Hemorrhoids

Hemorrhoids is the name given to a vascular cushion in the area of the rectum which, together with the sphincter muscle, seals off the anus. The haemorrhoids consist of a tissue with a good blood supply, which performs the function of a cavernous body (technically called corpus cavernosum recti). Normally, haemorrhoids are not noticeable. However, if individual vessels dilate like varicose veins or part of the tissue protrudes from the anus, this can cause discomfort. This discomfort is called hemorrhoidal disease or abbreviated just as the vascular cushion is called hemorrhoids.

Hemorrhoids are highly prevalent - affecting about one in two people after the age of 50. In many cases, however, the condition occurs at a much earlier age. Men are generally affected more often than women.

Blood clots in the superficial veins of the anal region can cause painful swellings, colloquially known as external haemorrhoids. However, these are not true hemorrhoids, but so-called perianal thromboses.

The main cause of haemorrhoids is chronic constipation. This is often caused by a diet low in fibre. Constipation causes the need to push harder on the toilet, which increases the pressure in the bowel, which can lead to dilatation of the blood vessels.

Additional factors that promote bowel sluggishness include low fluid intake, prolonged sitting, obesity, and lack of exercise. Individuals with hemorrhoids also often have weak connective tissue and a tendency to varicose veins.

Many women suffer from hemorrhoids during pregnancy. This is because the hormonal changes during pregnancy loosen the connective tissue. Another cause is the increased pressure in the abdomen.

People who prefer to eat a diet rich in plants and fibre have a much lower risk of developing haemorrhoids.

While many people have hemorrhoids, by no means all suffer from symptoms. Typical hemorrhoid symptoms are:

• Traces of bright red blood on the stool or toilet paper.
• Burning and oozing in the anal area
• Itching of the anus after defecation
• Pain during defecation
• Inflammation or eczema on the anus

Blood in the stool should always be clarified by a doctor. Bleeding is often the result of haemorrhoids, but it can also be a sign of other bowel diseases such as colon cancer.

If hemorrhoidal disease is suspected, a doctor should be consulted. A first indication of the disease is usually provided by the characteristic symptoms. Since the typical symptoms such as blood deposits on the stool can also be an indication of other diseases such as colon cancer, a thorough examination and diagnosis is important.

The doctor usually proceeds as follows:

• Anamnesis: This refers to the collection of medical history and questions about complaints such as blood deposits.
• Rectal palpation: This is a palpation examination with the finger, in which the tension of the sphincter muscle is examined. It also checks whether there are any lumps in the tissue.
• Rectoscopy (endoscopy of the rectum): The anal canal and the lower section of the rectum are examined with the aid of a small tube.

If there is blood in the stool, a colonoscopy is sometimes performed to rule out the possibility of a colon tumor.

For mild forms of hemorrhoids, it is usually sufficient to switch to a high-fiber diet and better bowel habits. Through the many fibers, chronic constipation can often be eliminated. Since this reduces the need to push so hard during bowel movements, the pressure on the blood vessels in the rectum is reduced, which can improve the hemorrhoidal condition. Under no circumstances should laxatives be used, as these lead to a worsening of the symptoms in the long term.

Numerous active substances are available to alleviate the symptoms with medication - these are usually applied to the haemorrhoids in the form of ointments or suppositories:

• For inflammation , the herbal active ingredient witch hazel is recommended. More effective are cortisone preparations such as prednisolone or hydrocortisone acetate. Until recently, preparations containing bufexamac were also recommended - however, these were withdrawn from the market in May 2010 as this active substance can trigger a contact allergy.
• Active agents like lidocaine, benzocaine, macrogollauryl ether, cinchocaine and quinisocaine help against itching and pain. These have a local anaesthetic effect.
• Escherichia coli bacteria promote the immune system of the intestinal mucosa. In this way they indirectly develop an anti-inflammatory effect and thus support wound healing.

Lukewarm sitz baths with tanning agents (for example oak bark extract) or the intake of stool softeners can also alleviate the symptoms. If you are out and about, the use of moist toilet tissues with anti-inflammatory and disinfecting ingredients is recommended.

In cases of moderate to severe discomfort, topical application of medication is sometimes no longer sufficient and outpatient measures or surgical interventions become necessary.

Outpatient measures would include:

• Sclerotherapy: In this procedure, a special fluid (for example, phenol almond oil, aethoxysclerol) is injected into the hemorrhoids, which scleroses and scars the blood vessels. The hemorrhoids then shrink and the symptoms improve. The treatment usually does not cause any pain, but the probability of a recurrence of the hemorrhoids is quite high.
• Infrared treatment: The tissue at the origin of the hemorrhoids is strongly heated by an infrared device, causing it to scab over and then recede. Recurrences are also common with this treatment.
• Rubber band ligation: In this procedure, the hemorrhoids are pinched off by a rubber band placed over them, causing them to fall off after a short time. This is the most common treatment for moderately severe hemorrhoids. Recurrences occur frequently.

Hemorrhoids are not a dangerous disease. In general, the earlier therapy is started, the better the symptoms can be alleviated. This is problematic in that many sufferers shy away from a visit to the doctor for haemorrhoidal disease. If hemorrhoidal disease is already far advanced, the therapy is much more complicated and costly.

The success of the therapy also depends to a large extent on whether patients change their lifestyle and eating habits and thus prevent further haemorrhoids.

The most important measure to prevent the development of hemorrhoids is a diet rich in fiber. This is also an important basic prerequisite for any therapy, as in this way chronic constipation can be counteracted. In addition, a sufficient fluid intake of 1.5 to 2.5 litres per day must be ensured.

The following points should be observed:

• To prevent hemorrhoids, foods such as cereals, whole grain bread, oatmeal, fruit (preferably with skin), vegetables and sesame seeds are recommended.
• Avoid foods such as rice, potatoes, white bread, chocolate, pasta, black tea and other products that can trigger constipation.
• Sufficient exercise and a healthy body weight
• Avoiding too much pressing during bowel movements
• the use of laxatives
• As soon as symptoms appear, a doctor should be consulted, as early treatment has the best prognosis.