Hemorrhoids affect the vascular cushions that line the lower rectum and anus. These swollen, enlarged veins are often triggered by increased pressure, leading to symptoms like discomfort, itching, and bleeding. While many cases resolve quickly with basic care, persistence beyond a few weeks suggests an underlying factor is constantly reinjuring the delicate tissue. This delay may also indicate that the symptoms are caused by a different, though similar, condition.
Common Reasons for Delayed Healing
The most frequent cause for a hemorrhoid that will not disappear is the continuation of habits that initially caused it to swell. Chronic straining during bowel movements, whether due to constipation or chronic diarrhea, places excessive downward pressure on the rectal veins. This repeated pressure prevents the inflamed tissue from shrinking back to its normal size and allows for recurrence.
Prolonged sitting on the toilet is another significant factor, as this position causes blood to pool in the anal veins, increasing swelling and inflammation. Insufficient intake of dietary fiber and water results in hard, difficult-to-pass stools that physically damage the hemorrhoidal tissue. Furthermore, certain medications, such as opioid pain relievers, can slow gut motility and lead to severe constipation. Heavy lifting or other high-strain activities that increase intra-abdominal pressure can also hinder the recovery process.
Identifying Signs of Acute Complications
A hemorrhoid that suddenly becomes severely painful may indicate an acute complication requiring immediate medical attention. A thrombosed hemorrhoid occurs when a blood clot forms inside an external hemorrhoid, creating a hard, bluish, and intensely painful lump near the anal opening. This pain typically peaks within the first 48 hours and can make sitting or walking difficult.
A strangulated hemorrhoid happens when a prolapsed internal hemorrhoid has its blood supply cut off by the anal sphincter muscles. This condition causes extreme pain and can lead to tissue death if not treated promptly. Signs of infection, such as fever, pus, or discharge along with increased redness and warmth, also signal an urgent need to consult a healthcare provider.
Conditions Often Mistaken for Hemorrhoids
When symptoms persist despite proper home care, the issue may not be a hemorrhoid at all, but one of several other perianal conditions that share similar symptoms. An anal fissure is a small tear in the lining of the anal canal that produces sharp, tearing pain with bright red bleeding. The pain from a fissure is typically most intense during and immediately after a bowel movement, which helps differentiate it from the chronic pressure and discomfort of a hemorrhoid.
A perianal abscess is a collection of pus caused by an infection in the small glands near the anus. An abscess causes constant, throbbing pain, often accompanied by local swelling, warmth, and possibly a fever or chills.
A perianal hematoma, sometimes confused with a thrombosed external hemorrhoid, is a collection of blood from a burst vessel under the skin near the anus. While both present as a firm lump, a hematoma results from a ruptured vessel and appears as a dark, bruised-looking swelling that is sensitive to pressure.
Professional Medical Interventions
When lifestyle changes and over-the-counter treatments fail to resolve the issue, a specialist can offer several effective interventions. Minimally invasive, non-surgical procedures are often the first line of treatment for persistent internal hemorrhoids. Rubber band ligation involves placing a small elastic band around the base of the internal hemorrhoid, which cuts off its blood supply, causing the tissue to wither and fall off within about a week.
Sclerotherapy is an office-based procedure where a chemical solution is injected into the hemorrhoidal tissue to cause scarring and shrinkage, effective for smaller bleeding internal hemorrhoids. Infrared coagulation uses heat to create scar tissue that reduces the blood supply to the hemorrhoid, causing it to shrink. For very large external hemorrhoids or severe internal hemorrhoids that have prolapsed and remain symptomatic, a surgical procedure called a hemorrhoidectomy may be necessary to remove the excess tissue.