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Treatment for hemorrhoids

Short version:

  • In general, hemorrhoids are not a threatening condition.
  • The typical symptoms are unspecific and can also indicate other diseases.
  • Discomfort in the area of ​​the anus as well as traces of blood in the stool always require medical clarification.
  • Basic therapy for hemorrhoids includes a high-fiber diet, plenty of fluids, and exercise.
  • Topical medication can help relieve symptoms such as itching, burning, or pain.
  • Hemorrhoidal nodules can be treated with surgery.

What are hemorrhoids?

Hemorrhoids are a network of blood vessels that lie under the lining of the rectum. As a ring-shaped, blood-filled swelling pad, together with the sphincter muscles, they ensure that the anus remains securely closed. You are particularly responsible for the fine closure of the anus. This serves to ensure that the stool and windlass do not inadvertently emerge from the anus.

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How do hemorrhoids develop?

Hemorrhoids in the true sense of the word only develop when the blood vessels expand and bulge in a nodular manner due to an excessive backflow of blood. These can cause symptoms such as bleeding, itching or burning. One then speaks of a so-called hemorrhoidal disease, a widespread disease that can now be treated well.

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How common are hemorrhoids?

Haemorrhoid disease is one of the most common diseases in industrialized nations (e.g. Austria) with an incidence (frequency) under medical treatment of around 4%. The peak of the disease is between the ages of 45 and 65, with men and women equally affected. It is assumed that around 70% of all adults Have problems caused by hemorrhoids at least once in their life.

What are the symptoms of hemorrhoids?

The typical symptoms are widespread and unspecific - this means that they can, but need not, indicate hemorrhoids. Therefore, it is advisable to consult a doctor for detailed clarification in the event of the following symptoms. These symptoms include:

  • Bleeding
  • Swelling
  • itching
  • Oozing
  • Burn
  • Pain

Pain as such is often mentioned as a symptom, but basically hemorrhoids are insensitive to pain. The feeling of pain is caused by accompanying fissures (cracks in the skin or mucous membrane), local thromboses and edema, abscesses or fistulas.

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How are hemorrhoids diagnosed?

The diagnosis is made by the proctologist using a basic proctological examination. This includes:

  • Medical history (questions about the type, duration and extent of the complaints)
  • Questions about bowel habits
  • Questions about familial carcinomas
  • Inspection of the hemorrhoids
  • digital rectal examination
  • Proctoscopy
  • possibly rectoscopy to rule out other diseases

If hemorrhoids are clearly diagnosed as such, the further individual approach to treatment is decided.

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How are hemorrhoids treated?

Which therapy is suitable in each individual case depends on the size of the hemorrhoidal nodules, the frequency, duration and type of complaints as well as any other illnesses of the patient. As a rule, the treatment is made dependent on the severity of the hemorrhoids, whereby the transitions are usually fluid. The following are used:

  • Grade 1: Medicines, suppositories, creams, ointments, sclerosing
  • Grade 2: Desolation, binding
  • Grade 3: Ligation, surgery
  • Grade 4: surgery

However, it also plays a role which treatments have been carried out so far and the experience of the treating doctor with individual therapeutic measures.

Conservative therapy

Conservative therapy for any haemorrhoidal disease includes keeping the stool soft and shaped by eating a diet rich in fiber, drinking plenty of fluids and exercising, avoiding long and hard pressing during bowel movements (defecation behavior) and gently cleaning the anus (hygiene behavior). Losing excess weight and avoiding sedentary activities are also beneficial. In the best case scenario, an only mildly developed hemorrhoid disease will disappear by itself with these measures.

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Medicinal and / or minimally invasive procedures

If these initial measures are not sufficient, medicinal and / or minimally invasive procedures are used.

  • Common drugs include ointments, creams, suppositories and anal tampons (suppositories with a mulle insert) that contain locally anesthetic (e.g. lidocaine), anti-inflammatory (glucocorticoids) or astringent substances (e.g. oak bark, witch hazel bark, bismuth gallate). These active ingredients have a purely symptomatic effect by alleviating typical symptoms. Flavonoid tablets can also help seal the blood vessels and prevent blood congestion.

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  • Minimally invasive surgical procedures include sclerotherapy (obliteration) and rubber band ligation. During sclerotherapy, either a 5 percent phenol solution is injected into the supplying arteries (supra-hemorrhoidal sclerotherapy) or a 3 percent polidocanol solution is injected directly into the hemorrhoidal cushions (intra-hemorrhoidal sclerotherapy). The aim of obliteration is to fix and stabilize the hemorrhoids and reduce the blood supply, which causes the nodules to shrink. In rubber band ligation, a rubber band is placed around the affected tissue, thereby tying it off. As a result, the tissue dies, scars and shrinks.

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Operative therapy

Surgical therapy is used for vascular nodes that are visible from the outside and that can be pushed back into the intestine after a bowel movement (grade 3), or those where manual return is no longer possible (grade 4). Alternatively, if conventional therapy fails, surgery can be used if the patient so desires.

During the surgical procedure, the excess tissue is removed under anesthesia. This procedure is very easy to carry out nowadays, possible complications such as urinary retention, heavy secondary bleeding or postoperative incontinence hardly occur any more. Special ointments with glycerol trinitrate, diltiazem or nifedipine can also be applied to prevent possible pain after the operation.

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Medical clarification makes sense if hemorrhoids are suspected

Discomfort in the area of ​​the anus as well as traces of blood in the stool always require a medical examination. Because other diseases in the area of ​​the anus or rectum can cause symptoms similar to hemorrhoids, but may require special treatment. This includes:

Above all, it is important to rule out cancer and inflammatory bowel disease as the cause of the complaints. For this reason, an early medical evaluation is always advisable if hemorrhoids are suspected.

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Dr. med. Matthias Thalhammer, Ulrich Kraft, doctor and medical journalist, Christopher Waxenegger (2020)
Medical review:
Dr. Michael Georg Lilgenau (2014), Dr. Matthias Grünbeck (2020)
Editorial editing:
Thomas Auinger, Dr. med. Peter Mahlknecht, Tanja Unterberger (2016), Astrid Leitner (2020)

Status of medical information:

Joos AK et al., S3 guideline "Haemorrhoidal disorders", status: 04/2019
Lohsiriwat V. Treatment of hemorrhoids: a coloproctologist’s view. World J Gastroenterol 2015; 21 (31): 9245-52
Sun Z, Migaly J. Review of hemorrhoid disease: presentation and management. Clin Colon Rectal Surg 2016; 29 (1): 22-29

Riede, Schäfer, Werner: General and special pathology. Georg Thieme Verlag 2004.

Müller: Surgery for study and practice. Medical publishing and information services 2016/17.

EbM guidelines for general medicine. Doctors publishing house 2007.

German Society for Coloproctology: Hemorrhoidal Diseases. Guidelines of the German Society for Coloproctology

George E. Reese, Alexander C von Roon, Paris P. Tekkis: Haemorrhoids. BMJ Clinical Evidence. Published online on January 29, 2009. Patient information: Haemorrhoids. BMJ Clinical Evidence, 10/2010

Satzinger U, Feil W, Glaser K (2009) Recto Anal Repair (RAR): a viable new treatment option for high-grade hemorrhoids. One year results of a prospective study. Pelippsineology 2009; 28: 37-42

Festen S, van Hoogstraten MJ, van Geloven AAW, Gerhards MF (2009) Treatment of grade III and IV haemorrhoidal disease with PPH or THD. A randomized trial on postoperative complications and short-term results. Int J Colorectal Dis (2009) 24: 1401-1405

Abstracts from the 37th German Coloproctologist Congress from March 31 to April 2, 2011 in Munich. coloproctology 2011 • 33: 55-70

Alonso-Coello, P / Guyatt, GH / Heels-Ansdell, D / Johanson, JF / Lopez-Yarto, M / Mills, E / Zhuo, Q: Laxatives for the treatment of hemorrhoids. Cochrane Database of Systematic Reviews (4) 2005.

More articles on the topic

Surgery for hemorrhoids

If other methods are ineffective, surgery can also be performed for hemorrhoids.

ICD-10: I84, I84.0, I84.1, I84.2, I84.3, I84.4, I84.5, I84.6, I84.7, I84.8, I84.9