Hemorrhoids are always painful

Hemorrhoids (haemorrhoids, hemorrhoids), Greek for “blood flow”, are an enlargement or swelling of the vascular cushion, which is placed in a ring under the rectal mucosa and is used to close the anus. Hemorrhoids are when the swelling of the buttocks causes discomfort.

Those affected describe hemorrhoids as very annoying, but according to the results of several surveys - regardless of the degree of disease - they have no significant impact on quality of life.

However, the topic is very taboo, so that those affected only go to the doctor if the symptoms are very hindering.

Hemorrhoids are usually a progressive disease. Since some serious illnesses are characterized by very similar symptoms, it makes sense for the doctor to make a diagnosis once.

As the buttocks expand or swell, the hemorrhoids increasingly emerge from the anus. Depending on the size and degree of emergence of the swelling, hemorrhoids are divided into 4 stages:

Stages of hemorrhoids

  • Grade I:
    Grade 1 hemorrhoids are painless and invisible. They are not recognizable from the outside and only through a reflection of the rectum as slightly swollen vascular cushions. The nodes, which bulge only slightly inside the intestine, can recede completely.
  • Grade II:
    Grade 2 hemorrhoids can be seen as palpable lumps. They emerge from the anus when defecating and pressing, but slide back into the body spontaneously. Grade 2 hemorrhoids are more likely to cause discomfort and pain during bowel movements and do not resolve on their own.
  • Grade III:
    Grade 3 hemorrhoids are almost always associated with pain. They emerge when exerted and no longer slide back by themselves. It is possible to push it back into the anus with your fingers. Grade 3 hemorrhoids can become trapped and bleeding may occur.
  • Grade IV:
    In the case of Grade 4 hemorrhoids, pushing back is no longer possible.

Symptoms

Symptoms of a hemorrhoidal disease include:

  • Burn
  • anal bleeding (bright red blood on the toilet paper or on the feces) up to anemia
  • anal oozing
  • excruciating itching (anal itching, pruritus ani)
  • Stool smear

In addition, there may be a feeling of incomplete emptying of the bowel. Pain rarely occurs, which is usually due to fissures, fistulas or abscesses.

If the sphincter no longer functions properly due to the swelling, intestinal gases and stool can no longer be reliably retained. There is increased stool smear through to anal incontinence and flatulence that cannot be held back. Grade 1 hemorrhoids need not necessarily cause discomfort.

When and to which doctor?

The first point of contact for questions as to whether your symptoms are caused by hemorrhoids is your family doctor. A good family doctor will recognize hemorrhoids without any problems and will know when to treat himself and when to refer to a specialist. There are several medical specialties that specialize in treating hemorrhoids:

  • Proctologists,
    these are specialists for the rectum;
  • Coloproctologists (Coloproctologists),
    are responsible for rectal and colon ailments;
  • Gastroenterologists,
    i.a. Particularly specialized in the intestines;
  • Dermatologists (dermatologists);
  • Surgeons.

Complications

In the advanced stage, the swellings can become trapped, which can make sitting very painful. Hemorrhoids can result in an anal crack or fissure if the hemorrhoids become sore after wiping them with toilet paper.

Constant bleeding from the hemorrhoids can lead to anemia (anemia).

frequency

Because many patients with hemorrhoids do not see a doctor, the frequency can only be roughly estimated.

Hemorrhoids are more common with age. Men are likely to be affected more often than women. It is believed that by the age of 50 and over, one in two people has had or has problems with hemorrhoids at some point. Some experts even estimate that around 70% of the population will be affected by it at some point in their life.

causes

What causes hemorrhoids is still largely unclear. However, the development of hemorrhoids is favored by various factors. Typical risk factors are:

  • Sedentary lifestyle and long periods of sitting
  • Diet low in fiber
  • constipation
  • Dehydration
  • hard bowel movements and heavy pressing
  • Permanently taken laxatives
  • Connective tissue weakness

Diagnosis of hemorrhoids

Even if you believe that clear symptoms indicate a hemorrhoidal condition, you should have the diagnosis confirmed by your doctor. Blood in the stool may also be a symptom of another disease - itching, e.g. B. can also be an indication of eczema, a fungal or worm disease, blood in the stool can be an indication of a tumor.

After the doctor has listened to the complaints (anamnesis), he will feel the affected area with his finger (rectal palpation). In this way, he can determine the stage of the disease and control the tension of the sphincter muscle.

If necessary, a rectoscopy (rectoscopy or proctoscopy) or an examination of the entire large intestine (colonoscopy) can be useful.

Treatment of hemorrhoids

Hemorrhoids without symptoms do not require treatment.

Patients with hemorrhoids should definitely improve their lifestyle in order to optimize the chances of success of a therapy. This includes lots of exercise, lots of drinking and a healthy, high-fiber diet.

The treatment method for hemorrhoids depends on the stage of the disease, the individual anatomy, the patient's complaints and the goal of therapy.

First and second degree hemorrhoids can be treated "conservatively" with ointments and suppositories. In the advanced stage, usually only an operation can remedy the situation.

  • Conservative treatment of hemorrhoids
    The aim of treating mild and moderate complaints is to reduce the symptoms, support the swelling of the vascular cushion and slow the progression of the disease.
    • Medication: Medication can help relieve symptoms of grade 1 and 2 hemorrhoids. Suppositories or ointments that contain anti-inflammatory agents or substances containing cortisone are used locally.
    • In addition, agents can be used that numb the itching and pain and have a hemostatic effect.
    • Sitz baths: Sitz baths with anti-inflammatory additives, e.g. B. oak bark or chamomile.
  • Anal stretcher: If the sphincter muscles are tense, the blood circulation can be improved with the help of anal stretchers, which can alleviate the symptoms.
  • Removal of the hemorrhoids
    First and second degree hemorrhoids can be treated with small outpatient procedures. There are several ways to do this, depending on how far the disease has progressed.
    • Sclerotherapy: (sclerotherapy, hemorrhoid sclerotherapy): For 1st and 2nd degree hemorrhoids, the hemorrhoidal node can be obliterated with the help of an injection. In this case, a drug is injected into the nodule and initially leads to inflammation, then to a reduction in blood flow and decongestion.
    • Rubber band ligation (rubber ligation): For 1st or 2nd degree hemorrhoids, an enlarged hemorrhoidal knot can be tied off with a rubber band. The rubber band constricts the blood supply so that the swelling dies and is eliminated with the stool after a few days.
    • Infrared treatment (infrared coagulation): The tissue at the source of the swelling is heated strongly, so that the tissue scabs and recedes.
    • Icing (cryohemorrhoidectomy): With the help of liquid nitrogen and nitrous oxide, the nodes are frozen at minus 90 degrees Celsius, so that the tissue dies and is shed after a few days. However, this procedure is rarely used today because it is difficult to limit the effect.
  • Surgical procedure
    If the hemorrhoid disease cannot be adequately treated with medication or outpatient procedures, surgery may be necessary with the aim of removing the nodes and restoring normal anatomical conditions. This operation can be performed under general or spinal anesthesia.

Tips

Hemorrhoids cannot always be avoided. But you can have a positive effect on reducing the risk of developing hemorrhoids:

  • High fiber diet
  • Prevent constipation
  • Avoid laxatives
  • Correct stool behavior (do not sit too long on the toilet and do not press hard)
  • Good hygiene
  • Lukewarm hip baths with anti-inflammatory tannins. Depending on your needs, approx. 3 times a day for 15 minutes each time.
  • Chair softener
  • If you are overweight, reducing your weight can relieve hemorrhoids
  • Sport promotes intestinal activity and thus healthy digestion