Hemorrhoids

Synonyms in a broader sense

obsolete: blind/golden wires

• Rectal varicose veins
• Haemorrhoidal diseases

Definition

The term “hemorrhoids” in colloquial language refers to the pathological swelling or varicose vein-like changes in the vascular plexus in the rectum, the plexus haemorrhoidalis. This “vein cushion” is arranged in a ring in front of the sphincter muscle. The task of the hemorrhoids is, in the normal state, the fine closure of the anus, they act like a corpus cavernosum.

In case of urge to defecate, the plexus haemorrhoidalis swells and thus supports the sphincter muscle. One speaks of hemorrhoids when these vessels are and remain permanently swollen beyond the normal extent. Hemorrhoids can be divided into four degrees of severity, depending on size and symptoms.

• Grade 1 refers to barely noticeable, minor swelling of the veins, which is not visible from the outside and often recedes without treatment.
• Grade 2 denotes visibly enlarged hemorrhoids, which are shifted outwards during pressing, but lie inside in the relaxed state.
• 3rd and 4th degree hemorrhoids are massively enlarged and protrude visibly out of the rectum, whereby 4th degree hemorrhoids cannot be pressed inwards anymore.

Frequency distribution

In 70% of all adults over 30 years of age, haemorrhoids can be detected in an appropriate proctological examination. However, they often do not cause any symptoms and therefore do not require treatment. More men than women are affected, in a ratio of 2:1, and the average age of patients with hemorrhoids is 50 years. There are about 1,000 new cases per 100,000 inhabitants every year.

Causes

Hemorrhoids usually form from the age of 30 onwards due to degeneration of the elastic fibers within the vascular plexus. These natural processes prevent the walls of the vascular cushion from returning to their normal size when there is no urge to defecate. Other causes are chronic constipation or the resulting frequent and intensive pressing during bowel movements, as well as a frequent increased tension of the anal sphincter, for example, due to frequent stool retention.

Furthermore, the regular intake of laxatives can promote the development of hemorrhoids. The reason for this is then the stronger pressing during defecation when no laxatives have been taken. In addition, people with sedentary jobs are at higher risk of developing hemorrhoids than people who stand or walk more often.

Again, the cause is ultimately a permanent pressure on the veins and arteries of the hemorrhoids. Very often, hemorrhoids also occur during pregnancy. The loosening effect of the hormones on the connective tissue can be made responsible for this.

However, it is important to know that hemorrhoids never appear overnight. They develop within years to decades and the predisposition is genetically inherited. During pregnancy, a more frequent occurrence of hemorrhoids can be observed.

However, 65-85% of women with hemorrhoidal complaints report having observed them for the first time during pregnancy. If haemorrhoids already exist at the beginning of pregnancy, in 85% of the cases a worsening of the haemorrhoidal condition occurs during pregnancy and delivery. Repeated pregnancies and births increase the risk of hemorrhoids.

This can be explained on the one hand by a hormone-induced increased arterial vessel inflow, and on the other hand by the restricted venous vessel outflow due to the increased pressure in the woman’s pelvis (through the uterus and the unborn child). The increased pressing due to the frequently observed constipation during pregnancy also promotes the development of hemorrhoids. During childbirth or during the expulsion phase, pre-existing hemorrhoids can worsen or new hemorrhoids can develop, as the blood return from the corresponding vessels is restricted in this phase of the birth process.

Apart from the pain, however, this has no negative influence on the birth. For a woman with haemorrhoids, the quadruped position is recommended for the birth. To relieve pain, the hemorrhoids can be cooled with a little counter pressure.Complaints of hemorrhoids during pregnancy and in the puerperium (period of six to eight weeks after birth) can in most cases be well controlled by conservative measures, such as a diet rich in fiber, sufficient exercise and adequate drinking and local, symptomatic ointment treatment. During the postpartum period, the resulting hemorrhoids usually regress well, as the triggering factors are no longer present. Therefore, a targeted treatment should be considered at the earliest two months after delivery.