The persistence of hemorrhoid symptoms can be frustrating, especially when attempting self-care. Hemorrhoids are swollen veins in the lower rectum and anus, similar to varicose veins. They affect a majority of adults at some point in their lives. When a hemorrhoid does not resolve on its own, it is often due to continued pressure, a misinterpretation of symptoms, or a need for more focused medical treatment. Understanding the factors that prevent healing is the first step toward effective relief.
Lifestyle Factors Preventing Healing
The most frequent reason a hemorrhoid fails to heal is the continuation of habits that originally caused or aggravated the condition. Chronic straining during bowel movements increases pressure within the anal cushions, the vascular structures that become inflamed and swollen to form hemorrhoids. This excessive force distends the veins and prevents existing swelling from reducing.
Insufficient dietary fiber and water intake is a significant contributor, leading to hard stools that require straining to pass. A high-fiber diet, including fruits, vegetables, and whole grains, is recommended to soften stool and increase bulk, promoting easier passage. Drinking at least six to eight glasses of water daily is important to maintain stool consistency and avoid the trauma of hard bowel movements.
Prolonged sitting on the toilet also undermines healing efforts. This position causes the anal veins to engorge with blood due to gravity, dramatically increasing pressure in the rectal area. Limiting toilet time to a few minutes and responding to the urge to defecate promptly prevents the stool from hardening, reducing the need to strain later.
Ignoring the urge to defecate can cause stools to become dry and difficult to pass, necessitating straining. Taking regular breaks from prolonged sitting throughout the day helps stimulate bowel function and improves circulation. Both actions promote the healing of existing hemorrhoids.
When Symptoms Point to a Different Condition
Persistent symptoms might indicate that the discomfort is not from a hemorrhoid at all, but rather from another similarly presenting anorectal condition. Anal fissures, which are small tears in the lining of the anal canal, are frequently mistaken for hemorrhoids. Fissures typically cause sharp, severe pain during a bowel movement that can linger, unlike the dull ache or itching associated with hemorrhoids.
Another common misinterpretation involves a perianal hematoma, a collection of clotted blood from a ruptured vessel under the skin near the anus. This condition appears as a painful, firm lump and is sometimes incorrectly referred to as a thrombosed external hemorrhoid. A perianal hematoma occurs outside the anal canal and is distinct from a prolapsed hemorrhoid.
For any persistent or unusual symptoms, it is important to be evaluated by a healthcare professional. Persistent rectal bleeding can sometimes be a symptom of more serious conditions, such as polyps or colorectal cancer. This is particularly relevant for individuals over age 50 or those who experience unexplained weight loss or a change in bowel habits.
Signs That Require Immediate Medical Attention
Severe, unremitting pain indicates the need for urgent medical evaluation. This often signals a thrombosed external hemorrhoid, which occurs when a blood clot forms inside the swollen vein. This causes intense throbbing and a hard, discolored lump near the anus.
Significant or unexplained rectal bleeding also warrants an immediate visit to a doctor. While hemorrhoids commonly cause small amounts of bright red blood, large amounts of bleeding or bleeding accompanied by lightheadedness indicate a more serious issue. Signs of infection, such as fever, chills, or the discharge of pus, also require prompt professional care.
A prolapsed internal hemorrhoid that cannot be gently pushed back inside the anal opening, known as an incarcerated hemorrhoid, is another situation requiring urgent attention. If symptoms do not show improvement after about a week of consistent home care and over-the-counter treatments, a medical consultation is necessary to confirm the diagnosis and determine the next steps.
Professional Treatment Options for Stubborn Cases
When lifestyle modifications and over-the-counter remedies fail to provide lasting relief, outpatient procedures are often the next step. Rubber band ligation is a widely used and effective treatment for internal hemorrhoids of Grade I to Grade III severity. During this procedure, an elastic band is placed around the base of the hemorrhoid, cutting off its blood supply.
The tissue withers and falls off within about a week, and the resulting scar tissue helps anchor the remaining vascular cushion, preventing future prolapse. This method has a high success rate and generally involves less pain and a shorter recovery period compared to surgery.
Sclerotherapy is another office-based option, particularly effective for smaller, bleeding internal hemorrhoids. This involves injecting a chemical solution, known as a sclerosant, into the tissue around the hemorrhoid. The solution causes a localized inflammatory reaction that leads to scarring and shrinkage of the hemorrhoid over several weeks.
For severe, recurring, or Grade III and IV hemorrhoids that have not responded to less invasive methods, a surgical hemorrhoidectomy may be recommended. This operation involves the excision of the hemorrhoidal tissue. Although this procedure is associated with more post-operative pain and a recovery period of two to four weeks, it offers the lowest recurrence rate and the best long-term outcome for advanced disease.