Hemorrhoids natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Overview

If left untreated, hemorrhoids may progress to develop strangulation, anemia or fecal incontinence. Common complications of hemorrhoids include secondary infection, thrombosis or strangulation. Prognosis is generally excellent and most cases respond to non surgical treatment. However, surgery gives the best prognosis with the least recurrence rate.

Natural History, Complications and Prognosis

Natural History

• If left untreated, hemorrhoids may progress to develop strangulation, thrombosis or infection.
• The main reasons for seeking delayed advise are as follows:

• Myths about the surgical treatment
• Postoperative pain
• Fear of incontinence after surgery

Complications

Most common complications

• Strangulation: If the anal sphincter muscle goes into spasm and traps a prolapsed hemorrhoid outside the anal opening, the supply of blood is cut off, and the hemorrhoid becomes a strangulated hemorrhoid.
• Secondary infection and abscess formation
• Hemorrhoid thrombosis

Less common complications

• Anemia due to chronic bleeding
• Fecal incontinence

Complications due to surgery

• Anal stenosis
• Wound dehisence
• Wound sepsis
• Fistula formation

Prognosis

Hemorrhoids are not dangerous, and only need to be treated if they cause very bothersome symptoms. If hemorrhoids occur during pregnancy, they will usually regress spontaneously after childbirth. For hemorrhoids related to constipation, the prognosis is also good, provided you make the necessary changes to your diet and lifestyle. For hemorrhoids that cause persistent symptoms despite nonsurgical treatment, the results from office treatment or surgery are usually very good.