Haemorrhoids

Haemorrhoids at a glance

Haemorrhoids are cushions of vascular tissue situated near the anus at the end of the digestive tract. These cushions are densely packed with blood vessels, supplied by a complex network of arteries and veins. Although everyone has haemorrhoids, they generally remain unnoticed until they become pathologically enlarged. In a medical context, this condition is known as haemorrhoidal disease or symptomatic haemorrhoids. In such cases, blood accumulates in the vascular cushions, leading to an uninterrupted outflow of blood and various symptoms including itching, a burning sensation, bleeding or moisture.
Haemorrhoids play an essential role in the body: they work together with the internal and external sphincters to close the anal canal and facilitate controlled emptying of the bowels. These closure mechanisms are sometimes subjected to greater strain, such as when a person coughs, sneezes, or lifts heavy objects, causing the pressure on these mechanisms to increase.

Causes of haemorrhoidal disease

The precise cause of haemorrhoids often remains unknown, but several factors can increase the risk of developing them. These include

• chronic constipation
  
• frequent diarrhoea
  
• sitting for long periods, particularly on the toilet
  
• being overweight
  
• a fibre-deficient diet
  
• pregnancy: Due to the hormonal changes, the mother’s connective tissue weakens.
  
• Age plays a role as well, as the tissue supporting the haemorrhoids weakens over time.

Incidence and age

Haemorrhoids are very common among the Swiss population. Studies show that about half of the population over the age of 50 experience symptoms of haemorrhoids at some point in their life.

Symptoms

The symptoms of haemorrhoidal disease vary greatly among individuals. In the beginning, there is no pain or discomfort. Nevertheless, you should consult a doctor if the symptoms persist, especially if there is blood in your stool. The following symptoms indicate enlarged haemorrhoids:

• itching at the anus
  
• pain during bowel movements
  
• traces of blood on the toilet paper
  
• faecal urgency or involuntary bowel movements
  

You should see a doctor as soon as possible if you notice blood in your stool. In stages III and IV the haemorrhoids are externally visible or palpable.

Severity of haemorrhoidal disease

Haemorrhoidal disease is classified in four levels of severity, which reflect the stage of the disease and the associated symptoms.
 

Stage 1:

This is the initial stage where the haemorrhoids are still inside the anal canal. They are not visible and usually do not cause pain. However, typical symptoms may include slight bleeding or discomfort, often only noticed during a bowel movement.

Stage 2:

At this stage, the haemorrhoids protrude from the anal canal during a bowel movement, but then retract on their own. In addition to bleeding, itching and a feeling of non-completion after a bowel movement may also occur.

Stage 3:

This is a more advanced form in which the haemorrhoids prolapse and no longer retract into the anal canal on their own. However, they can be pushed back manually. Symptoms can include pain, bleeding and significant discomfort.

Stage 4:

This is the most severe stage of haemorrhoidal disease. The haemorrhoids are permanently displaced outwards and can no longer be pushed back into the anal canal. This condition can cause severe pain, inflammation and considerable discomfort, and often requires surgery.

Each stage of haemorrhoidal disease requires a specific treatment strategy, and it is important to see a doctor if you experience any signs or symptoms in order to obtain a correct diagnosis and treatment.

Diagnosis

The diagnosis can often be made during an initial consultation based on your medical history. In addition, your doctor can perform the following examinations to determine the severity more precisely:

• Rectal examination: the doctor uses a finger to examine your rectum.
  
• Proctoscopy (endoscopic examination of the anal canal): By inserting a proctoscope, the doctor can easily assess the severity of the haemorrhoidal disease.
  
• Colonoscopy: A colonoscopy is performed as soon as blood is found in your stool.

The treatment and therapy of haemorrhoidal disease depends on its severity.

Treatment of haemorrhoids

The treatment of haemorrhoids depends on the stage of the disease and the severity of the symptoms. Haemorrhoids in State I and II can be treated conservatively with decongestant, anti-inflammatory and pain-relieving ointments or suppositories. Elimination of the chronic constipation is decisive for the success of the procedure. Fibre-rich food, sufficient fluid intake and regular exercise can counteract constipation.

If there are haemorrhoids in Stage III or IV, surgery is usually unavoidable. There are various methods available to surgically remove haemorrhoids. Find out more in the Anal surgery section.

Preventing haemorrhoidal disease

Haemorrhoid prevention focuses primarily on avoiding constipation and reducing pressure on the veins in the anal area. A high-fibre diet that includes plenty of fruit, vegetables, whole grains and pulses can keep stools soft and reduce the need for straining during bowel movements, which is a key factor in the development of haemorrhoids. Adequate fluid intake also aids digestion and prevents hard stools. Regular exercise promotes bowel function, likewise contributing to prevention.

Moreover, you should avoid long periods of sitting or plan to take regular breaks to minimise pressure on the anal region. If necessary, you can also adjust your position on the toilet to promote a more natural and less strenuous bowel movement. Avoiding excessive straining during bowel movements, and using soft toilet paper or wet wipes can also help to prevent irritation and reduce the risk of developing haemorrhoids.