Hemorrhoids

What is a haemorrhoidal disease?

Haemorrhoid venous cushions are normal structures of the anorectum and are in the area of transition from the rectum to the anus and lined by rectal mucosa which causes the fine sealing of the anus. From haemorrhoids or haemorrhoidal disease is been spoken when these cause discomfort

What complaints cause a haemorrhoidal disease?

Haemorrhoids can cause bleeding or itching, burning, oozing and stool smearing in the anal area. It can cause the feeling that the bowel has not complete emptied. Haemorrhoidal disease is classified in four stages (grade I-IV) according to the size of the venous cushions and the tendency to prolapse Constant straining during the movements of the bowel allows the haemorrhoids to become gradually larger (grade I) and can emerge out of the anus (grade II). Initially they withdraw of their own accord into the anus after the movement of the bowel. In the next stage of overstretch it needs a reposition with the use of fingers in the anus (grade III). When this is no longer successful, the haemorrhoids are fixed outside the anus, this is called haemorrhoids grade IV.

What are the causes of haemorrhoidal diseases?

A haemorrhoidal disease arises also through strong pressing during defecation, or by a too soft unformed stool, e.g. after laxative abuse. The main cause is a genetic (familial) disposition, which has a degeneration of connective tissue as result. Also increased pressure in the peritoneal cavity as a result of pregnancy and childbirth may cause a haemorrhoidal disease.

Complications:

Constant and excessive bleeding from the hemorrhoids may cause anemia (anemia). Painful but harmless anal thrombosis, a thrombosed anal- or haemorrhoid prolaps, or an anal fissure ("After crack") may also be a consequence of a hemorrhoid disease.

What tests are needed?

The doctor looks at the anus area and digitate the anus and rectum with a finger Thus, other sources of bleeding in the rectum such as polyps and tumors can be diagnosed; the man’s prostate gland is also examined. The doctor inserts his finger in the rectum and asks the patient to press and pinch and then to spread his buttocks doing the same procedure in consequence, the doctor gains an impression of the state of the sphincter and the pelvic floor muscles. He can detect prolapsed haemorrhoids or even a prolapsed rectum of the anus. What he cannot feel are haemorrhoids! These are so soft that they are empty pressed while examined with the index finger. With a tubular instrument (proctoscope) , the doctor can assess the haemorrhoids (grade I and II). The examination with this device is painless, as it is only slightly thicker than a finger.

What other tests are required?

To exclude a higher source of bleeding it may be necessary to use a mini camera in the rectum (sigmoidoscopy) or the colon (colonoscopy).

Therapy:

Basis of the treatment of haemorrhoids is emptying soft molded feces without excessive pressing. The further treatment is carried out depending on the degree of haemorrhoidal disease. In early stages the sclerosetherapy (obliteration) and the Ligaturtherapie (tie off with rubber rings) are proved methods. Laser and cryotherapy (cold) have proved to be unsuitable. In later stages surgery may be required. The time-limited use of cortisone, over scab or local anesthetic ointments, anal tampons and suppositories can only temporarily relieve the symptoms, but do not shrink enlarged haemorrhoids.

Prevention:

A forced bowel movement by pressing should be avoided . Daily bowel movement is not required! A high-fiber diet with plenty of fluid intake is recommended.

Warning:

A self-treatment without diagnosis can have serious consequences. Only the doctor can certainly exclude other causes of rectal discomfort, e.g. such as cancer.