Hemorrhoids: Whats the Worst That Can Happen?

Medically reviewed by: Gary H. Hoffman, MD

Hemorrhoids.  Usually Just Annoying.  But They Could Be Worse.

Most adults know about hemorrhoids.  If you haven’t laughed at a hemorrhoid joke, if you haven’t seen a Preparation H commercial, or if you have not experienced a symptom from a hemorrhoid, then you probably are not yet an adult.  Lucky you.  A proctologist, also known as a colon and rectal surgeon, sees hemorrhoids every day.  Whether hemorrhoids are an incidental finding during an exam, or whether they are causing problems, hemorrhoids are the most common affliction bringing a patient to the office.

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Hemorrhoids are bundles of nerves, arteries, veins and connective tissue.  There are usually three hemorrhoidal groups in the anal canal.   They serve as cushions, or bumpers, for stool as it passes through the canal.  So, hemorrhoids are normal.  As we age, and for reasons unknown, hemorrhoids can enlarge.  As they enlarge, they can stretch the skin (also known as mucosa) overlying them.  It is at this time that they can begin to cause symptoms.

Symptoms.  You’ve Heard The Jokes.  Not Funny!

Ask a hemorrhoid sufferer about the humor in hemorrhoids.  You are likely to get a blank stare or a scowl.  Why?  Here’s why?

  • Pain.
  • Bleeding.
  • Itching.
  • Mucus discharge.
  • Prolapse (falling out).
  • More pain.  A lot more pain.

Anything Else?  Anything Worse?

Since you asked, hemorrhoids are occasionally associated with two other conditions which can really cause problems.  They are anemia and strangulation and necrosis (A fancy term.  Read on.)

As the lining over the hemorrhoid begins to stretch, it becomes irritated.  As this lining is a delicate tissue, one of the responses to this stretching is to bleed.  The bleeding is usually minor.  Injections, also known as sclerotherapy, can stop the bleeding.  However, if the bleeding is severe, or if it is minor but occurs unnoticed for a long period of time, it can lead to anemia.  Anemia is simply  a condition whereby the level of red cells in the blood, those cells which carry oxygen to the tissues, becomes low.  If it becomes too low, it will cause shortness of breath, fatigue and a general feeling of malaise.  These hemorrhoids require treatment.

As the hemorrhoids enlarge, they may begin to prolapse, or protrude from the anal opening.  They will usually spontaneously reduce (return to the anal canal).  Or, you may have to push them in.  But, when they do not reduce, the are permanently prolapsed.  If they enlarge, they become constricted by the anal sphincters (muscles).  Eventually, the pressure is so great, that no blood can get into or out of the hemorrhoid.  Without blood, there is no oxygen flowing to the hemorrhoids.  This leads to a condition called necrosis, or cell death.  This becomes an emergency.

What Next?

An operation, some type of hemorrhoidectomy, is needed urgently.  Whether the operation is a PPH (procedure for prolapse and hemorrhoids), a THD (transanal hemorrhoidal dearterialization), or a traditional surgical hemorrhoidectomy, the colon and rectal surgeon must act quickly to avoid further complications.  An experienced surgeon will help you through this process.  The operation is performed under anesthesia at an outpatient surgical center or at a hospital such as Cedars-SinaiMedicalCenter.

Los Angeles Colon and Rectal Surgical Associates

The surgeons of Los Angeles Colon and Rectal Surgical Associates are board certified and have the experience to help you swiftly through a hemorrhoidal crisis.  It is important that you schedule a consultation to begin the process of cure.  By calling (310)273-2310, you can begin that process.  The path to curing hemorrhoids begins with the first step.

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