Anatomically speaking, haemorrhoids are blood-filled cavernous bodies under the mucous membrane of the lower rectum. The main function of these cavernous bodies is to seal off the mucus-forming rectum (or rectum) from the dry anal canal.

This fine sealing function of the haemorrhoids accounts for around 15% of our continence organ and is therefore very useful. 

We only speak of hemorrhoidal disease as a clinical picture when the hemorrhoids become enlarged or when symptoms begin. 

• Haemorrhoidal disease is one of the most common diseases in industrialized nations and in Germany around 3.3 million patients are treated by doctors every year.
• The peak incidence of hemorrhoid complaints is between the ages of 45 and 65.
• Hemorrhoidal disease affects women and men about equally.
• The positions of the hemorrhoids are described from the doctor's point of view in front of the patient and are found at 3, 7 and 11 o'clock. This means that there are always 3 nodes.

In contrast to other diseases in the anus and rectum, enlarged hemorrhoids usually only cause minor pain. The enlargement often becomes noticeable through bright red blood deposits on the toilet paper, blood on the stool or painless bright red bleeding from the anus.

In addition to the bleeding, other symptoms may include mucus flow from the anus, itching, burning, oozing and a foreign body sensation. In advanced stages, stool smearing may also occur due to inadequate closure.

Various risk factors are discussed for the development of a hemorrhoidal disease from normally functioning hemorrhoids. However, the main cause is a remodeling of the hemorrhoid tissue with subsequent descent of the cushions into the anal canal. 

• Acute or chronic constipation (constipation)
• Physical exertion or strength training
• Increased alcohol consumption and a spicy diet
• Lack of exercise
• Diet low in fiber (questionable)
• Overweight (questionable)
• Diarrhea (questionable)

No connection with the development of haemorrhoidal disease has yet been established for gender, marital status, heredity, level of education, pregnancies and type of delivery.

Hemorrhoidal disease is divided into 4 grades according to Goligher based on the size of the hemorrhoidal nodes. However, there can also be sliding transitions, so that it can also be classified as grade 1-2, for example.

Hemorrhoids can occur individually as nodes or in all 3 places. This is then referred to as circular prolapse. In most cases, this prolapse can be pushed back with the finger. 

In pure haemorrhoidal prolapse, the haemorrhoids are covered with a fine, moist and slightly pink skin, the mucous membrane (mucosa). However, the skin at the anal opening (anoderm) often also protrudes, which is then referred to as anoderm prolapse.    

This difference, which can only be diagnosed by an experienced doctor or proctologist, is important in terms of treatment and possibly the choice of surgical methods.

As it is a benign disease, hemorrhoidal disease does not necessarily need to be treated in the early stages. However, the symptoms usually increase and the itching and bleeding are particularly troublesome for many patients.

Without treatment or a change in their own behavior, the hemorrhoids become larger and larger and can lead to loss of bowel control (incontinence).

Severely enlarged hemorrhoids that hang out of the anus can also cause incarceration, which leads to a proctologic emergency and is very painful. Prevention is therefore advisable.

A first measure is to achieve regular bowel movements. This includes

• A high-fiber diet with e.g. fruit and vegetables, bran and linen.
• Drinking a sufficient amount of two liters of tea or water a day allows the fiber to swell, which makes the stool softer.
• It is also important to engage in daily endurance sports to prevent the bowel from becoming too sluggish. Weight training is rather unfavorable due to the high abdominal pressure.
• Toilet sessions should not last longer than three to five minutes and the final toilet hygiene should only consist of clear water and soft toilet paper. Under no circumstances should you wipe too hard, as this irritates the sensitive skin around the anus and can lead to severe itching.

Likewise, too much contact with water should be avoided, as this dries out the skin, which in turn leads to increased itching. Ointments and suppositories for hemorrhoidal disease from the pharmacy can be used to provide relief and are harmless.

Grade 1 and 2 hemorrhoids can usually be treated without surgery using minimally invasive therapy with rubber band ligation or sclerotherapy (sclerotherapy). However, it is important to maintain a high-fiber diet and a high fluid intake in order to avoid recurrence of the symptoms. Long toilet sessions (over 5 minutes) should also be avoided.

Grade 3 and 4 hemorrhoids (approx. 10 % of patients with hemorrhoidal disease): In this case, surgery is necessary. A basic distinction is made between hemorrhoid removal, such as the Milligan-Morgan operation, lifting and stapling of the hemorrhoids (hemorrhoidopexy), such as the Longo stapling procedure, and hemorrhoid closure with suturing and stapling (HAL-RAR). 

We also offer the particularly gentle minimally invasive procedures of radiofrequency ablation (Rafaelo) and

Laser therapy (LHP), which can be used for grade 2 and 3.

Hemorrhoid sclerotherapy (sclerotherapy) is a very effective treatment for hemorrhoidal disease in stages 1-2 and, in exceptional cases, also in stage 3. The therapy can be performed on an outpatient basis and takes about 15 seconds. Approximately 0.3 - 0.6 ml of the substance ethoxysclerol 3% is injected directly into the 3 hemorrhoidal nodes.

Sclerotherapy usually takes place directly after the examination, but can also be performed during the initial examination. The examination and sclerotherapy take a total of 1 minute. No laxative measures need to be carried out beforehand and menstruation is not a problem for us.

The hemorrhoids themselves are not sensitive to pain, but the injected fluid can cause a feeling of pressure, which some patients find unpleasant. This feeling of pressure can last for 1-2 days. There may also be a slight discharge of blood during bowel movements during this period.

The fluid triggers a scarring process via a small inflammation in the hemorrhoid wall, which leads to a reduction in the size of the hemorrhoid by restricting the blood flow. The haemorrhoid is no longer as well supplied with blood and can therefore no longer swell up as a so-called blood sponge. At the same time, the hemorrhoid is better attached to the rectal wall due to the scarring and thus lifts slightly. The symptoms subside.

In order to achieve a lasting effect, we recommend two to three injections at intervals of around 6-8 weeks for larger findings. The treatment works very well for bleeding, which usually stops shortly after the injection. The treatment can also be used safely and effectively in patients on blood-thinning medication (ASA, Plavix, Marcumar etc.).

It is not a lifelong therapy. The hemorrhoids often have to be repeated at annual intervals.

Patients can return to work immediately after treatment. Strength training should be avoided on the day of treatment. In the days that follow, there may be slight bleeding during bowel movements and a feeling of pressure.

Very rarely, spotting occurs up to 14 days after the treatment or small blood clots (thromboses) within the haemorrhoids, which can, however, be treated well with anti-inflammatory agents.

Rubber band ligation is generally suitable for treating hemorrhoidal disease in stages 1-2 and, with the appropriate equipment, also in stage 3

During ligation, the individual hemorrhoidal nodes are aspirated and a small, tight rubber ring is placed over them. This tight ring cuts off the blood supply and outflow of part of the hemorrhoidal node, which means that it is no longer supplied with blood and dies.

In this state of necrosis, part of the hemorrhoid falls off with the ring during bowel movements after 4-8 days, unnoticed by the patient.

The rubber band ligation usually takes place directly after the examination. The examination and ligation take a total of 1 minute. No laxative measures need to be taken beforehand and menstruation is not a problem for us. 

Very rarely, quite heavy bleeding from the wound area can occur after ligation, which is why this procedure must not be used on patients taking blood-thinning medication (ASA, Plavix, Marcumar).

It is important to emphasize that not the entire haemorrhoid is ligated, but only a part of it. Treatment is therefore often carried out in 2-3 sessions at intervals of approx. 6-8 weeks, with a maximum of 2 ligatures per session.

Patients can return to work immediately after treatment. Strength training should be avoided for the first 24 hours as the elastic bands may loosen. In the following days, slight bleeding during bowel movements and a feeling of pressure are possible. There may also be slight sensory disturbances with the urge to defecate.

If the rings fall off with the dead tissue after a few days, slight bleeding may occur from the open wound area in rare cases, which usually stops on its own. The rubber bands can fall off or slip out of place if the patient pushes hard or has a hard stool, which can lead to pain.

If the hemorrhoids come out during a hard bowel movement, they should be pushed back in immediately, otherwise painful swelling may occur, which can last for several days.

If possible, patients should not take any long flights for up to 10 days after the treatment, as adequate treatment cannot be guaranteed if bleeding does occur.

In contrast to sclerotherapy, rubber band ligation therapy is also suitable for pregnant women and breastfeeding mothers and can be repeated over many years if necessary.