PNG icon of the PrecisionIR logo for the website.
  1. Home
  3. Conditions
  5. Chronic Hemorrhoids

Chronic Hemorrhoids

50% of Americans will experience hemorrhoids at some point in their lives.1 In most cases, hemorrhoids will go away on their own, or they can be treated with lifestyle changes, diet modification, topical creams or medications/supplements. For some, however, hemorrhoids do not respond to these “conservative” treatments and the symptoms of bleeding, itching and difficult/painful bowel movements can impact their lives. These are known as chronic hemorrhoids.

Left untreated, chronic hemorrhoids can prolapse or even burst. They can also cause bleeding, blood clots, infection, perianal thrombosis and other more serious health conditions.

chronic hemorrhoids

What causes hemorrhoids?

Hemorrhoids are swollen veins inside the lower rectum or anus. They are similar to varicose veins, and can be treated in similar fashion. They occur most often in people between the ages of 45 and 65. They may be caused by an increase in pressure in the lower rectum through one or more of the following factors:

  • Extended periods of sitting
  • Straining during exercise or bowel movements
  • Being overweight or obese
  • Pregnancy or after childbirth
  • Heredity (family history)

A high fiber diet, regular exercise and proper hydration can help prevent hemorrhoids.

What are my treatment options for chronic hemorrhoids?

Conservative Treatment

Initially, conservative treatment for hemorrhoids should be attempted. These can include everything from dietary changes to over-the-counter treatments and sitz baths. NSAID pain relievers (such as Tylenol or Advil) may be used to control pain. If the symptoms persist, and if you are experiencing pain, bleeding or changes in bowel habits, you may wish to speak with your doctor about treatment options.

Surgery

In some cases, surgery may be required to treat chronic hemorrhoids, especially if you have grade IV prolapsed internal hemorrhoids or if you experience strangulation (blood flow to the hemorrhoid is completely cut off). Hemorrhoidectomy is the surgical removal of hemorrhoids. Stapled hemorrhoidopexy is the surgical repositioning of prolapsing internal hemorrhoids. Surgery involves a longer recovery and postoperative pain.

Rubber Band Ligation

A less invasive procedure known as rubber band ligation is another way to treat grades I – III internal hemorrhoids. During the procedure, a small rubber band is placed around the hemorrhoid, cutting off its blood supply. Because the procedure is performed within the rectum, recovery from rubber band ligation can be painful or uncomfortable and cause bleeding. Large or multiple hemorrhoids often require treatment over several visits. Furthermore, people on anticoagulant or antiplatelet drugs are at a significantly higher risk for post-operative procedure bleeding.

Hemorrhoidal artery embolization (HAE)

This minimally invasive procedure is rapidly gaining popularity for several reasons. First, it is not performed through the rectum so the painful recovery is avoided. It is performed through a small puncture in the wrist or groin (similar to a blood draw) to access the bloodstream. Additionally, it is highly effective, even for large or multiple hemorrhoids.

  1. Cleveland Clinic. (2025, May 5). Hemorrhoids: Symptoms, causes & treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/15120-hemorrhoids

Hemorrhoid FAQs

Most Americans will experience hemorrhoids at some point, and most will go away over time. For some people, however, hemorrhoids and their bothersome symptoms persist for several months or more. These are called chronic hemorrhoids, and treatment may be required for them.

Internal hemorrhoids develop inside the rectum and often can’t be seen or felt. Their most common sign is painless bleeding during a bowel movement, though larger ones can prolapse, or push outside the anus. External hemorrhoids form under the skin around the anus and tend to be more noticeable, sometimes causing itching, swelling, or pain. It’s possible to have both at the same time.

Hemorrhoids develop when there’s increased pressure on the veins in the rectal and anal area. Common contributors include straining during bowel movements, chronic constipation or diarrhea, sitting for long periods, pregnancy, heavy lifting, and a low-fiber diet. The tendency to develop hemorrhoids can also increase with age as the supporting tissue weakens.

Symptoms vary depending on the type, but common ones include bleeding during bowel movements, itching or irritation around the anus, discomfort or pain, swelling, and a sense of fullness or a lump near the anus. With chronic hemorrhoids, these symptoms tend to persist or keep returning rather than resolving on their own.

Hemorrhoids are very common across all adults, but certain factors raise the likelihood, including pregnancy, aging, obesity, a sedentary lifestyle, chronic constipation or diarrhea, and jobs or habits that involve prolonged sitting or heavy lifting. A diet low in fiber can also play a role.

In most cases, yes. Many hemorrhoids resolve over time or improve with conservative measures like increased fiber and water, over-the-counter creams, and avoiding straining. When symptoms persist for months despite these steps, the hemorrhoids are considered chronic, and it may be time to discuss other options.

While hemorrhoids themselves are usually not serious, leaving chronic hemorrhoids untreated can lead to complications. Over time they can prolapse or even burst, and they may contribute to blood clots, infection, perianal thrombosis, and other health concerns. Persistent symptoms are worth having evaluated.

Bleeding is a common hemorrhoid symptom, but it’s important not to assume that’s always the cause. Rectal bleeding can sometimes signal other conditions, so any new, persistent, or significant bleeding should be evaluated by a medical provider to rule out other issues.

If your symptoms have lasted for several months, keep coming back, interfere with your daily life, or include ongoing bleeding, it’s a good time to talk with a specialist. A consultation can help identify whether your hemorrhoids are chronic and what treatment options may be right for you.

They can. Even when symptoms ease, the factors that contribute to hemorrhoids (diet, pressure, lifestyle) can cause them to return. For people with chronic hemorrhoids that repeatedly come back despite conservative care, addressing the underlying blood supply may offer longer-lasting relief. You can learn more about non-surgical treatment that addresses the root cause here.

Learn more about our minimally invasive Hemorrhoid Artery Embolization procedure by clicking the link here.

Skip to content