Is it possible to widen the anus

What helps with hemorrhoids?

Itching and burning in the anus, pain when defecating and traces of blood on the toilet paper - many Germans are familiar with this. All kinds of diseases can be behind this, from anal fissures to colon cancer, but enlarged hemorrhoids are often to blame. Find out in the current guide how you can help yourself with hip baths, ointments and anal tampons and what ailments the doctor should be consulted about.

Often but taboo

About 4% of the population seek medical treatment for a hemorrhoidal disease every year. But because many people are embarrassed by the itching and burning sensation in their anus, hemorrhoids are still a taboo subject and the number of unreported cases is high: Experts estimate that half of Germans will suffer from them in the course of their lives.

What is actually behind the "hemorrhoids"?

Basically, everyone has hemorrhoids: In the anatomical sense, these are the vascular cushions, which are used as ring-shaped cavernous bodies to close the anus. They only cause complaints when they are enlarged. Then one speaks of a haemorrhoid disease - often abbreviated as "haemorrhoids". The vascular cushions are often not only enlarged, they also form single or multiple lumps that can burst (and bleed) and protrude from the anus. In the advanced stage, the inner closure of the anus is so damaged that intestinal gases and stool escape in an uncontrolled manner.

Depending on the extent of the changes, the hemorrhoidal disease is divided into 4 stages: In grade 1, the vascular cushions are enlarged. In Grade 2, they are temporarily pushed out of the anus while pushing when defecating, but they retract on their own. Grade 3 means that the prolapsed hemorrhoids have to be pushed back into the anus manually, with grade 4 hemorrhoids this is no longer possible, the vascular nodes are permanently outside the anal canal.

Causes still unclear

Why the hemorrhoids enlarge is still unclear. In any case, the elastic and muscular fibers of the vessels, which are damaged in a hemorrhoidal disease, play a role. The following factors may be the reason for this:

  • congenital weakness of the connective tissue
  • degenerative (age-related) or inflammatory changes in the connective tissue
  • Heavy pressing in the case of chronic constipation and too hard stools, diet with too little fiber
  • frequent diarrhea and too soft or runny stool (because the vascular cushions then have to actively hold back the stool and thus cannot relax sufficiently), abuse of laxatives
  • Obesity, pregnancy (because every pound puts more strain on the pelvic floor, which also causes the blood vessels in the anal area to expand
  • Lack of exercise, sedentary work (because they favor constipation)
  • Increased alcohol consumption (because alcohol also dilates the vessels in the anal area, i.e. also the hemorrhoids).

Always have complaints clarified!

The painless bleeding occurs in all stages. It is caused by the bursting of a vascular node from which bright red, i.e. arterial blood is emptied. This also explains the traces of blood on the toilet paper or dripping bleeding from the anus. Often there are also secretions of mucus from the anus; the permanent irritation of the mucous membrane leads to itching and burning sensation in the anus. From stage 3 there is also a risk of stool smear with traces in the underwear because the stool can no longer be completely held back.

Pain does not appear until later stages. They often arise from accompanying small tears in the anal mucosa or from thrombosis in the vascular nodes. Then the lumps can also make themselves felt as a foreign body sensation or a feeling of incomplete emptying of the bowel.

All of these complaints are unspecific and can indicate other diseases. Since these range from harmless anal fissures to colon cancer, self-diagnosis is strongly discouraged.

Note: Whether light red or dark red, a lot of blood or just traces of the toilet paper: Any blood leakage through the anus must be clarified by a doctor!

More movement for the intestines and people

Less sitting, more exercise and reducing excess weight: these are the measures that are recommended for people with hemorrhoidal disease. Whether they will help is uncertain as there are insufficient studies on this. A change in diet should also have a supportive effect: more fiber makes hard stools softer and strong pressing unnecessary, which in turn reduces the risk of bleeding when defecating.

Tip: If the stool is too hard, Indian psyllium husks are recommended. The dose required varies from person to person. Ask your pharmacy for advice on how best to use this herbal product.

From stunning to tanning

In the early stages (1 and 2), conservative therapy with local agents is possible. In some cases, the enlarged hemorrhoids recede in this way. Local therapeutics are also used in stages 3 and 4 as prescribed by a doctor, for example when waiting for an operation.

  • Numbing agents. Lidocaine (e.g. in Posterisan® acute ointment with anal dilator or posterisan acute suppository) and quinisocaine (e.g. in Haenal® acute cream) is recommended. Both active ingredients are available without a prescription. The creams and ointments may only be used as self-medication for a few days (e.g. until you see a doctor), suppositories for up to 6 weeks. Both active ingredients are forbidden during breastfeeding; during pregnancy they should only be used after consulting a doctor. The use of cinchocaine is also limited to one week; it is available on prescription as an ointment, anal tampon and suppository (e.g. DoloPosterine®N).
  • Tannins. Tannins help with external complaints such as itching and burning. They are used as hip baths and ointments, typical representatives are basic bismuth gallate (plus secretion-binding titanium oxide or zinc oxide), for example in Mastu® Ointment or suppository or Eulatin NH ointment. Witch hazel extracts also have a tanning effect, for example in fact® Contains lind ointment with witch hazel or Haenal® witch hazel suppositories. Sitz baths and envelopes can be made from Tannosynt, for example® liquid solution or Tannolact® Make bath additive. Whether tannins can be used during pregnancy and breastfeeding must be clarified individually with the doctor.
  • Cortisone. For severe inflammation and pain, the doctor will in exceptional cases prescribe local agents that contain cortisone in addition to the anesthetic lidocaine (e.g. Doloproct® Rectal cream or doloproct® Suppositories). These can be used for a maximum of two weeks, as they can lead to a breakdown of the anal mucous membrane and also promote infection with fungi in the intestine.

Note: Anyone who uses rectal agents must be careful during anal intercourse: the tear resistance of condoms is then no longer guaranteed.

Ointment, suppository or hip bath?

In order to bring the soothing active ingredients to the site of action, there are different dosage forms, each with advantages and disadvantages.

  • Anoint. They are especially useful for the external anal area. However, if they are to reach the hemorrhoids lying in the anal canal, they must be administered with an applicator and / or an anal dilator.
  • Suppositories. They are practical to use, but after administration they slide past the hemorrhoids and into the rectum. In this way, the active ingredients reach the vascular cushions only for a short time during bowel movements, which is why the effect of suppositories is often poor.
  • Anal tampons. Anal tampons are fixed in the anal canal with the help of a gauze strip and therefore work directly on the site of the action. Their disadvantage is the feeling of foreign bodies they cause during the period of exposure.
  • Sitz baths and compresses. They only work on the outer skin around the anus. They have no influence on the hemorrhoids lying in the anal canal.

Tip: When using local agents, secretions often drain from the anus. Anal pads or breathable panty liners, which you can get at the pharmacy, are suitable for catching.

What does the doctor do?

The medical treatment methods are divided into so-called interventional and operative procedures. The former include sclerotherapy and rubber band ligation, both procedures are possible on an outpatient basis.

  • During sclerotherapy, a sclerosing agent is injected into the vascular cushions, which fix them in the upper part of the anal canal. Sclerotherapy is mainly used in stages 1 and 2. The disadvantage is the high relapse rate.
  • In rubber band ligation, the hemorrhoidal tissue is tied off with a rubber band so that the enlarged hemorrhoids die and fall off. The relapse rate is lower here.

In stages 3 and 4, an operation must be performed; this is usually done in an inpatient setting. There are various options for doing this, depending on the extent and location of the hemorrhoids. For example, the hemorrhoids can be completely removed with a scalpel or laser. This operation is called a hemorrhoidectomy.

A more recent procedure is the staple operation, in which the hemorrhoids are "lifted" with the help of a stapler and are clipped to the anal canal mucosa in their original position. The prognosis is good for all procedures, but relapses and recurrence of hemorrhoidal symptoms can sometimes occur.

Sources: Katrin Krämer, DAZ 2020, No. 16, p. 54; www.internisten-im-netz.de

Authors

Dr. med. Sonja Kempinski | last changed on at 12:08