Treatment in Stages
By Isabel Weinert and Marta Campbell / Around 70 percent of all adults in Germany experience in the course of their lives a temporary or permanent disorder of this cavernous body system. The tendency to develop haemorrhoids is a genetic predisposition. But whether this eventually comes to bear is influenced by a number of factors.
Sitting daily for long periods, a low-fibre diet, overweight and pregnancy are risk factors which can often result in constipation. When constipated it is necessary to push hard which increases the pressure on the haemorrhoids. If a backlog of blood then occurs, the haemorrhoidal cushions will swell and protrude. The most frequent symptom is anal bleeding during a bowel movement. Afterwards, »smudging« may also occur as the closing of the anal canal due to the protruding haemorrhoidal cushions is no longer guaranteed. This can cause mucus membrane irritation and itchiness.
If a customer asks for a remedy for haemorrhoids at the pharmacy, it will need to be clarified first whether the »haemorrhoids« had been diagnosed by a doctor. If the answer is no, self-medication should not be recommended.
Doctors differentiate between four disease stages in haemorrhoids (see box). At the early stage, self-medication using suppositories or ointments is quite possible. The preparations contain astringent active substances such as »Bismutgallat«, »Hamamelis« extract, or Tannin, or have an anti-inflammatory effect with camomile extract or panthenol. The local anaesthetics lidocain and quinisocaine take away the pain and the itchiness promptly. Preparations which facilitate the slipping out of the faeces also bring relief by coating the rectum and the anus with a layer of fat. This protects the anal mucus membrane from cracks and prevents itchiness. Topical preparations are applied to the irritated areas several times a day. Suppositories should not be inserted too deeply if possible after bowel movement. When using haemorrhoid ointments it is important that the tube is fitted with an appropriate applicator. Only in this way can the ointment be placed directly on the area. The so-called anal or rectal tampons also facilitate the treatment directly on the cavernous body. They should remain in the bowels for several hours to allow release of the active substances over a longer period of time. Application is recommended in the morning after a bowel movement, and in the evening before going to bed. The integrated gauze strip serves to absorb mucus and blood and is later disposed of. For many patients it is recommendable to use anal sanitary pads. They absorb occasionally excreting mucus and protect the underwear from wetness and leaking haemorrhoidal remedies. The patient places the pads in the anal fold.
The affected persons should observe a fibre-rich diet. Fibres, also in the form of psyllium husks, make the faeces softer and increase the stool weight. The anal canal is thereby stretched without any hard pushing being necessary. Regular pelvic floor exercises help to prevent blockages. Patients can find the appropriate exercises in the internet. It is also important to avoid long periods of sitting and to walk a lot regularly.
As an alternative to self-medication the doctor can suggest to carry out a sclerotherapy or ligation. In the case of a sclerotherapy, the doctor injects a sclerosing agent into the haemorrhoidal knots. As a result the treated haemorrhoidal cushions shrink and can retreat again to the rectum. In the case of a ligation, the doctor works with an elastic band with which he ties up the haemorrhoids. This causes the haemorrhoidal tissue to die and to drop off after a few days. Both the sclerosing as well as the elastic band ligature are painless treatment methods.
If the disease progresses (stages 3 and 4) a small surgical procedure will often be unavoidable. In this case the surgeon completely removes the sick haemorrhoids. /
Beitrag erschienen in Ausgabe 01/2019
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