Hemorrhoids: The consequences can be serious
Hemorrhoids are the number one taboo. Every second person suffers more or less from it, but no one talks about it. No wonder, because the complaints are often associated with anus pain, itchy skin and after-wetting. When hemorrhoids swell, suffering begins. But only very few then go to the family doctor or proctologist. They shy away from clearing their anus. Timely therapy is much less unpleasant than the late effects. These can go hand in hand with permanent anal pain and even unwanted bowel movements and bleeding.
Suffering begins when they swell. But most people shy away from going to the doctor in time. Early treatment would be much less uncomfortable before other symptoms such as persistent anal pain, unwanted bowel movements and bleeding occur.
Hemorrhoids often covered with shame
Hemorrhoids are an uncomfortable topic for most people because itching, anus burning, hard bowel movements or blood in the stool are symptoms that nobody likes to talk about. "Just keep to me" many people think, although the problem is anything but rare. Rather, it is now a "people's disease", which is estimated to affect at least a third of the population beyond the age of 30, about 3.5 million cases are treated by doctors in Germany alone every year.
However, out of shame, many of those affected go to the doctor late and instead try to ignore the first signs and symptoms. However, this can have bad consequences because hemorrhoids are not life-threatening, but if left untreated they can lead to complications such as anal fissures, anal fistulas, increased arterial bleeding or an abscess.
An important natural part of the anal canal
Hemorrhoids are arteriovenous erectile tissue that form an annular vascular cushion just above the sphincter muscles. Hemorrhoids are not a disease at first, instead they are found in every human being and are an important, natural component of the anal canal.
"Everyone has these cushions. They seal the rectum outwards and prevent stool residues from escaping and irritating the sensitive skin in the anal area, ”explains Prof. Alexander Herold from the rectum and colon center in Mannheim.
The first enlarged cushions have disease value
Hemorrhoids only become pathological when the blood accumulates in the vascular pad and can no longer flow away unhindered. In this case, doctors speak of a "hemorrhoidal disease". "If pressure is exerted on the blood vessels for a longer period of time, the blood can no longer drain, the veins expand and their delicate connective tissue wears out," continues Herold.
The high pressure arises above all from permanent constipation (constipation) or strong pressing when emptying the stool, so according to Herold, the toilet should only be used when there is actually a urge to stool. In addition to this, there are other beneficial factors and causes, such as a congenital weakness of the connective tissue, overweight, lack of exercise or pregnancy.
Certain "quirks" such as spending a long time in the toilet are considered risk factors for hemorrhoidal disease, "you should therefore avoid reading newspapers extensively on the toilet," Herold advises.
Hemorrhoids are only visible from the outside from stage two
Depending on how pronounced the enlargement of the hemorrhoids is, four disease stages are usually distinguished, which are associated with different symptoms. In the first stage, the naturally occurring hemorrhoids are already enlarged, but still comparatively small and not recognizable from the outside, so that the doctor can only make a diagnosis by mirroring the anal canal and the rectum (proctoscopy).
Accordingly, there is usually no pain here, if those affected notice the suffering so early, usually through small traces of blood in the stool or on the toilet paper. Grade II, on the other hand, means an advanced enlargement of the vascular nodules: "In the second stage, they emerge from the anus during bowel movements, but then withdraw on their own", Bernhard Lenhard of the German Dermatological Society (DDG) told the "dpa" . On the one hand, this can cause pain, in addition there is burning and itching, inflammatory reddened skin and oozing in the anus area, and it is also possible to feel that you are not completely empty.
In the further course, the hemorrhoids are permanently in front of the anus opening
In the third stage, the knots can then "slide out" completely out of the anus when defecating, doing physical work or spontaneously, whereby this is medically referred to as a "prolapse". In this case, however, the hemorrhoids no longer automatically retreat into the anal canal, "so that those affected have to push them back by hand," continues Bernhard Lenhard. In the last stage of hemorrhoidal disease it is no longer possible, instead the hemorrhoids are permanently in front of the opening of the anus and are therefore also permanently visible (fixed prolapse).
In most cases there is also a so-called “anal prolapse”, in which not only the hemorrhoidal node, but also the anal mucosa protrudes from the anus. In addition to itching, burning and pain, other symptoms such as unwanted bowel movements and a permanent foreign body sensation in the anus area occur in phases three and four.
If you have blood in your stool, go straight to the doctor!
But these consequences are easy to prevent, because if a hemorrhoidal disease is treated in time, it usually takes a positive course. Accordingly, if you have blood in your stool (hematochecia), you should immediately consult a proctologist who is specially trained for the treatment of rectal diseases. According to Bernhard Lenhard, this is important in order to be able to rule out other diseases, because hematochecia can also indicate blood diseases, vascular inflammation or even colon cancer, for example.
Examination is usually painless
According to Lenhard, those affected should not be afraid of the examination, because since the hemorrhoids are covered with pain-resistant intestinal mucosa, it is usually painless. At the beginning there would be a scan of the rectum, through which "[...] nodular changes or restrictions [.] As well as pressure and tension of the sphincter" could be felt and checked, according to Bernhard Strittmatter, chairman of the professional association of coloproctologists in Germany (BCD).
Proctoscope enables exact observation of the inside of the intestine
However, since the tissue of the hemorrhoids can usually not be palpated, a so-called “proctoscope” is used, which is inserted into the anal canal and allows an exact view of the inside of the intestine. "In the event of bleeding that cannot be explained by the findings in the rectum, the rectum behind it and, if necessary, the entire colon should be examined as a precaution," explains Strittmatter.
In the end stage, only one operation usually helps
If the hemorrhoidal disease is still at the beginning, sclerotherapy is usually sufficient. According to Strittmatter, an agent is injected into the slightly enlarged upholstery, which shrinks and solidifies the fabric. In parallel, creams and anal tampons can help, but these could not affect the size of the hemorrhoids, but only alleviate the symptoms. The so-called “rubber band ligation” can also help in the second stage: “The doctor puts a tiny rubber ring over the hemorrhoids.
The excess tissue then no longer gets blood and falls off with the stool within the next two weeks, ”says Strittmatter. If these procedures are unsuccessful or if the hemorrhoids are at an even more advanced stage, usually only surgery to remove the nodes helps. But even after that, there is still the possibility that enlarged hemorrhoids will appear again later on - accordingly, according to Strittmatter, care should be taken to avoid favorable factors such as heavy pressing during bowel movements.
Use sensible home remedies for prevention
In addition to this, a lot can be done preventively to reduce the likelihood of enlarged hemorrhoids. The main focus here is on a healthy, high-fiber diet and lots of exercise, whereby long walks or swimming, for example, can have a very positive effect. In order to avoid hard stool, you should always drink enough besides, and various home remedies for constipation, such as Indian psyllium husks or wheat bran help to make the stool “more supple” and thus prevent hemorrhoids. (sb, nr)