Even though the chronic and often complicated course of hemorrhoids affects the sufferer psychologically and physically, we very often experience that many people suffering from this condition are reluctant to see the doctor. The reason for this lies in the completely unfounded prejudice that this condition is offensive. In the Middle Ages, even for this reason, the term hemorrhoids disappeared from the vocabulary for some time and was replaced by more harmless-sounding names.
Definition and causes of hemorrhoids
The defining symptom of hemorrhoids is the bleeding of the nodules and the prolapse of the intestinal mucosa. What are hemorrhoids actually? Nothing more than varicose veins, dilated veins, on the rectum. They appear when there is congestion in the area of portal circulation. This circuit, which carries blood from the gastrointestinal tract, pancreas and spleen to the liver, is particularly sensitive to congestion. It lacks the valves present in other veins that help ensure that blood flows back to the heart. A second complication is that the portal vein is divided into numerous branch and capillary vessels without a “motor” – such as that of the heart – being connected in front of it. Both conditions result in an uninterrupted column of blood from the liver to the anal veins, which in itself constitutes a quite considerable mechanical stress. Under these circumstances, it is understandable that outflow congestion can very easily occur. Together with a certain weakness of the connective tissue, they favor the development of varicose veins in the rectum, as soon as a triggering factor is added to these causative moments, for example, strong and above all persistent pressing during bowel movements and the widespread chronic constipation. This subheading also includes a predominantly sedentary lifestyle and sudden physically strenuous activity when the person concerned does not otherwise work hard. It has also been observed that people who like to eat and drink, giving preference to spicy, hearty foods, are more likely to suffer from hemorrhoids. In addition, space-constraining processes in the abdomen and pelvis, such as tumors, uterine and ovarian tumors, liver congestion and even normal pregnancy can also trigger hemorrhoids.
Symptoms and signs
Characteristic symptoms of this disease include constant oozing and dampness at the anus, anal itching and, as a result, eczema formation, and stabbing pain radiating to the surrounding area. Chronic constipation can be regarded as a contributory cause and symptom of hemorrhoids, so that one must speak of a vicious circle caused by constipation. If the constipation persists for a long time and the first lumps begin to appear, there is often a constant feeling of dampness in the anal region. This is secretion from the mucous membrane of the rectum and the hemorrhoidal nodes. This secretion is unpleasant not only because of its odor and soiling of underwear, but rather because it leads to a much more troublesome disease sign, anal itching and anal eczema. These two closely related diseases are particularly stubborn against any treatment and cause intense itching. Often, small tears, so-called anal fissures, appear additionally in this already damaged mucous membrane of the rectum, which can cause unbearable pain during defecation. However, the decisive symptom that leads most patients to the doctor is the bleeding of the nodes and the prolapse of the intestinal mucosa. Both are signs that the disease has already reached its peak. The bleeding is usually triggered during defecation, when the pressure conditions are particularly unfavorable and the hemorrhoidal node is subjected to mechanical overstress, such as muscle pressure. Initially, only one node generally bleeds during defecation, so blood loss remains minimal. Later, however, there is heavy bleeding from several increasingly congested nodes, which can then also occur completely independently of defecation and cause heavy blood loss.
Complications
Another complication is prolapse of the rectal mucosa, which bulges outward during defecation, initially regresses on its own, but later remains outside the bowel.This entrapment of the mucosa leads to abscesses, ulceration, sometimes gangrene, and severe inflammatory processes in the rectum. Since almost all of these symptoms can also occur in other diseases, especially rectal cancer, the doctor can only make the correct diagnosis after a thorough examination.
Diagnosis and treatment
The most important diagnostic tool has proven to be the proctoscope, an instrument similar to an internally illuminated, fenestrated tube that allows the hemorrhoidal nodes to be easily visualized. One of the most essential parts of the treatment of hemorrhoids is to adjust the lifestyle and diet of the patients concerned so that bowel movements are regular. Inflammation can be improved by bed rest, moist compresses, sitz baths and analgesic suppositories. Caution is advised when using ointments, as they promote the formation of the dreaded anal eczema. Only when these conservative treatment methods fail or there are frequent relapses, surgical intervention or injection treatment must be used, namely the so-called sclerosing injection therapy is increasingly gaining acceptance. In this procedure, the tissue is hardened by injecting an appropriate preparation into the area around the nodules. By this we achieve that the blood supply is throttled and the hemorrhoidal nodes gradually dry up. Hemorrhoids can therefore not only be a nuisance and, due to their complications such as itching, burning, stinging and bleeding, severely hinder their carriers, but from case to case they can also cause serious damage to health. Therefore, the principle that prevention is better than cure also applies to this disease. Plenty of exercise, a sensible lifestyle and diet, and regular bowel movements are suitable measures to prevent the development of this disease. However, if it still occurs, one should not hesitate to consult the doctor.
