Hemorrhoids refer to hemorrhoidal disease and are characterized by swollen or inflamed veins of the anus and lower rectum. They are a benign anorectal disease and affect all age groups. Most people are unaware of when they get hemorrhoids because they tend to be painless. However, pain and discomfort can escalate during flare-ups. Affected individuals commonly complain about itching and irritation near or inside the anus.
Treatment options are mainly focused on managing the pain through non-invasive means. Except for surgical procedures that excise the hemorrhoidal structure, simpler ways include taking frequent Sitz baths, using topical ointments, and taking painkillers.
Causes of hemorrhoids are linked to trauma and increased pressure inside the rectum. This can irritate hemorrhoidal structures and cause the inflamed veins to bulge out.
Although rarely dangerous, that does not rule out the possibility of worst-case scenarios for hemorrhoids. Before getting into that, we will explain their classification. Yes, there are different types of hemorrhoids, three to be exact.
People generally have internal hemorrhoids since they are the most common type. These tend to be harmless, and pain is only experienced in severe cases. Internal hemorrhoids occur on the inside of the anal region. The rectum lining is moist and does not have many pain receptors; this makes internal hemorrhoids painless for most people.
They are given 4 grades based on the severity and progression of hemorrhoidal swelling. We will only discuss Grades I and II in this section. Grade I internal hemorrhoids are the least severe and exhibit minor swelling. Grade II hemorrhoids can swell and bulge out of the anus, but the swelling resolves on its own over time.
These occur on the skin outside of the anus. Since it also has many innervated pain fibers, external hemorrhoids can be extremely painful. They are also easier to identify as compared to internal hemorrhoids.
When hemorrhoids swell up, blood can clot inside the inflamed veins. These thrombosed veins give rise to thrombosed hemorrhoids. They can either be internal or external. The clots obstruct blood flow and add to the severe pain and discomfort experienced by a person.
Thrombosed hemorrhoids are not dangerous in most cases and usually heal on their own. The clots will fibrose and get reabsorbed by the blood. However, complications can still occur.
Causes of Hemorrhoids
Numerous factors contribute to increased pressure in the lower rectum. The leading cause of hemorrhoidal disease is sitting for prolonged periods. Sitting down puts pressure on the anus. The rectum walls cannot withstand increased pressure for an extended period and cause hemorrhoids to swell.
Similarly, forced or strenuous bowel movements also irritate the rectal lining and cause flare-ups. They provide a multipronged risk since they can cause trauma to the rectal walls and increase intra-abdominal pressure.
Other common factors that contribute to the risks of forming hemorrhoids include the following:
- Physical strain and inactivity
- Dehydration, constipation, and diarrhea
- Pregnancy and childbirth
- Prior history of hemorrhoidal disease
- Anal intercourse
- Old age and loss of muscle tone/ inelasticity
Another rare cause is liver cirrhosis from alcoholism. Converted metabolites of alcohol are known to damage the walls of the anus at the cellular level. Similarly, other anorectal diseases like fissures can also increase a person's likelihood of developing hemorrhoids. Lack of fiber and roughage in the diet are also essential contributors because they make stool hard and dry.
Worst-Case Scenarios for Hemorrhoids
Hemorrhoids are known to cause pain and discomfort in individuals. Their symptoms also include rectal bleeding, which is not harmful in most cases. But what about worst-case scenarios for hemorrhoids? Can complications accompany this condition and worsen the symptoms?
Yes, there can be complications that can cause severe pain and health concerns. Whether hemorrhoids are internal, external, or thrombosed, the following complications will likely make things worse for your condition.
Hemorrhoids can resolve on their own, but sometimes the skin doesn't retain its elasticity. The stretched skin is left behind in the form of skin tags. Severely stretched ones can cause the skin to split and contract infections. The infections take the form of pus-filled pockets.
Perianal Abscesses and Fistulas
Infectious skin tags can cause pus-filled pockets to develop. The infection occurs when bacteria become trapped in the cracked skin and cause severe pain. If left untreated, perianal abscesses can develop into fistulas and other complications. Fistulas are abnormal tunnels under the skin that connect the anal canal to the skin of the buttocks. They are extremely dangerous and can lead to long-term infections or even anorectal sepsis.
The pressure sometimes is so severe that no blood gets into hemorrhoids. This usually happens with untreated chronic hemorrhoids that become extremely swollen. Due to the obstruction of blood, no oxygen can get to the structures, and the hemorrhoids become strangulated. Strangulated hemorrhoids undergo a condition called necrosis, or cell death.
Prolapse and Thrombosis
Grade III and IV internal hemorrhoids can protrude from the anus and make the person unable to sit down. They are severely painful and can cause strangulation of hemorrhoids. Prolapsed hemorrhoids of Grade IV cannot be pushed back inside the anus and require surgical treatment.
Similarly, they can become thrombosed. The resulting blood clots can obstruct blood flow, whether thrombosed hemorrhoids are internal or external. This increase in pressure can cause the lumps to rupture and bleed. Rectal bleeding from ruptured hemorrhoids can, under severe circumstances, cause anemia. An anemic person feels weak and exhausted without any particular reason. Red blood cell count can also drop, reducing oxygen supply in the body. Anemia can significantly worsen the symptoms of hemorrhoids.
We hope this article helped you learn more about the worst-case scenarios for hemorrhoids. If you are experiencing any of the aforementioned symptoms, make sure to consult a doctor.