Hemorrhoids natural history, complications and prognosis

If left untreated, hemorrhoids may lead to 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.

• If left untreated, hemorrhoids may lead to strangulation, thrombosis, or infection.
• The main reasons for a delay in seeking medical advice are as follows:

• Myths about the surgical treatment
• Postoperative pain
• Fear of incontinence after surgery^[1]

• Strangulation: The prolapsed hemorrhoids can be trapped outside the anal canal if the anal sphincter goes into spasm. This can lead to thrombosis of the hemorrhoids or cutting of the blood supply to the hemorrhoids
• Secondary infection and abscess formation
• Hemorrhoid thrombosis

• Anemia due to chronic bleeding
• Fecal incontinence

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

• The prognosis is excellent.
• Most cases respond well to non surgical procedures such as rubber band ligation (recurrence rate is 30-50% after 5 years); however, the 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.

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