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Complications of Haemorrhoids

Complications of haemorrhoids

  • Profuse bleeding is rare, mainly externally but some time internally. Bleeding diathesis and use of anticoagulants may worsen the situation.
  • Strangulation. Second-degree  haemorrhoids may be gripped by the external sphincter, leading to venous congestion, cause of considerable pain, if not reduced within hours strangulation  is followed by thrombosis.
  • Thrombosis. The affected haemorrhoid become dark purple or black,  feel solid and is painful.
  • Ulceration. Superficial ulceration  often accompanies strangulation  with thrombosis.
  • Gangrene occurs when strangulation is sufficiently tight to constrict the arterial supply of  the  haemorrhoid.  The   resulting  sloughing  is  usually  superficial  and  localized . Occasionally, as a whole haemorrhoid  sloughs off, leaving an ulcer which heals gradually.
  • Fibrosis. After thrombosis, internal haemorrhoids  sometimes become converted into fibrous tissue. The fibrosed haemorrhoid is at first sessile, but by repeated traction during prolapse at defecation, it becomes pedunculated and constitutes a fibrous polypus.
  • Suppuration  is  uncommon and occurs  as  a  result  of  infection  of  a  thrombosed haemorrhoid, present as throbbing  pain followed  by  perianal  swelling resulting in a  perianal  or submucous abscess.
  • Pylephlebitis (syn. portal pyaemia).  Theoretically, infected haemorrhoids should be a potent cause of portal pyaemia and liver abscesses, fortunately rare.
  • Anaemia, hypoproteinaemia due to chronic blood loss.

Most of these complications respond to early institution of suitable chemotherapeutic agents, analgesics, and physical measures to relieve pain followed by surgery.