or diarrhea can lead to increased pressure due to frequent straining during bowel movements, which weakens vein walls and makes them susceptible to swelling and prolapse.
Sitting on the toilet for extended periods also increases pressure, hindering blood flow and contributing to hemorrhoid development. A low-fiber diet can worsen constipation, indirectly leading to persistent hemorrhoids. Obesity, pregnancy, and regularly lifting heavy objects can also increase abdominal pressure, further straining rectal veins and making hemorrhoids more likely to persist or return.
Managing Persistent Hemorrhoids
Managing persistent hemorrhoids involves lifestyle adjustments and medical interventions. Increasing dietary fiber intake is a primary recommendation, as it softens stools and adds bulk, reducing the need to strain during bowel movements. This can be achieved by consuming more fruits, vegetables, and whole grains, or by taking fiber supplements, ensuring adequate hydration alongside to prevent worsening constipation.
Regular exercise, even moderate activities like walking for 20-30 minutes daily, can stimulate healthy bowel movements and reduce pressure on rectal veins. Avoiding prolonged sitting, especially on the toilet, and addressing the urge to have a bowel movement promptly also helps prevent recurrence and aggravation.
When lifestyle changes are insufficient, medical interventions become necessary. Over-the-counter remedies like creams containing lidocaine, witch hazel, or hydrocortisone can provide temporary relief from pain and itching.
Non-surgical procedures are often effective for persistent internal hemorrhoids. Rubber band ligation involves placing a small rubber band around the hemorrhoid’s base to cut off its blood supply, causing it to shrink and fall off within about a week. Sclerotherapy injects a chemical solution to cause scar tissue formation and shrink the vein. For larger or more severe cases, surgical options like a hemorrhoidectomy, which removes excess tissue, may be recommended. Consulting a healthcare provider is important to determine the most appropriate course of action.