A hemorrhoid is a vascular cushion within the anal canal, located above the anal sphincter. Hemorrhoids serve an important function as they help sealing the anus. Despite being covered by intestinal mucosa not sensitive to any pain, they can cause several complaints during defecation if they are enlarged and prolapsed.
Hemorrhoids / hemorrhoidal disease
Stages of hemorrhoidal disease
Hemorrhoidal disease is divided into four stages:
- I: vascular cushion is only visible during proctoscopy
- II: prolapse of hemorrhoids during defecation/bearing down that retracts after it
- III: prolapse of hemorrhoids during defecation/bearing down that has to be pushed back manually
- IV: prolapse of hemorrhoids and the lower anal canal that cannot retract or be pushed back manually
Symptoms hemorrhoids / hemorrhoidal disease
Enlarged or prolapsed hemorrhoids can cause bleedings, often without pain. In addition, a discharge of intestinal mucosa may irritate the skin. Blood clots within the hemorrhoids can result in a painful swelling of the prolapsed vascular cushions.
Causes hemorrhoids / hemorrhoidal disease
Factors causing hemorrhoids/hemorrhoidal disease are genetic disposition, nutrition and defecation habits (e.g., bearing down).
Diagnostics hemorrhoids / hemorrhoidal disease
Important diagnostic means are the rectal examination (inspection, feeling for anomalies with fingers) and rectoscopy/proctoscopy (inserting a rectoscope for better vision). Anal manometry (tests the pressure of anal sphincter) is not mandatory.
Treatment hemorrhoids / hemorrhoidal disease
First steps of treating hemorrhoids/hemorrhoidal disease are changes in diet (high-fiber diet and sufficient liquid intake) as well as anal hygiene (cleaning with lukewarm, clear water without soap or shower gel).
The specific treatment is subject to the stage of the hemorrhoidal disease:
- I: sclerotherapy (= shrinking blood vessels; may cause skin irritations)
- II: sclerotherapy, rubber band litigation
- III: surgery: modified Milligan-Morgan procedure or stapled hemorrhoidopexy (Longo´s procedure)
- IV: surgery: Milligan-Morgan procedure or reconstructive hemorrhoidectomy (Fansler-Arnold method)