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Hemorrhoids: Good to know

When to treat haemorrhoids, when to operate? And what is the optimal treatment? We make the decision individually for each patient. The most important criteria are the stage of the haemorrhoids (stages I - IV, depending on the presence and severity of an external prolapse), the leading symptom (bleeding, feeling of pressure, oozing) and the extent of your subjective impairment. An important point is also whether and how long conservative treatment measures have helped in the past and whether there is a suspicion of a malignant change in the skin or mucous membrane.
10 simple tips for haemorrhoids - treatment without surgery

  • Improve the stool composition (stool consistency): The target is a shaped, not too hard chair. Patients often try to keep the stool very soft, especially in painful conditions. Too soft stool, however, has a longer contact time with the skin, penetrates into every tiny wound or mucous membrane niche and leads to inflammation. Soft stool is more difficult to control (stool smearing) and exerts a lesser evacuation stimulus (with the possible consequence of the evacuation disorder). Proven measures are
    • dietary supplementation with swelling and dietary fibre (psyllium husks, healing clay, absorbents)
    • Probiotics (bacterial cultures to stabilize the intestinal microbiome)
    • a sufficient amount to drink
    • the exclusion of food intolerances (lactose, fructose, gluten, histamine) by dietary diary and/or examination by a gastroenterologist
  • Optimize your stool habits
    • Go to the toilet if you have to and not if you want to. Take your time, time pressure and stress to activate the sympathetic nervous system, which reduces intestinal activity.
    • Avoid extreme pressure on the toilet, a slight activation of the abdominal press at the beginning is allowed.
    • Use physiological reflexes such as the gastrocolic reflex. Simply put, a filling of the stomach leads to an emptying stimulus in the rectum. Drinking a large glass of liquid in the morning after getting up makes it easier to "do business" before rushing into rush-hour traffic.
    • Compensate for the design of northern European toilets, which promote comfortable sitting but tend to make defecation more difficult due to an awkward anorectal angle. Since the bestseller "Bowels with Charm", we know that a stool under the feet supports the natural position.
    • Read the newspaper at the breakfast table or on the underground, not in the quiet lavatory. Prolonged "toilet sessions" increase the pressure in the haemorrhoidal circulation and should therefore be avoided.
  • Use moist cotton pads (available in drugstores) instead of moist toilet paper (can cause allergies), use natural care (marigold ointment, zinc ointment, baths with oak bark extract).

How does the proctologist treat?

Proven: Sclerotherapy and rubber band ligature

This treatment without surgery has the aim of tightening and stabilizing the connective tissue. During the so-called sclerosing, a drug (Ethoxysklerol®) is injected into the area of the vessels leading to the hemorrhoids or into the hemorrhoids themselves, which shrinks them and strengthens the anchoring on the muscle layer of the rectum. This measure can easily be performed on an outpatient basis, is painless and is therefore used very frequently. As a rule, it must take place several times at intervals of a few weeks. It can take from a few months to a few years for the symptoms to disappear completely. Complications are extremely rare.

With the rubber band ligature, excess mucous membrane is tied off with a rubber ring, the tissue repels itself after one to two weeks. This reduces the size of the haemorrhoids and fixes them in their natural position by scarring. This measure must also not cause any pain, otherwise a different method of treatment must be chosen.

Bleeding or post-operative bleeding are risks, especially if you are taking blood-thinning medications. The tied tissue can be uncomfortable until it is rejected, so it is advisable not to put more than one or two bands in one treatment session.

In patients with chronic inflammatory bowel diseases (Crohn's disease, ulcerative colitis), a weakened immune system or a latex allergy, ligation is not the best treatment option.

Innovative: Non-invasive sclerotherapy with LASER

A new approach to hemorrhoid treatment is the use of medium energy laser energy, which strengthens the connective tissue and shrinks the hemorrhoids, but remains below the pain threshold. The practical implementation is comparable to sclerotherapy. We perform this treatment on an outpatient basis using a proctoscopy with a local anaesthetic gel, an anaesthetic is not required. Our experience with this technique is very good, especially persistent bleeding often responds well to this treatment.

Hemorrhoid surgery with the Circular Stapler (Longo surgery)

In this procedure, a strip of mucous membrane is removed above the haemorrhoid base over the entire circumference of the haemorrhoid base and the mucous membrane is then reunited using a stapler. This both restricts the blood flow to the haemorrhoids and rejoins the prolapse (hence the name stapler - haemorrhoidopexy, "fastening"). The staples heal into the scar or are gradually expelled. The procedure is widely used due to a short operation time as well as painless aftercare. Nevertheless, we no longer use this procedure after hundreds of successfully performed haemorrhoid operations, following reports in publications of rare but serious adverse events (tearing of the staple suture, intolerance of the staples).

 

 

Surgical therapies: Treating haemorrhoids with laser

If the disease has progressed too far or the conservative therapy methods have not led to success, haemorrhoids can be treated by laser. These include laser haemorrhoidectomy, laser haemorrhoidoplasty and haemorrhoid artery ligation.

If you are interested in a treatment of your haemorrhoids in our proctological centre in Munich, Dr. Hofer and Mr. Bärtl are at your disposal for all questions. Give us a call, we are here for you.

DR. BERNHARD HOFER & COLLEAGUES

Specialists in surgery, proctology

Brienner Str. 13, D-80333 Munich, Germany

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