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Hemorrhoids: treatment, symptoms, prevention

by Josephine Andrews
Published: Last Updated on 442 views

Enlarged hemorrhoids cause unpleasant symptoms such as burning and itching in the anus. Those affected want to get rid of them as quickly as possible. There are different possibilities for this. Read more about: What exactly are hemorrhoids? What complaints do they cause? How can hemorrhoids be treated and prevented?

Hemorrhoids: a quick overview

  • Treatment: depending on the severity, wound ointments, zinc paste or herbal ointments ( hamamelis , aloe vera ), cortisone ointment, local anesthetics, “sclerotherapy”, constriction (rubber band ligation), surgery
  • Home remedies: anti-inflammatory and anti-itch sitz baths, linseed (to facilitate bowel movements)
  • Prevention: high-fiber diet, regular daily bowel movements, few straining during bowel movements, sufficient drinking, daily physical activity.
  • Typical symptoms: foreign body sensation, weeping, pain and/or itching in the anal area, bright red blood on the stool or toilet paper
  • Examinations: physical examination with palpation of the anal reflection (proctoscopy) and rectal reflection (rectoscopy)
  • Possible complications: skin irritation, anal eczema, anemia, fecal incontinence

Hemorrhoids: treatment

Everyone has hemorrhoids (also: haemorrhoids): The spongy, well-perfused vascular cushion is located at the exit of the rectum. Together with the sphincters, it seals the anus.

However, when the hemorrhoids are enlarged, they can cause discomfort. Those affected complain, for example, of pain, itching and burning in the anus. Doctors then speak of hemorrhoidal disease . Colloquially it is simply said: someone has hemorrhoids.

There are various ways to treat such abnormally enlarged hemorrhoids. The severity of the hemorrhoidal disease plays a role here:

  • Grade 1: The mildest and most common form is grade 1 hemorrhoids. They cannot be felt and are only visible during an anal canal reflection (proctoscopy).
  • Grade 2: Grade 2 hemorrhoids bulge outwards when you strain and then retract back into the anal canal on their own.
  • Grade 3: Grade 3 hemorrhoids also come out of the anus when you press. But you have to push them back with your finger.
  • Grade 4: Grade 4 hemorrhoids are permanently visible on the outside of the anus. They can no longer be pushed back into the anal canal. Often some anal mucosa protrudes (anal prolapse).

Depending on the severity of the hemorrhoidal disease, various treatment options can be considered. It is best to discuss with your family doctor which treatment method makes the most sense in your case. He will then refer you to the right place. Because which doctor is ultimately the right contact person for hemorrhoids depends on the type of treatment. This can be a proctologist , surgeon or gastroenterologist .

The basis of any hemorrhoid treatment is a healthy diet and regular bowel movements . Both also help prevent hemorrhoids. If necessary, conservative measures such as pain-relieving ointments can also be used. In the case of persistent symptoms or severe haemorrhoids, an operation is usually necessary.

Hemorrhoids treatment with medication

Medications are used in hemorrhoid treatment to relieve the symptoms. They can be helpful for hemorrhoids of any severity. Various active ingredients are available. Some are anti-inflammatory, others are local anesthetics.

anti-inflammatory drugs

Painful hemorrhoids can be treated well with wound ointments or zinc paste. Herbal ointments or suppositories are also available, for example preparations based on Hamamelis virginiana (Virginian witch hazel) or aloe vera . The preparations are intended to help against hemorrhoidal symptoms such as skin irritation and itching.

In addition, your doctor may prescribe cortisone ointments for you. They contain, for example, prednisolone or hydrocortisone acetate. These active ingredients inhibit the immune system, which counteracts inflammation in the anus. Only use cortisone ointments for as long as your doctor recommends. Long-term use can lead to skin atrophy. This means that the skin becomes irreversibly thinner and therefore more vulnerable. In addition, cortisone ointments promote fungal infections in the intestine .

Local narcotics

Local anesthetics also help against itching and pain. These numb the affected area locally so that the patient no longer feels any pain. Examples of local anesthetics are benzocaine, cinchocaine and lidocaine.

Like cortisone ointments, local anesthetics may only be used for a short time. The reason: They can cause allergies. If you have previously had an allergic reaction to local anesthetics, you should inform your doctor before having hemorrhoid treatment.

application of the medication

The ointments can be placed directly in the anus using an applicator. Alternatively, you can spread the ointment on a compress and use it as an insert.

Some active ingredients are offered as anal tampons . These are suppositories that are provided with a gauze strip. They remain in the anal canal and release their active substance there. Conventional suppositories, on the other hand, release their active ingredient in the upper sections of the intestine.

Be careful with laxatives!

When you have hemorrhoids, defecation can be very painful and cause bleeding in the anus. However, only use laxatives after consulting your doctor. Some preparations only help against constipation in the short term and make the intestines sluggish with longer use. This causes them to become clogged again.

Destroy, freeze or constrict hemorrhoids

Mild hemorrhoids (especially grade 1) are often obliterated. To do this, the doctor injects sclerosing substances in the area of ​​a hemorrhoid, such as zinc chloride. Blood flow to the hemorrhoid is blocked, causing the tissue to shrink and tighten. This method is called sclerotherapy . If performed correctly, it is painless for the patient. In order to treat all enlarged hemorrhoids, however, several interventions are usually necessary.

Hemorrhoids can also be destroyed by irradiating them with infrared light. However, this infrared coagulation is not very successful.

Another option is to freeze the hemorrhoids with nitrous oxide or liquid nitrogen. Doctors call this a cryohaemorrhoidectomy . Similar to infrared coagulation, the chances of success are not very high.

“Tying off” the hemorrhoids offers a better chance of success: rubber band ligation or hemorrhoid ligation . The doctor sucks in individual hemorrhoids and ties them off with rubber bands. The patient generally does not feel any pain. The tissue dies due to the interrupted blood supply. The hemorrhoid falls off after a week or two. This can lead to bleeding. A hemorrhoid treatment using a rubber band ligation is carried out especially for second degree (sometimes also third degree) hemorrhoids.

operate on hemorrhoids

The last option in hemorrhoid treatment is classic hemorrhoid surgery. The hemorrhoids are completely cut out. This hemorrhoidectomy is indicated when the symptoms cannot be alleviated with other treatment methods (such as sclerotherapy ). Grade 3 and 4 hemorrhoids often require surgery.

There are different techniques for hemorrhoid surgery. The hemorrhoid tissue can be removed with the help of scissors, a scalpel or a laser. With some procedures, the surgical wound in the rectum is completely or partially sewn up, with others it remains open.

Modern methods of treating hemorrhoids

There are now some modern methods that can be used to remove hemorrhoids. They are considered gentler than a classic hemorrhoidectomy. An example is Longo’s stapler operation :

It is suitable for grade 3 hemorrhoids: These are hemorrhoids that have protruded from the anus (prolapse) but can still be pushed back easily. During the procedure, a strip of anal mucosa above the hemorrhoids is punched out with a special stapler (stapler). Then the prolapsed hemorrhoids are “pulled” back into the anal canal and the edges of the wound are stapled together.

The method is considered less painful than a hemorrhoidectomy. Patients usually need less painkillers afterwards and can leave the hospital earlier. But there are also disadvantages, including the increased risk of recurrence: After a Longo operation, new hemorrhoids form more quickly and more frequently than after a hemorrhoidectomy.

Hemorrhoids: home remedies

As a hemorrhoid patient, you can do a lot yourself to combat your condition. For example, you can take sitz baths with anti-inflammatory tannins to relieve itching and pain in the anus. To facilitate bowel movements, you can take flaxseed with plenty of liquid.

The various home remedies and advice are sometimes enough to make mild hemorrhoids go away. But they are also useful for more advanced haemorrhoids: They can alleviate the symptoms and support medical treatment.

Home remedies have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.

You can find out more home remedies and valuable advice for hemorrhoids in the article on hemorrhoids – home remedies .

prevent hemorrhoids

The basic measures of hemorrhoid treatment also apply if you want to prevent hemorrhoids: high-fiber diet and regular bowel movements .

The most important tips for prevention and as basic therapy for hemorrhoids are:

  • Eat foods high in fiber regularly. This prevents constipation. There is a lot of fiber in wholemeal bread, muesli, wheat bran, sesame, oatmeal, legumes, vegetables and fresh fruit (with peel).
  • Drink at least 1.5 liters of fluids per day. Then the roughage in the gut can swell well. Water and other calorie-free drinks such as unsweetened tea are particularly recommended.
  • Eat as few foods as possible that promote constipation. These include, for example, white bread, chocolate, white rice and white pasta. Black tea also makes the intestines sluggish if it has been steeped for a long time.
  • Get enough and regular exercise. If you are overweight, consider shedding a few pounds.
  • Take your time when you have a bowel movement and if possible always at the same time of the day (e.g. after breakfast). This is how you get your intestines used to regular bowel movements.
  • Do not strain too hard when having a bowel movement.
  • Only use laxatives (including natural or herbal products) after consulting your doctor!

Hemorrhoids: Symptoms

How do patients first become aware of possible hemorrhoids? Blood in the stool is often the first sign. The color of the blood is decisive: bleeding haemorrhoids give off bright red blood. It indicates bleeding from arterial vessels. Dark red blood usually comes from a venous vessel. Here other diseases of the intestine must be considered.

Haemorrhoids often bleed after defecation because straining causes more blood to accumulate in the vessels. The blood may be on the top of the chair, stuck to the toilet paper, or dripping down the toilet. Normally, bleeding from hemorrhoids is light. However, they can become very strong, especially in advanced disease. Then you should definitely see a doctor.

Advanced Hemorrhoid Symptoms

Haemorrhoids usually change their symptoms as the disease progresses: itching and burning in the anus occur in advanced haemorrhoids . Some patients also complain of a foreign body sensation , weeping , sore skin in the anal area or palpable bulges . The latter are nothing more than the hemorrhoids that have fallen out of the anal canal. Pain often only shows up in advanced hemorrhoids.

Diarrhea is not a typical hemorrhoid symptom. Nevertheless, during the course of the disease, symptoms similar to diarrhea can occur: those affected often report mucous secretions from the intestine. Some patients also suffer from fecal incontinence . This means that stool or mucus passes uncontrollably. The reason is that enlarged hemorrhoids can no longer fulfill their main task: the tight closure of the anus.

Fake (external) hemorrhoids

True (internal) hemorrhoids arise from dilated arteries in the vascular cushion that is located inside the rectum near the exit (anus). A distinction must be made between so-called false (external) hemorrhoids : These are protrusions of blood clots (thrombosis) in the venous system of the anal sphincter that develop on the outer edge of the anus. They are sometimes mistaken for true hemorrhoids, which bulge out of the anus. That is why they are also called false or external hemorrhoids. The medically correct term is perianal thrombosis .

Hemorrhoids: causes and risk factors

Basically, hemorrhoids are an enlargement of the arterial vessels of the hemorrhoidal cushion. But how exactly do hemorrhoids develop?

There are now various theories as to which factors promote their development and vasodilatation in the rectum. One of these factors is repetitive training during bowel movements . This is especially common in people with chronic constipation . That is why they often suffer from hemorrhoids. Constipation is usually caused by a low-fiber diet, lack of exercise and/or insufficient fluid intake.

Like straining when having a bowel movement, lifting heavy loads increases abdominal pressure. Carrying heavy loads on a regular basis can also promote hemorrhoids.

Another possible cause of haemorrhoids is frequent diarrhea : if you constantly only pass thin stools, the sensitive closure system of the anus is not sufficiently trained. As a result, the arteries in the hemorrhoidal cushion can dilate.

Circumstances that impede the flow of blood from the erectile tissue can also contribute to the development of hemorrhoids. These include pregnancy , obesity and sedentary work .

congenital weakness of the blood vessel walls can also promote the development of hemorrhoids. Such vascular wall weakness probably also contributes to the fact that the risk of hemorrhoids increases with age: the vascular walls become less elastic over the years.

By the way: There are also hemorrhoids in children , albeit much less frequently than in adults. Chronic constipation is one of the possible causes.

Hemorrhoids: Pregnancy

Pregnancy is a known risk factor for hemorrhoidal disease. But how do hemorrhoids develop during pregnancy?

As mentioned above, one reason is the reduced blood flow from the arteries of the hemorrhoidal cushion: the growing child in the stomach presses on the mother’s rectum. This blocks blood circulation, causing the vascular cushion at the rectum to expand.

The hormonal changes during pregnancy also promote hemorrhoids.

You can read more about hemorrhoids in expectant mothers in the article on hemorrhoids in pregnancy .

Hemorrhoids: investigations and diagnosis

Complaints such as burning and itching in the anus and blood in the stool are embarrassing for many people. They don’t like going to the doctor. It is very important to have the symptoms clarified by a doctor. Enlarged hemorrhoids are often the cause. Then the following applies: The earlier they are detected, the easier they can be treated.

Sometimes other diseases are also the reason for the symptoms such as perianal thrombosis, anal abscess, herpes, eczema or fungal infections. In the worst case, colon cancer is behind it (blood in the stool!). So don’t be afraid to consult your family doctor early on if you suffer from the symptoms mentioned.

Detailed conversation

The doctor will first talk to you in detail to collect your medical history (anamnesis). He will ask you the following questions, among others:

  • Since when are you having those complaints?
  • Have you noticed blood after a bowel movement?
  • Do you feel pain or itching in the anus?
  • Do you suffer from constipation?
  • Do you eat a lot of fruits and vegetables?
  • What do you do for a living (sedentary or physically active)?


This is followed by the physical examination . The doctor feels the anal area and the anal canal with his finger (digital rectal examination). In this way he can examine the anus sphincters and the condition of the anal mucosa. The examination often provides clear indications of hemorrhoids. For further examinations, your family doctor can refer you to a specialist, for example a proctologist.

He will examine the rectum in more detail. To do this, he can perform an anal canal endoscopy (proctoscopy) or a rectal endoscopy (rectoscopy). A small tube of different lengths with a tiny camera is inserted into the rectum so that the doctor can get a visual impression.

Sometimes it is also necessary to examine the entire large intestine ( colonoscopy ). It is primarily used to rule out colon cancer if there is blood in the stool.

Hemorrhoids: course of the disease and prognosis

Many sufferers ask themselves the question: ” Are hemorrhoids dangerous? “. The answer to this is: Basically, hemorrhoids are not threatening and have a good prognosis. The earlier they are detected, the better they can be treated. However, the larger the hemorrhoids are, the more difficult and complex the therapy is. So go to the doctor early!

Complications can arise as the haemorrhoidal disease progresses . Enlarged hemorrhoids can cause skin irritation . These in turn promote anal eczema : the skin on the anus is reddened and inflamed, it weeps and itches. Skin blisters and scabs can also form.

Heavy, recurring bleeding sometimes causes persistent anemia (chronic anemia). As a result, patients often feel listless and tired or complain of dizziness.

Hemorrhoids can become trapped as they exit the anus. Doctors then speak of incarceration. She is very painful. As a result of the entrapment, the blood builds up in the vessels and the blood flow slows down. This is how thrombosis can form in hemorrhoids .

Enlarged hemorrhoids can no longer adequately fulfill their main task: ensuring stool continence. This threatens faecal incontinence in the case of a long-lasting illness : those affected pass stool uncontrollably.

If you already have hemorrhoids, you may experience pain or bleeding during anal sex. Therefore, if you have hemorrhoids, you should be careful with anal intercourse and use enough lubricant. Better yet, don’t do it until the hemorrhoids have healed. Another important tip: Because of the risk of bleeding from hemorrhoids, only ever practice anal sex with a condom!

Hemorrhoid Surgery: Possible Complications

Complications can also occur after surgery. These include, for example, postoperative bleeding, pain and the formation of blood clots (thrombosis) in the anus. Infections, abscesses and narrowing of the anus (anal stenosis) are also possible. Rarely, hemorrhoid patients can no longer voluntarily control their bowel movements after the operation (fecal incontinence).

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