Hemorrhoids

What are hemorrhoids?

Hemorrhoids are vascular cushions in the rectum that are formed by a dense network of blood vessels and connective tissue.
These vascular cushions have an important function: they contribute to the fine regulation of the sphincter muscle and enable complete control of bowel movements.
It is important to understand that everyone has hemorrhoids – they only become a problem when they become enlarged or inflamed.

Internal vs. external hemorrhoids

Internal hemorrhoids develop above the so-called “linea dentata”, an anatomical boundary in the anal canal.
They are covered with mucous membrane and are usually painless in the early stages.
This form of hemorrhoids usually only causes pain if they protrude through the anus at an advanced stage (prolapse) or if a thrombosis occurs.

External hemorrhoids The “dentate line”, on the other hand, develops below the dentate line and is covered with normal skin.
They are often more painful as this area contains more pain receptors.
External hemorrhoids may be visible and manifest as painful, swollen lumps around the anus, especially if blood clots form.

The four stages of hemorrhoidal disease:

Grade 1: Enlarged nodes remain in the anal canal. There is often slight bleeding.
Grade 2: The swellings protrude during bowel movements but retract on their own.
Grade 3: The lumps protrude and have to be pushed back manually.
Grade 4: The swellings remain permanently outside the anus and can no longer be pushed back, which can lead to serious complications such as thrombosis or incarceration.

Causes

The exact cause of hemorrhoids is often multifactorial, i.e. there are several risk factors that can contribute to their development.
Here are the most common causes:

1. Increased pressure in the abdomen: Frequent and forceful pushing during bowel movements – for example due to constipation – can lead to swelling of the hemorrhoids.
   This exerts additional pressure on the veins in the rectum, which promotes the formation of hemorrhoids.
2. Pregnancy: Pregnant women are particularly susceptible to hemorrhoids.
   During pregnancy, the uterus enlarges and exerts pressure on the veins in the pelvic area.
   Hormones such as progesterone help to relax the walls of the blood vessels, which promotes the development of hemorrhoids.
   Many women develop hemorrhoids during pregnancy or immediately after giving birth.
3. Genetic predisposition: People with a family history of haemorrhoids have a higher risk of being affected themselves.
   A genetic predisposition can lead to the vein walls being weaker and expanding more quickly.
4. Nutrition: A low-fiber diet often leads to constipation and hard stools, which in turn increases the risk of haemorrhoids.
   Fiber helps to soften the stool and regulate bowel movements.
   A lack of fiber can therefore lead to problems with bowel movements.
5. Overweight and lack of exercise: People who are overweight have a higher risk of developing hemorrhoids, as the extra body weight increases the pressure on the veins in the pelvic and anal area.
   Lack of exercise exacerbates the situation, as physical activity promotes venous return and improves blood circulation in the rectal area.
6. Chronic diarrhea: Frequent diarrhea can also contribute to the development of hemorrhoids, as the constant pressure on the anus can cause irritation of the veins.

Symptoms

The symptoms of hemorrhoids vary depending on the severity and type of hemorrhoid.
Typical signs are

1. Bleeding: Bright red blood on toilet paper or in the stool is often one of the first symptoms of hemorrhoids, especially internal hemorrhoids.
   The bleeding can be minor, but in some cases it can be massive, which can lead to anemia.
2. Pain and discomfort: External hemorrhoids are usually more painful than internal ones.
   Thromboses caused by the formation of a blood clot in the hemorrhoids are particularly painful.
   The pain can be sharp and persistent and can be aggravated by prolonged sitting or physical exertion.
3. Itching and burning: These symptoms often occur when the hemorrhoids are irritated or inflamed.
   The discharge of mucus can lead to skin irritation and severe itching around the anus.
4. Swelling: External hemorrhoids can be felt as swollen lumps or lumps around the anus.
   These swellings may be sensitive to touch and may worsen during bowel movements.
5. Feeling of incomplete bowel evacuation: Patients with advanced haemorrhoids often report a feeling of not being able to empty their bowels completely.
   This leads to frequent trips to the toilet and increased straining, which puts additional strain on the haemorrhoids.

Diagnosis

The diagnosis of hemorrhoids is usually uncomplicated and is made by a combination of medical history, physical examination and instrumental examinations:

1. Medical history: The first step in the diagnosis is a detailed medical history.
   The doctor will ask questions about the symptoms, bowel habits and possible triggers.
   Particular attention will also be paid to family history and lifestyle factors.
2. Physical examination: An inspection of the anal area enables the doctor to detect external hemorrhoids or other abnormalities.
   Palpation of the anus and rectum helps to determine the size and location of the hemorrhoids.
3. Proctoscopy: With the help of a proctoscope, the doctor can examine the internal anal canal and assess the condition of the internal hemorrhoids.
   The proctoscope is a narrow, tubular instrument that is inserted into the anus and allows a direct view of the hemorrhoids.
   This examination is usually painless and only takes a few minutes.
4. Rectoscopy: If further examinations are necessary, especially if blood is found in the stool, a rectoscopy can be performed.
   This is an examination of the lower part of the rectum using a flexible endoscope.
5. Colonoscopy: A colonoscopy may be necessary in patients with persistent bleeding or if other bowel problems are suspected.
   This examination makes it possible to check the entire colon for abnormalities.
6. Differential diagnoses: It is important to differentiate hemorrhoids from other conditions such as anal fissures, fistulas, abscesses or even rectal and anal cancers.
   A thorough examination is therefore essential in order to make a correct diagnosis and initiate appropriate treatment.

Modern treatment methods

The treatment of hemorrhoids depends on the severity of the symptoms and the stage of the disease. At the VenaZiel Proctology Center, we offer a wide range of modern treatment options, from conservative approaches to surgical procedures.

Conservative treatment methods

1. Change of diet: A high-fiber diet is the key to preventing haemorrhoids and their symptoms.
   Foods such as fruit, vegetables, wholegrain products and pulses promote bowel function and make bowel movements easier.
2. Hydration: Drinking enough water is crucial to keep stools soft and prevent constipation.
3. Drug treatment: There are various over-the-counter and prescription ointments, suppositories and creams that are used to relieve hemorrhoids.
   These often contain anti-inflammatory substances such as corticosteroids or painkillers that help to reduce itching, pain and swelling.
4. Venotonics: These medications strengthen the walls of the veins and improve venous return, which helps to reduce hemorrhoids.
5. Stool softeners: These substances help to soften the stool and reduce pushing.

Minimally invasive procedures

1. Rubber band ligature: This method is used for internal hemorrhoids.
   A small rubber band is placed around the base of the hemorrhoid to cut off the blood supply.
   Within a few days, the hemorrhoids shrink and fall off.
   The treatment is painless and does not require anesthesia.
2. Sclerotherapy: In sclerotherapy, a sclerosing solution is injected directly into the haemorrhoids, causing the tissue to shrink.
   This method is particularly effective for hemorrhoids in the early stages.
3. Infrared coagulation: An infrared beam is used to heat and cauterize the tissue of the haemorrhoids.
   This method is well suited to smaller hemorrhoids and only requires a short recovery time.
4. Hemorrhoidal artery ligation (HAL-RAR): This innovative procedure aims to cut off the blood supply to the hemorrhoids by ligating the affected arteries.
   The procedure is performed under local anesthesia and is minimally invasive.

Surgical treatment

1. Hemorrhoidectomy: Surgical removal may be necessary for advanced hemorrhoids, especially grade 3 and 4.
   Hemorrhoidectomy is the classic surgical procedure in which the hemorrhoids are completely removed.
   The recovery time can be several weeks, but the results are permanent.
2. Stapler hemorrhoidopexy: This modern procedure uses a special stapling device to remove hemorrhoid tissue and fix the remaining area upwards.
   This technique is less painful than a traditional hemorrhoidectomy and allows for a faster recovery.
3. Laser treatment: The use of lasers to remove hemorrhoids is one of the latest and most advanced techniques.
   The laser creates precise incisions without damaging the surrounding tissue.
   This results in less pain and faster healing.

Prevention of hemorrhoids

Prevention of hemorrhoids is key to avoiding uncomfortable symptoms and minimizing the risk of recurrence after successful treatment.
Here are some tips for prevention:

1. High-fiber diet: Eating high-fiber foods such as fruits, vegetables, whole grains and legumes improves intestinal health and prevents constipation.
2. Adequate fluid intake: Drink at least 2 liters of water per day to keep stools soft and prevent constipation.
3. Regular exercise: Physical activity promotes bowel function and improves blood circulation.
   Just 30 minutes of exercise a day can significantly reduce the risk of hemorrhoids.
4. Avoid heavy pressing: Take your time to have a bowel movement and avoid pushing too hard.
   A relaxed and regular visit to the toilet is important.
5. Avoid prolonged sitting: Long periods of sitting, especially on the toilet, should be avoided as they increase the pressure on the anus veins.

Complications with untreated

Untreated hemorrhoids can lead to serious complications, including:

1. Thromboses: External haemorrhoids can become painful due to blood clots (thromboses).
   These thromboses can lead to severe swelling and acute pain.
   In some cases, surgical removal of the clot is necessary.
2. Anemia: Prolonged bleeding from hemorrhoids can lead to anemia.
   This is a particular risk for older patients.
3. Incarceration: If hemorrhoids pass through the anus and become trapped, the tissue can die, leading to a serious infection.
   This condition requires immediate medical intervention.

Patient guide: When should you see a doctor?

If you suffer from the symptoms described above or notice bleeding, you should definitely consult a specialist in proctology.
Especially in the case of persistent or heavy bleeding, acute pain or changes in bowel habits, a medical examination is essential.
Timely diagnosis and treatment of hemorrhoids can significantly reduce the risk of complications.

Summary

Hemorrhoids are a common but often misunderstood condition that affects many people. Although they are unpleasant, they can be treated effectively with timely diagnosis and modern therapy. At VenaZiel Berlin MVZ, we offer a variety of treatment options tailored to the individual needs of our patients. Our aim is to help you lead a pain-free life.