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.