How can you get hemorrhoids

Treatment for hemorrhoids

Grade 1 and 2 hemorrhoids are mostly treated conservatively, while Grade 3 and 4 hemorrhoids are usually operated on. Conservative treatment methods should primarily reduce the symptoms and achieve regression of the hemorrhoidal cushion. Surgical treatment aims to completely remove the hemorrhoids. Enlargement of the hemorrhoidal pad without discomfort is usually not treated.

In parallel to treatment, patients should permanently change their way of life. This can improve the chances of success of the therapy and reduce the risk of new hemorrhoids forming.

Conservative therapy

Mild to moderate discomfort can be relieved with ointments or suppositories. However, a short-term improvement in symptoms should not obscure the fact that these drugs may not correct the condition in and of themselves. The preparations individually or in combination contain, for example, anti-inflammatory agents such as witch hazel (vegetable), bufexamac or substances containing cortisone. However, caution should be exercised with ointments containing cortisone: they facilitate the development of fungal infections of the intestine. The itching and pain are locally anesthetized with benzocaine, cinchocaine or lidocaine, among other things. Sitz baths with anti-inflammatory tannins, e.g. from oak bark or chamomile, can provide relief.

If the sphincter muscles are very tense, the muscles can be relieved by the use of Anal stretchers be loosened and better supplied with blood. This can also alleviate the symptoms.

The removal of 1st and 2nd degree hemorrhoids is mainly done with the so-called Sclerotherapy, i.e. sclerotherapy by injecting appropriate substances. The hemorrhoid cushion becomes smaller as the treated tissue dies and can regress into the rectum. The doctor will usually choose a different form of treatment for pregnant women and patients with acutely inflamed hemorrhoids, high blood pressure or a tendency to thrombosis.

Alternatively, the Rubber band ligation applied. The doctor sucks in the hemorrhoids and then ties them off with rubber bands. The tied tissue is then rejected by the body after a few days. This procedure is suitable not only in the 2nd, but in some cases even in the 3rd stage of the hemorrhoidal expression. Both sclerotherapy and rubber band ligation are painless treatments.

Further treatment methods are the sclerotherapy with the help of infrared radiation ( Infrared coagulation) as well as icing with laughing gas or liquid nitrogen ( Cryohemorrhoidectomy). However, these are not considered to be very successful.

Modern, gentler processes

For hemorrhoids that have emerged from the anus (prolapse) and are easy to push back into the anus, there is one OP after Longo which is a newer, less painful procedure without cutting out any hemorrhoidal tissue. A special stapler is used to gather the intestinal mucosa above the hemorrhoid area, thereby eliminating the prolapse. Experts also refer to the Longo method as "anal lifting", because with this method the doctor attaches the protruding anal canal back up to its original location. Since only the excess haemorrhoidal parts are removed during the Longo operation, ideally a normal sized haemorrhoid region remains. Thus, the hemorrhoids remain in their function as erectile tissue, with the advantage that mucus and air do not later escape uncontrollably. However, defecation disorders, incontinence, and other serious complications can occur. With the Longo method, the surgical suture is always above the pain-sensitive anal canal, which saves the patient pain after the operation. Overall, patients who are operated on according to Longo require significantly less pain medication than those who undergo a conventional procedure (e.g. Milligan-Morgan procedure). People treated according to Longo can also leave the hospital much earlier and be able to work again sooner.

Even the gentle one HAL Method (Hemorrhoid Artery Ligation) The doctor can only use it if the hemorrhoids that have emerged (prolapse) can still be pushed back - or as experts put it: if they can still be reduced. The doctor detects the hemorrhoidal lumps with an ultrasound device and stabs them to reduce the blood supply. The arteries are tied off with sutures, which reduces the blood supply. As a result, the hemorrhoids collapse and any bleeding stops. After a few weeks, the hemorrhoids will atrophy without forming sores. The patient does not need anesthesia for this procedure and can often go back to work a day after the operation.

An almost painless, minimally invasive hemorrhoid treatment, which is particularly suitable for stage II and III, is theRecto-Anale-Pexie (abbreviated as RAR from English Recto-anal repair) which is also known as Doppler sonographically targeted mucopexy (DGM). As with the HAL method, the supplying vessels in the rectum, which is only slightly sensitive to pain, are precisely searched for and tied off with a special ultrasound probe. Then the mucous membrane is tightened with a suture deep inside. The tissue protruding from the anus is pulled inwards so that the hemorrhoids disappear. This process is repeated several times until the hemorrhoids are treated in the entire curve of the anus. The RAR method is considered to be particularly gentle because, unlike conventional surgery, there is no open, weeping and painful wound. Most patients feel a slight pulling just a few days after the operation, although the wound may still bleed slightly for the first week. Within a few weeks, the previously pathologically expanded venous pads completely retract. The recto-anal pexia (RAR) should not be confused with the LONGO operation, in which the vessels are tied with a mechanical stapler and defecation disorders, incontinence and other serious complications can occur. Damage to the sphincter is practically impossible with RAR. A short hospital stay, no restrictions after the operation and return to normal activity within 24-48 hours are further advantages of the RAR method.

Surgical treatment

In the case of persistent complaints and 3rd and 4th degree hemorrhoids, the only remaining option is usually to remove them surgically, which necessitates an inpatient hospital stay. Different surgical procedures are used, the aim of which is the complete removal of the hemorrhoids with their blood-supplying vessels.

A new surgical procedure represents the Stacker method With the help of a stapler - the stacker - the hemorrhoids can be removed with less pain and more gently than with conventional methods. Both the operation time and the hospital stay are shorter than with traditional surgical methods.