Therapy For Hemorrhoids

Hemorrhoids: Therapy

The treatment of a hemorrhoidal disease depends primarily on its severity. If the hemorrhoids are only weakly pronounced, spontaneous regression or freedom from symptoms may occur. Especially in advanced stages, a hemorrhoidal disease usually leads to increased symptoms.

In addition to local therapy, there is the possibility of drug treatment as well as endoscopic and surgical measures.

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• How is hemorrhoids treated?
• How is the drug therapy of hemorrhoids carried out?
• How is endoscopic therapy carried out?
• How is the heat treatment done?
• How is the surgical therapy carried out?
• Whom can I ask?
• How are the costs going to be covered?

How is hemorrhoids treated?

In the foreground of conservative (non-surgical) treatment is initially the optimization of eating habits and bowel movements. In addition, a high level of anal hygiene should be ensured.

The basic therapy mainly includes the following measures:

• Administration of fiber or appropriate stool regulation (especially with flea seeds),
• Influencing bowel habits (especially avoiding heavy pressing and long sessions),
• careful anal hygiene,
• Chronic constipation should be treated in any case, preferably with so-called bulking agents.

In the case of insufficient success or more pronounced hemorrhoidal disease, drug therapy and the two non-surgical measures sclerotherapy and rubber band ligation can be used.

Degree of disease hemorrhoids © bilderzwerg

How is the drug therapy of hemorrhoids carried out?

In drug treatment, a distinction is made between preparations for local ("external") and systemic use ("internal").

• "Hemorrhoid remedies" ("Externa"): These preparations are used externally and serve to alleviate minor or acute complaints (grade I-II). Local ointments, creams, suppositories or so-called anal tampons and hip baths are available. They contain local anesthetics, astringents (astringent, anti-inflammatory, and hemostatic agents) or anti-inflammatories.
• Flavonoids ("internals"): Treatment with tablets is also possible (systemic therapy). The so-called flavonoids (citrus bioflavonoids, hesperidin, diosmin, rutin and hydroxymethyl rutinosides) represent one of the most frequently administered groups of substances for hemorrhoidal disorders. They are used on the one hand for causal therapy and on the other hand to optimize the course after an operation.

In rare cases, side effects have been observed with the use of drug therapies. After using flavonoid-containing ointments, these are local skin complaints and, if flavonoids are taken orally, systemic side effects such as myalgia (muscle pain), diarrhea, tachycardia or an increase in liver values. The generally very cautious use of medication in pregnant women (and breastfeeding women) should therefore be maintained even with a (mostly harmless) haemorrhoidal disease.

How is endoscopic therapy carried out?

If drug treatment is unsuccessful, the next step is endoscopic methods such as sclerotherapy and rubber band ligation.

Sclerotherapy (sclerotherapy, injection therapy)

The aim of sclerotherapy is to reduce the blood flow to the hemorrhoids and thereby make them shrink. There are two techniques available for this, which can be used for milder hemorrhoidal diseases (grade I-II).

• Intrahemorrhoidal sclerotherapy: This sclerotherapy is mainly used for grade I-II hemorrhoids. A Polidocanol solution is usually injected directly into the hemorrhoids.
• Suprahemorrhoidal sclerotherapy: an almond or peanut oil phenol solution is injected under the mucous membrane. The therapy is effective in more than two thirds of patients with hemorrhoids grade I – III.

In principle, the injections are painless because the treated tissue has no free nerve endings. Complications are rare, but relapses are common.

Rubber band ligation (GBL)

With rubber band ligation, the hemorrhoidal pads are tied off with rubber bands. These cut off the blood flow, causing the tissue to die within a few days. The tissue, including the ligament, is excreted with the stool. This procedure is suitable for the treatment of bleeding hemorrhoids of grade II – III, has few complications and side effects and can be carried out on an outpatient basis. Rubber band ligation is the most common endoscopic therapy.

How is the heat treatment done?

Infrared therapy

In infrared therapy, infrared radiation is introduced into the tissue by means of a so-called infrared photoconductor. It generates local heat there, which scabs the tissue on the surface. Infrared therapy can be used to treat bleeding in mild hemorrhoidal disorders.

Diathermy, electrocoagulation

These procedures also use heat to destroy hemorrhoidal tissue. A heat-induced coagulation of the hemorrhoidal node is aimed for by applying electricity. This subsequently leads to shrinkage and death of the treated tissue.

How is the surgical therapy carried out?

Hemorrhoidal disease surgery is necessary if conservative procedures do not provide adequate symptom relief. It can be used as primary therapy for severe hemorrhoidal disorders (grade III – IV) with high levels of suffering. In the case of patients with certain diseases (e.g. chronic inflammatory bowel disease, increased bleeding tendency, restricted immune competence, severe metabolic disorders), it must be clarified individually whether an operation is possible. The aim of the surgical therapy is to restore anatomical conditions (condition before the formation of the hemorrhoids), in particular to correct hemorrhoids that have emerged from the outside (prolapse).

If there are abscesses, fistulas or tissue necrosis (gangrene), treatment is the first priority. Acute complications of hemorrhoid disease, such as entrapment that cannot be suppressed (incarceration) or hemorrhoidal thrombosis, are initially usually treated with painkillers and anti-inflammatory drugs. Depending on the course, surgery may be required later.

The most common surgical procedure used is hemorrhoid artery ligation (HAL). Ultrasound is used to locate the supplying blood vessels, pierce them and correct the prolapse with sutures.

In conventional surgical procedures, pathologically enlarged hemorrhoidal tissue is removed. Different procedures are available for this, depending on the severity of the hemorrhoidal disease.

Whom can I ask?

The therapy of a hemorrhoidal disease offers high chances of recovery. If you have problems in the rectum, you should therefore consult a general practitioner as soon as possible. Blood in the stool should always be checked, as this can also be caused by other diseases such as colon cancer.

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

• Right to treatment
• Visit to the doctor: costs and deductibles
• What does the hospital stay cost?
• Prescription fee: This is how drug costs are covered
• Health Professions AZ
• and via the online guide to reimbursement of social insurance costs.