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The most dangerous complication is thrombosed hemorrhoidal nodes, when a blood clot forms inside them; this manifests as sharp pain that doesn't go away even at rest, along with hardening and a bluish discoloration in the anal area. You should also be alarmed by heavy bleeding that doesn't stop on its own, or signs of infection - fever, severe swelling, purulent discharge - because in an advanced state this can lead to sepsis.

Hemorrhoid bleeding is what I'd pay close attention to first, because it can be subtle but dangerous. When blood is lost gradually but constantly, anemia develops, and a person might not even notice how bad things get. I remember one friend of mine thought she was just getting tired for no reason, felt sluggish, started getting shortness of breath - turned out her hemoglobin had dropped to critical levels because of hemorrhoids.

But yeah, the author of the previous answer is right about thrombosis - it's a serious complication that needs immediate attention. If you suddenly get unbearable pain that doesn't ease up even when you're lying down, the node turns black or blue, becomes hot and firm - that's a reason to go to the hospital right away, don't wait for the weekend. Pain with regular hemorrhoids is unpleasant but tolerable; with thrombosis it's a completely different level.

You also need to watch for signs of infection: if fever joins the pain, you feel generally unwell, the swelling around the node keeps getting bigger - that could be an abscess, and you can't drag your feet there either. Basically, if something suddenly got worse or something new showed up, don't be lazy - go see a doctor. Hemorrhoids are an unpleasant thing, but manageable if you don't let them go.

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