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^[1]

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

Prognosis is excellent.
Most cases respond well to non surgical procedures as rubber band ligation (recurrence rate is 30 -50%) after 5 years, however recurrence rate is much less with surgical hemorrhoidectomy (2-5% after 5 years).^[2]^[3]
The difference in recurrence rate is more pronounced with grade III hemorrhoids.

References

↑ Guttenplan M (2017). "The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist". Curr Gastroenterol Rep. 19 (7): 30. doi:10.1007/s11894-017-0574-9. PMID 28567655.
↑ Jayaraman S, Colquhoun PH, Malthaner RA (2007). "Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery". Dis. Colon Rectum. 50 (9): 1297–305. doi:10.1007/s10350-007-0308-4. PMID 17665254.
↑ Shanmugam V, Thaha MA, Rabindranath KS, Campbell KL, Steele RJ, Loudon MA (2005). "Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids". Cochrane Database Syst Rev (3): CD005034. doi:10.1002/14651858.CD005034.pub2. PMID 16034963.

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[pmid28567655-1] Guttenplan M (2017). "The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist". Curr Gastroenterol Rep. 19 (7): 30. doi:10.1007/s11894-017-0574-9. PMID 28567655.

[pmid17665254-2] Jayaraman S, Colquhoun PH, Malthaner RA (2007). "Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery". Dis. Colon Rectum. 50 (9): 1297–305. doi:10.1007/s10350-007-0308-4. PMID 17665254.

[pmid16034963-3] Shanmugam V, Thaha MA, Rabindranath KS, Campbell KL, Steele RJ, Loudon MA (2005). "Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids". Cochrane Database Syst Rev (3): CD005034. doi:10.1002/14651858.CD005034.pub2. PMID 16034963.

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