Haemorrhoids: symp­toms, causes and treatment

Eine Frau im Badezimmer sitzt auf der Toilette und schaut in ihr Smartphone.

Haemorrhoids is a subject that no-one likes to talk about. Yet many people suffer from haemorrhoidal disease. The condition particularly affects women during or after pregnancy. We explain what it is and what helps.

Overview: what are haemorrhoids?

Everyone has haemorrhoids. These are cushions of blood vessels located in the end part of the rectum that work in conjunction with the sphincter muscle to seal the anal opening. To enable the fine closure of the bowel, they are bulging with blood. The blood only drains away during bowel movements in order for the outlet to open and the stool to pass.

Irritation of the haemorrhoids

Haemorrhoids themselves are not a disease. However, they can become irritated due to a predisposition or to stool irregularities such as constipation or diarrhoea. This causes them to swell and become symptomatic.

Haemorrhoidal disease

To describe this pathological change in the vascular cushions, people often talk of “having haemorrhoids”. However, the medical term for enlarged haemorrhoids that cause problems is “haemorrhoidal disease”. Haemorrhoidal disease differs in terms of severity and can cause symptoms that range from itching to bleeding. This can be prevented by eating a high-fibre diet.

Severity of haemorrhoidal disease

Haemorrhoids are assigned 4 different grades of severity:

  1. Grade I: the haemorrhoids remain unnoticed inside the anus and don't cause any complaints.
  2. Grade II: the haemorrhoids come out of the anus when straining or during a bowel movement, presenting as a soft or rough swelling.
  3. Grade III: the haemorrhoids come out of the anus when straining and don’t go back inside on their own, but can be pushed back inside with a finger.
  4. Grade IV: it's no longer possible to push the haemorrhoids back inside and they remain touchable and visible outside the anus.
The most common symptom is bleeding during or after a bowel movement.

Typical symptoms of haemorrhoidal disease

  • Burning and itching or an inflamed anus
  • Pain during bowel movements
  • Bright red blood on the toilet paper (blood in the stool)
  • Mucous discharge
  • Soiling

Further complications

Tears in the mucous membrane of the anus (anal fissure), infections, rarely abscesses (accumulation of pus, anal abscess), haemorrhoidal thrombosis (blood clot in the haemorrhoid), suddenly very painful bluish lump on the anus

Causes for the develop­ment of haemorrhoidal disease

A common cause is prolonged, forceful straining during bowel movements. Pushing hard during a bowel movement creates pressure that can cause the attachment of the vascular cushions to tear and the mucous membrane to slide downwards with the cushions. As a result, the blood in the haemorrhoids can no longer drain away properly, causing them to grow bigger and lumps to form.

Other causes of enlarged haemorrhoids

  • Congenital weakness of the connective tissue
  • Hard stools
  • Chronic constipation
  • Constant diarrhoea and laxative abuse
  • Prolonged and frequent sitting
  • Increased pressure in the anal area, possibly due to obesity, weight training or pregnancy

Treatment of haemorrhoids

There are many gentle and effective therapies for treating haemorrhoidal disease.

Further treatment by your doctor or in hospital

  • Physical examination of the anal region
  • Endoscopy of the rectum (proctoscopy)
  • Endoscopy of the colon (colonoscopy)

Possible therapies

  • Anti-inflammatory and anti-swelling tablets, suppositories, ointments and lotions
  • Elastic band tied around the base of individual haemorrhoids (rubber band ligation)
  • Injection treatment / heat treatment for individual haemorrhoids (fall off on their own)
  • Thrombosed haemorrhoids can be removed by a small incision

What can I do myself?

Haemorrhoids only require treatment if symptoms such as severe pain or bleeding occur.

Good anal hygiene

After a bowel movement, it’s advisable to clean the anal area with chamomile or moist sanitary tissues. Or, instead of toilet paper, clean gently and thoroughly with water using a shower device. The essence to achieving soft stools is to eat a high-fibre diet and ensure sufficient fluid intake. Physical activity also promotes good digestion.

Minimise the risk

The following steps will minimise the risk of enlarged haemorrhoids:

  1. Lose excess weight.
  2. Avoid flatulence-inducing foods such as oven-hot bread, garlic and pulses.
  3. Offset frequent and prolonged sitting with exercise.
  4. Avoid long “toilet sessions”.

Household remedies for inflamed and enlarged haemorrhoids

Oak bark sitz baths are a tried-and-tested remedy for inflamed haemorrhoids. They have an itch-relieving, anti-inflammatory and astringent (contracting) effect.

Toilet stool

In evolutionary terms, our intestinal system isn't designed for us to defecate sitting at a 90-degree angle. In this position, the bowel is trapped by a special sphincter muscle. To make it easier to defecate, place your feet on a toilet stool. This sets you at an ideal 35-degree angle, leading to a complete release of the muscle and an open rectum.

Haemorrhoidal disease: neither a rarity nor a reason for shame

Many people suffer from haemorrhoidal disease in the course of their lives. It’s estimated that the probability of developing symptomatic haemorrhoids is 50%. Enlarged haemorrhoids are one of the most common bowel-related diseases and can severely impair a person’s quality of life.

Early action pays off

Patients often don’t act because they're embarrassed by the symptoms. Fear of medical treatment or serious illness can also be reasons for postponing a trip to the doctor. However, treatment becomes more difficult at an advanced stage.

Pregnant women are particularly frequently affected

It’s estimated that around half of all pregnant women suffer from grade I or II haemorrhoids. The probability increases with the woman's age and the number of pregnancies she’s had. Symptoms can occur particularly in the third trimester and after the birth.

Causes in pregnant women

The reason for the frequency is the pressure of the growing baby on the bowel (which promotes constipation), the mother's weight gain and the hormone progesterone. This loosens tissue, blood vessels and the pelvic floor in order to provide sufficient space for the growing baby. The vascular cushions in the anus are also affected, which can facilitate their protrusion.

Unpleasant for the woman, but harmless

Inflamed haemorrhoids during pregnancy are annoying but not usually dangerous for mother or baby. Nevertheless, patients shouldn't be embarrassed to consult their midwife or gynaecologist. These are the people best placed to judge which treatment is best for each individual.

When to see a doctor?

  • The first time you see blood in your stool
  • If your bowel movements have been irregular recently
  • If your haemorrhoids and their effects bother you

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