Hemorrhoids: Symptoms, causes and minimally invasive treatment methods

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 are important. They help to precisely regulate the sphincter muscle. This gives us full control over bowel movements. It is important to know that everyone has hemorrhoids. They become a problem when they become larger or inflamed.

Internal vs. external hemorrhoids

Internal hemorrhoids arise 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 type of hemorrhoid usually only causes pain when it passes through the anus. This happens at an advanced stage or when 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 are often visible. They appear as painful, swollen lumps around the anus. This happens especially when 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 outwards during bowel movements, but retract on their own.
Grade 3: The more enlarged nodes protrude outwards and have to be pushed back manually.
Grade 4: The severely enlarged swellings remain permanently outside the anus. They can no longer be pushed back. This can lead to serious problems 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. The enlargement of the vascular cushions in the rectum plays an important role. It helps to seal the anal canal. Here are the most common causes:

1. Increased pressure in the abdomen: Frequent and forceful pushing during bowel movements can cause the hemorrhoids to swell. This often happens with constipation. This exerts additional pressure on the veins in the rectum, which encourages 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. This can promote 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 the first sign of hemorrhoids. This is especially true for internal hemorrhoids. The bleeding can be slight, 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 haemorrhoids 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 hemorrhoids often feel that they cannot empty their bowels completely. This leads to frequent trips to the toilet and increased straining, which puts additional strain on the hemorrhoids.

Diagnosis

The diagnosis of hemorrhoids is usually simple. It is made by taking a medical history, physical examination and a few tests.

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 allows 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 inner anal canal and assess the condition of the internal hemorrhoids. The proctoscope is a narrow, tubular instrument. It is inserted into the anus. This allows the hemorrhoids to be seen directly. 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 diseases. These include anal fissures, fistulas, abscesses and rectal or anal cancer. A thorough examination is therefore essential in order to make a correct diagnosis and initiate appropriate treatment.

Note: The examination usually only takes a few minutes and is well tolerated by most patients. However, the exact duration may vary depending on the method and individual circumstances.

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 many modern treatment options. These include conservative approaches and surgical procedures, which are particularly effective for enlarged haemorrhoids.

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 many over-the-counter and prescription ointments, suppositories and creams available. These help to relieve hemorrhoids and can alleviate discomfort in the short term. These often contain anti-inflammatory substances such as corticosteroids or painkillers, which help to reduce itching, pain and swelling.
4. Venotonics: These medications strengthen the vein walls. They improve the return flow of blood. This 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. Hemorrhoid artery ligation (HAL-RAR): This new procedure is designed to stop the blood supply to hemorrhoids. This is done 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 haemorrhoidopexy: This modern procedure uses a special stapling device. It removes hemorrhoid tissue and fixes 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

Preventing hemorrhoids is important. In this way, unpleasant symptoms can be avoided. It also reduces the risk of relapse after successful treatment. Here are some tips for prevention:

1. High-fiber diet: Eat foods with lots of fiber. These include fruit, vegetables, whole grains and pulses. These foods improve the health of your bowels. It also helps to prevent constipation.
2. Drink enough fluids: Drink at least 2 liters of water a day. This keeps the stool soft and prevents 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 sitting for long periods: Long periods of sitting, especially on the toilet, should be avoided. They increase the pressure on the anus veins.

Complications with untreated

Untreated hemorrhoids can lead to serious complications, including:

1. Thromboses: External hemorrhoids 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 come out through the anus and become trapped, the tissue can die. This can lead to a serious infection. This condition requires immediate medical intervention.

Patient guide: When should you see a doctor?

If you have the above symptoms or see bleeding, you should consult a proctologist. 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 many treatment options. These are tailored to the needs of our patients. Our aim is to help you lead a life free of symptoms.