Haemorrhoidal disease is abnormally enlarged, protruding blood vessels of the venous and intermediate arterio-venous links, which are part of the dense vascular network in the area of the anus, lower part of the rectum, and around them.
The rectum is the last few centimeters of the large intestine. It connects to the anal canal, which expels feces from the body through an opening called the anus. Problems in this part of the body are common, but people are often embarrassed to seek help. Common symptoms include bleeding, pain, and itching. When they occur, it is important to get examined by a doctor.
There are three types of haemorrhoids — internal, external, and combined.
Internal haemorrhoids are located inside the rectum — above the dentate line. Its main feature is rectal bleeding. Straining during defecation increases the pressure that pushes the stool through the anus.
With excessive straining, haemorrhoids protrude out of the anus. This condition is known as prolapse or prolapse, and it is accompanied by pain. Internal haemorrhoids, depending on the degree of prolapse, are divided into four grades: I, II, III, and IV. Grade IV haemorrhoids are the most severe.
External haemorrhoids are located outside the dentate line — under the skin around the anus. This area contains many pain receptors. External nodes usually hurt. The pressure that increases when passing stool often causes bleeding.
Combined haemorrhoids involve the presence of both external and internal nodes at the same time.
Causes of haemorrhoidal disease
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Haemorrhoids develop as a result of repeated straining during bowel movements, sometimes due to prolonged constipation or diarrhea. They are also commonly seen in any condition that leads to increased pressure inside the abdomen.
Haemorrhoids occur when:
- Pressure in the rectal area increases due to obesity, long periods of sitting, or pregnancy.
- Excessive straining occurs during bowel movements or sitting too long on the toilet.
- Straining while lifting heavy objects.
- Frequent constipation or diarrhea.
- Eating very spicy or heavily seasoned food.
- Consuming alcohol or smoking cigarettes.
- Weakening of the tissues surrounding the anus and rectum due to aging.
For the prevention of haemorrhoidal disease, it is better to avoid everything that leads to the formation of pathological nodes. Engaging in sports, strengthening the pelvic floor and perineum through special exercises will help prevent haemorrhoids in old age.
Symptoms of combined haemorrhoids of the 3rd degree
With external haemorrhoids, the nodes are palpable as a bulge on the skin near the anal opening. The most common signs are pain or itching. If an external haemorrhoid becomes thrombosed, the pain increases significantly.
Internal haemorrhoids in the first stage do not cause any symptoms. Painless rectal bleeding is common. Patients notice bright red blood on toilet paper or in the toilet bowl. Another symptom that appears and worsens with prolapse of the haemorrhoids is the feeling of tissue coming out of the anus during bowel movements.
Symptoms of haemorrhoids include:
- Anal itching or pain, especially noticeable when sitting or during bowel movements.
- Rectal bleeding, usually bright red.
- Tissues or lumps bulge around the anus.
- Stool leakage.
Internal nodes III degrees when straining during defecation, they protrude beyond the anal verge and do not return inward without manual reduction. They are larger in size and have more severe symptoms than grade I and II haemorrhoids.
How are haemorrhoids diagnosed?
Haemorrhoids are suspected when the nodes cause the characteristic symptoms listed above.
External haemorrhoids are often visible during visual examination of the anus. A complete examination usually includes a digital rectal examination, in which the doctor, wearing gloves, inserts a finger into the rectum. The nodes are usually easily palpable.
Internal haemorrhoids are detected during an external examination if the nodes protrude when straining and are not reduced. In the rectum they are detected during examination using special equipment, in the form of a flexible or rigid tube with a light and a camera. The tube is inserted so that the doctor can see the inside and bottom of the anal canal.
Alternatively, the specialist inserts a small plastic speculum to examine the rectum. The mirror is called a anoscope, and the flexible tube is called a sigmoidoscope.
Treatment of combined haemorrhoids of the 3rd degree
Mild symptoms will be facilitated by proper nutrition and a healthy lifestyle. It is important to avoid tension. Tension increases pressure in the veins around the anus, which increases the risk of developing haemorrhoids or makes them worse.
One of the best ways to relieve pain or discomfort caused by haemorrhoids is to avoid constipation or hard stools. Sometimes constipation or hard stools can be relieved with a few dietary changes.
- Increase the amount of dietary fiber in your diet. Fiber is found in fruits, vegetables, grains and legumes that cannot be digested by the human digestive system. Insoluble fiber helps intestinal function by absorbing water and pushing waste through the digestive tract. It is recommended that adults consume 25-35 grams of fiber per day. Consciously adding fresh, plant-based foods to your diet is beneficial. This will not only improve digestion, but also bring health benefits.
- Increase your water intake If you don’t drink enough fluids, your body pulls more water from your intestines, causing your stool to become hard and dry. Drinking enough fluids relieves constipation because more water remains in the intestines, making stool soft and easy to pass through the anus.
If this doesn’t help, people take fiber supplements and laxatives. These measures make bowel movements easier and reduce straining during defecation. As a result, pressure on haemorrhoids decreases, which prevents bleeding and prolapse of haemorrhoids.
If you soak the affected area for 20–30 minutes three times a day in warm water — taking warm sitz baths with potassium permanganate — it can help reduce symptoms. Pharmacies offer sitz bath kits, which are inexpensive portable basins that fit over the toilet seat for those who prefer not to fill up a tub for each session.
Daily walks in the fresh air and physical exercises as a warm-up during a sedentary workday improve blood circulation and help reduce pressure in the blood vessels near the rectum and anus.
Rectal suppositories, creams, ointments for haemorrhoids
Various topical preparations are sold in pharmacies without a doctor’s prescription. They are used to relieve discomfort and itching associated with haemorrhoids. Some products contain phenylephrine or similar drugs that constrict blood vessels in the rectal area.
Others contain hydrocortisone — a steroid that reduces inflammation and relieves swelling. Some topical medications contain lidocaine or pramoxine, which are local anesthetics and ease pain. Some medications contain a combination of these drugs.
For example:
- Procto-Glyvenol, cream;
- Relief, suppositories;
- Relief Advance, suppositories;
- Procto-Glivenol, suppositories;
- Posterisan, ointment for rectal and external use;
- Posterisan Forte, suppositories and ointment for rectal administration;
- Beautiful women extract, rectal suppositories.
Some people note that if you wipe the anal area with a wet towel or a ‘baby wipe’ after defecation, the pain and itching are relieved.
It is important to remember that haemorrhoids do not fully go away with conservative treatment. They usually recur, but there may be no symptoms between episodes of flare-ups.
Effective treatment of grade 3 mixed haemorrhoids
In cases where haemorrhoids do not go away, bleed constantly, or complicate the patient’s life, they need to be treated radically. Modern minimally invasive methods are well-suited for this:
- Latex ligation involves placing a small ring at the base of an internal haemorrhoid above the dentate line. The treated tissue then sloughs off and a scar forms. The procedure is often performed on an outpatient basis, but pain, a feeling of pressure, and delayed bleeding are possible. Painkillers are chosen according to the doctor’s recommendation: aspirin and some anti-inflammatory drugs may increase the risk of bleeding and are not suitable for everyone. Persistent symptoms sometimes require a repeat session or other treatment. In cases of severe pain, fever, urinary retention, or significant blood loss, urgent medical attention is necessary.
- Infrared coagulation: through an anoscope, the doctor brings the probe to the selected area of internal haemorrhoidal tissue and applies a measured thermal effect. Discomfort, pain, and bleeding are possible. The method is more often used for early stages of internal haemorrhoids according to indications; the need for repeated procedures is discussed in advance.
- Sclerotherapy. A medically approved chemical substance is injected directly into the haemorrhoidal node. The drug destroys haemorrhoidal tissue. Suitable for removing certain internal and external haemorrhoids.
- Lasers are used in various surgical techniques: the specific effect and outcome depend on the method and the form of the disease. It is not equally suitable for all age groups and all stages of haemorrhoids. Before the procedure, the severity of prolapse, external nodes, concomitant conditions, and previous therapy are assessed, and then the laser option is compared with alternatives. Pain, bleeding, incomplete elimination of symptoms, and recurrence are possible. The discharge time is determined by the condition after the procedure and anesthesia; return to work and normal activities is discussed separately. Follow-up examinations and stool recommendations remain a necessary part of care. The advantage of any method is assessed according to individual indications, not by the promise of a permanent result.
- Stapled haemorrhoidopexy. The doctor uses a special circular stapler to remove internal haemorrhoids. The advantages of this procedure are that it is less painful than conventional surgeries.
- Surgical intervention. Removal of enlarged, stretched veins located externally in combined grade 3 haemorrhoids. The operation is performed by a general or colorectal surgeon in the operating room. Haemorrhoidectomy is the best method for complete removal of haemorrhoids.
The operation is necessary under the following circumstances:
- when thromboses form in external haemorrhoids;
- ligation cannot be applied for internal haemorrhoids, or it was previously ineffective;
- a protruding haemorrhoidal node cannot be reduced;
- the patient is troubled by severe, persistent bleeding.
Haemorrhoidectomy removes excess tissue that causes bleeding and swelling. It is done under anesthesia and requires hospitalization. The sooner a person seeks help from a doctor, the less painful and more effective the treatment will be. You can book a consultation (check the cost when booking) with our specialists to get professional recommendations on our website. Just leave your request, and we will get in touch with you very soon!
The material clarifies identified medical inaccuracies. Methods, contraindications, and recovery depend on the individual situation; the information helps prepare for a consultation.
ASCRS: Haemorrhoid Guidelines, 2024 · NIDDK: haemorrhoidal disease