3. Hemorrhoids

Definition:

The word hemorrhoid originates from the Greek language and is literally translated as "blood river". They look like sponge tissue filled with blood, in which a network of entering (arteries) and exiting (veins) blood vessels exist. The blood vessels also penetrate the external and internal sphincter (closing) muscle. Since in particular the internal closing muscle must be flexed in order to lock the anus, the blood from the hemorrhoidal tissue cannot flow out and is accumulated. So, they form a circular pad in the final intestine and supports the sealing function of the sphincter muscles. The hemorrhoids -in a sense- function as micro control of the anus.

If the closing muscle relaxes with the defecation, the blood from the hemorrhoids can flow out, whereby the nodules relax and the stool can be emptied unhindered. If this mechanism is disturbed, the closing muscle does not relax completely and the blood remains accumulated in the tissue. Then the increased nodules present an obstacle and will be pressed in the anal channel by the defecation.

Causes:

· Predominantly sitting inactively and lack of movement in the modern office environment

·Obesity

·Low Fiber diet, low fluid intake and de-hydration

·Constipation, extended pushing and long toilet meetings (newspaper reading)

·Over-consumption of laxatives

·Genetic weakness of the connective tissue

·Hormonal changes during and after pregnancies

·Diarrhea with damage of the hemorrhoidal pads

Schematic representation of the anatomy of the final intestine:


a) final intestine, b) anal channel, c) anal edge veins
d) sfincter muscles, e) hemorrhoids

The reasons specified above lead -in time- to the enlargement of the hemorrhoids. This enlargement alone does not constitute an illness. When the typical symptoms and complaints become common, one can speak of the illness.

Symptoms:

Depending on size and indications, the hemorrhoidal illness can be separated into four stages.

Stage 1
The hemorrhoid is neither visible nor can be felt by examination. The main symptom is the light red blood in the stool. Pain does not exists. Occasionally, it will itch and will feel like the existence of a foreign object in the final intestine.

Stage 1

Stage 2
The hemorrhoidal tissue can be pushed out during defecation while pushing. However, they slide back inside immediately after. In addition to visible bleeding, itching, burning sensation, leaking as well as pain is present with the defecation.

Stage 2

Stage 3
The hemorrhoidal tissue does not retract by itself but can manually be pushed back in. The bleeding becomes less since the mucous membrane tissue which surrounds the hemorrhoids begin to thicken and harden and is therefore less sensitive in to injuries. Pain, itching and leaking increase which can lead to eczemas at the surrounding anal skin. Occlusion in the hemorrhoidal veins can occur, which leads to very painful thrombosis.

    
Stage 3

Stage 4
This stage is called fixed anal prolaps. The hemorrhoids are now constantly outside and cannot manually be pushed back in any more. The anal mucosa is pushed inside out and leaks constantly. This causes irritation of the skin and can lead to unpleasant eczemas and infections. Bleedings are rare but involuntary defecations may occur. In time, ulcers may form, choked tissue or necrosis may occur due to pinched blood vessels which are extremely painful.

Stage 4

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AAnal diseases - still a topic with taboo   |   Anatomy of the final intestine   |   How does the illness of the hemorrhoids developed?   |   How does the hemorrhoidal illness express itself?   |   How Hemorrhoids are treated?   |   How is the treatment in the Proktoklinik?   |    Anal fissure   |   Anal fistula / Anal abscess   |   Anal thrombosis   |   Illness of the Linea Dentata   |   Skin folds (Mariscs)   |   Condyloms