If it itches after a bowel movement, burns and red spots may appear on the toilet paper, the hemorrhoids are usually enlarged. Bad habits and diet often play a role in the common condition.
Whoever speaks of hemorrhoids usually means bleeding, itching and burning in the anus, which can occur when blood vessels in the area of the anus have enlarged. Doctors refer to this as hemorrhoidal disease. Strictly speaking, haemorrhoids are the normal, non-enlarged annular cushion of blood vessels that is part of the intestinal closure mechanism.
Hemorrhoids can enlarge if you strain during a bowel movement. Another cause is hard stool, which is usually caused by poor nutrition. Initially, enlarged hemorrhoids can often be controlled by changes in bowel habits, a high-fiber diet, increased physical activity, and medication. In late stages, surgery may become unavoidable.
Hemorrhoids Causes And Risk Factors
In essence, the experts know little about why hemorrhoids become pathologically enlarged. However, there are a few circumstances that favor this development. The factors have in common that they increase the pressure in the abdomen and thus also on the hemorrhoids. They are filled with blood to aid in intestinal obstruction. Pressure can cause the bulging vessels to protrude, just like veins on the forehead or neck sometimes do during physical exertion. The pressure stretches the wall of the hemorrhoid. In the long run, the vessels can lose their firmness, they "wear out" and no longer return to their original position. When you have a bowel movement, the feces push protruding hemorrhoids down. The vessels can sink until they protrude beyond the anal opening. This is how experts roughly imagine the development of hemorrhoids.
Risk factors
Poor bowel habits, a low-fiber diet and age all contribute to the enlargement of hemorrhoids. There are good study results for this. However, the influence of pregnancy is uncertain. Only empirical values exist for other factors. That is why experts sometimes have different opinions as to the importance of the individual circumstances. However, the risk factors that can be addressed are of fairly general health importance. In other words, preventing hemorrhoids also prevents other common conditions, such as urinary incontinence. Negative effects are not to be feared as long as nobody overdoes their efforts.
- Unfavorable bowel movement behavior: The vessels in the hemorrhoidal tissue only empty involuntarily through a reflex that precedes the normal bowel movement. So when people force a bowel movement, the hemorrhoids don't contract. Therefore, in order to overcome their resistance, one must push. As a result, the stool presses on the blood-filled vessels and at the same time pushes them outwards. The blood vessels dilate, enlarge and can bulge like sacks. When you have a normal bowel movement, your intestines also pass more stool than when you have a forced bowel movement. Therefore, they require frequent trips to the toilet. Many of those affected press even harder and the load on the vessels in the hemorrhoidal tissue increases. Sitting on the toilet for a long time is also considered a disadvantage. This increases the time during which pressure strains the vessels.
- Poor Diet: A diet lacking in fiber easily leads to hard stools, acute or chronic constipation. All three strain the vessels in the haemorrhoidal tissue, especially since many people strain to relieve themselves when constipated.
- Dehydration: When the body is dehydrated, stools become more dense and hard.
- Diarrhea, laxatives: Very frequent bowel movements, such as those caused by diarrhea or caused by laxatives, are also said to encourage hemorrhoids to enlarge.
- Hereditary factors: Whether certain genes promote hemorrhoidal disease has not been proven. In general, however, it is assumed that a hereditary predisposition to weakening of the connective tissue facilitates its development.
- Age: Haemorrhoids occur more frequently with age, probably because the connective tissue loses its elasticity.
- Overweight, obesity: With a high body mass index (BMI), the pressure in the abdominal cavity increases because the fat deposits weigh on it.
- Pregnancy and childbirth: Opinions differ here. Some professionals believe that both can cause and worsen hemorrhoids. Others, on the other hand, believe that this assumption is based on the fact that perianal vein thrombosis (often referred to as "external haemorrhoids" here) and skin tags, which are common during pregnancy and childbirth, are often mistaken for real haemorrhoids. This is supported by the fact that most affected women are symptom-free six months after childbirth.
- Diseases: Diseases in which the amount of blood in the abdomen increases (e.g. heart failure, cirrhosis of the liver) also increase the pressure at the same time.
- Sports: sports in which the pressure in the abdomen increases (weight training, weightlifting, etc.) or in which abrupt jumping movements are common (volleyball, tennis, etc.) are considered unfavorable.
- Poor anal hygiene: Remnants of faeces can promote itching, inflammation and irritation in enlarged hemorrhoids.
- Other: Alcohol, spicy foods, chronic bronchitis, COPD, sitting on cold surfaces have shown negative effects in individual studies. For most experts, these indications are too weak, so they do not count the circumstances mentioned as risk factors for enlarged hemorrhoids.
Hemorrhoids Symptoms
Do you occasionally see blood on the toilet paper or on the surface of the stool?
Does your anus sometimes itch or burn?
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| Hemorrhoids |
If so, it could be an enlarged hemorrhoid. Their most important, earliest hallmarks are minor bleeding. They can occur once, recurring or permanently. The bright red blood is easily seen on toilet paper, but can also sometimes be seen on the surface of the stool. The anus often itches or wets. From a certain stage, enlarged hemorrhoids can be felt as small bumps immediately after a bowel movement. These protrude further in later stages. The itching, bleeding, and weeping may become more severe and more frequent. Pain and inflammation (eczema) in the anus often occur as well. During defecation and sometimes also during physical exertion, the hemorrhoids clearly protrude outwards. After the bowels are emptied, they no longer retract on their own. However, the knots can still be pushed back into their original position, but this becomes impossible as the process progresses: the hemorrhoids are permanently outside the anus. Their size, pain and swelling usually increase. Itching may be permanent. In addition to bleeding, inflammation, oozing and pain, ulcers on the anus, faecal incontinence and other complications can occur.
When to the doctor?
Other illnesses, some of which are serious, can cause the same symptoms as enlarged hemorrhoids. If bleeding, itching or weeping occur frequently in the anus, you should always have the cause clarified by a specialist!
Hemorrhoidal Disease Treatment
The type of treatment depends on how severe the hemorrhoidal disease is. Usually, the first approach is to change your diet. Concomitant or subsequent medication may be helpful before surgery is considered. If a change in lifestyle and over-the-counter remedies do not achieve a satisfactory effect, a doctor should deal with the condition after two weeks at the latest.
Basic therapy – nutrition, lifestyle and self-help
Diet and possibly a change in lifestyle are the basic therapy for hemorrhoids. The aim is to avoid straining during a bowel movement, hard stool and irregular bowel movements. A high-fiber diet and drinking enough (two liters a day) are very helpful to keep the stool soft. Additional roughage and well-tolerated, light laxatives can also be used temporarily to make bowel movements easier. Hot spices should be avoided: They increase the burning sensation during bowel movements.
Those affected should move a lot, as this stimulates digestion. Prolonged sitting, lying down, and other lack of physical activity increase the risk of hard stools and constipation. Many experts advise patients who are overweight to lose a few kilos.
Careful anal hygiene can improve itching, burning and other symptoms. After a bowel movement, the anal region should first be cleaned with soft toilet paper and then, if possible, with a damp cloth. Warm water or damp cloths are suitable for this, but there is a risk of allergic reactions. Medicinal sitz baths can be used as support, which not only cleanse but also alleviate the symptoms with herbal or synthetic active ingredients. Cool pads such as ice packs and cool pads can also help with minor pain.
Medication
Taking light laxatives such as flaxseed, wheat bran, psyllium and lactulose can be helpful. They soften the stool, increase its volume and facilitate bowel emptying. If blockages occur more frequently, their origin should be clarified professionally.
As long as the hemorrhoids are only slightly enlarged and the symptoms are only mildly pronounced, classic “hemorrhoid remedies” (hemorrhoidalia) can be used for external treatment: These are ointments, gels, creams, additives to sitz baths, suppositories and suppositories with gauze inserts that contain medicinal substances . They often work with substances against itching (e.g. menthol, camphor), local anesthetics (e.g. lidocaine, benzocaine), anti-inflammatories (e.g. chamomile, glucocorticoids) and tanning agents (e.g. extracts from oak or witch hazel), which stop bleeding and dry out and contract the skin . Anti-inflammatory preparations with glucocorticoids (e.g. cortisone) should only be used in the short term because they make the skin thinner in the long term, making it easier for hemorrhoids to appear.
Local cooling can relieve mild pain. Oral drugs such as ibuprofen can be used to treat more severe pain. Local anesthetic preparations may be beneficial because they do not increase the risk of bleeding.
Vein agents (e.g. flavonoids) can be taken or applied locally. However, experts do not agree on their effect.
There are still few results on the effect of bacterial mixtures (probiotics). Some doctors consider them useful for hemorrhoids.
In addition to the active ingredients mentioned, many other preparations are available. For example, natural and artificial waxes or fats (e.g. Vaseline, beeswax) can be applied to enlarged hemorrhoids to reduce the friction when emptying the bowel.
Treatment by the doctor
Outpatient procedures:
- Obliteration is available for the treatment of early stages; it is also called sclerotherapy or injection therapy. Doctors use a special instrument (proctoscope) to insert an injection needle into the anus and inject a sclerosing agent into the hemorrhoids. The remedy indirectly decreases blood flow, causing the enlarged hemorrhoid to shrink. Depending on the extent and number, several sessions may be necessary. The procedure is painless, uncomplicated, low-risk and is performed on an outpatient basis. However, two out of three people treated have problems with their hemorrhoids again within three years. Because of the high recurrence rate, other treatments are often preferred today.
- In a rubber ring or rubber band ligation, doctors use rubber bands to clamp off hemorrhoidal nodes from the blood supply. The tissue atrophies, so the dead knots fall off along with the gum after a few days. The risk of the outpatient procedure of side effects and complications is low.
- The haemorrhoidal artery ligation (HAL) is relatively young. Here, doctors use threads to tie off the arteries that supply blood to the hemorrhoid nodes. The outpatient procedure poses hardly any risks, the success rate is said to be around 65%. There are not yet enough long-term results on the number of recidivism rates.
Other non-surgical procedures are considered outdated, not effective enough or too risky. Treatments with infrared (infrared coagulation) are not very successful, freezing (cryotherapy) can cause prolonged pain, therapies with direct or high-voltage current (electrotherapy, bipolar diathermy coagulation with high-frequency current) have not been proven to be effective, and anal stretching (sphincter stretching) relatively often leads to injuries and fecal incontinence.
Surgical procedure:
If the procedures described are unsuccessful, other interventions can be considered. The goal is not necessarily to remove all enlarged hemorrhoids. The focus is often on creating a state that allows those affected to have normal bowel movements and significantly reduces their symptoms. The choice of procedure depends on the patient's health and the size, location and number of hemorrhoidal nodes.
- With the stapler method, or stapler surgery, doctors use a special instrument (stapler device, surgical stapler, stapler) to remove altered tissue and staple the wounds together directly. Compared to other methods, the stapler operation has a number of advantages: the operating, lying, recovery and downtime of the patient are shorter and the pain after the operation is less. However, hemorrhoids come back more often than after conventional hemorrhoid removal (conventional hemorrhoidectomy).
- In conventional hemorrhoidectomy, the doctor cuts out the lumps and then recreates the anal canal. There are various methods that are used.