Haemorrhoids: Causes, home remedies, treatment options

There are various unpleasant medical conditions affecting the anal region and the anus, many of which are commonly referred to as haemorrhoids. However, it is incorrect to label all complaint involving a thickening, fold or bulge in the anus as such in the strict medical sense. As a result, appropriate treatment also differs.

In the following, we provide an overview of common conditions affecting the anus or rectum to help identify genuine haemorrhoids. This is especially important because the whole area around the bowel, anus and rectum is still unfortunately associated with significant shame and taboos, even though it plays an essential role in our well-being - and on many other aspects that are discussed elsewhere in this guide.

In addition to haemorrhoids, other pathological conditions in this region may include marisca (skin tags), anal thrombosis, or even carcinoma. We will not discuss the latter in detail, as immediate medical attention is required. If anything is unclear, a professional diagnosis should be obtained.

What are haemorrhoids

Several structures interact in the rectum to ensure that the anus is properly closed. In addition to the pelvic floor muscles, the anal sphincter (sphincter ani) plays the key role. Slightly deeper in the rectum is a network of small arteries and veins which regulates fine control for complete closure (in the case of softer stools). This system is called the haemorrhoidal fringe or haemorrhoidal plexus and refers to a ring-shaped collection of (note!) haemorrhoids. The term therefore does not describe a desease, but rather a normal anatomical structure that contributes significantly to continence.

Strictly speaking, a pathological change should be termed as haemorrhoidal disease rather than simply haemorrhoids but for the sake of simplicity we will leave it at the usual term.

Internal haemorrhoids

Haemorrhoidal disease occurs when individual blood vessels in the haemorrhoidal plexus become enlarged or displaced for a variety of reasons and are categorised from grade 1 to grade 4. As long as the enlargement is mild and remains inside the rectum, it is referred to as internal haemorrhoids. These are often not noticed and cause little or no discomfort. If the causes are not addressed and internal haemorrhoids continue to swell and enlarge, they may temporarily or permanently protrude outwards.

External haemorrhoids

If the swollen tissue or protrusions can be felt on the outside of the anus, these are external haemorrhoids. These abnormal swellings, bulges or skin tags sometimes appear overnight and cause alarm. External haemorrhoids are usually noticed when cleaning after a bowel movement or due to itching, pain or bleeding.

Classification or severity of haemorrhoids

The classification of haemorrhoids is divided into the following degrees of severity:

Grade 1 haemorrhoids refer to the internal variant with no or only minor symptoms.

Grade 2 haemorrhoids temporarily protrude from the anal canal - usually after a bowel movement - but then recede spontaneously or gradually afterwards.

Grade 3 haemorrhoids are those that do not retract back into the anal canal on their own, but can be pushed back into the rectum manually using a finger or dilators (see below). This process is known as reduction.

Grade 4 haemorrhoids cannot be reduced manually and remain permanently outside the anal canal. Grade 4 haemorrhoids can usually only be removed surgically.

However, there are also other conditions affecting the anal region:

Anal thromboses, anal fissures and mariscuses

As mentioned at the beginning, haemorrhoids are often confused with other conditions in the anal region, such as marisci, anal fissures or anal thromboses. How can you tell the difference between these and haemorrhoids?

In contrast to other conditions, an anal thrombosis is an acute event: Within a few hours, a clot forms, creating a bluish-black, bulging lump. Another clear sign is sharp, stabbing pain. An anal thrombosis or thrombosis of anal vein - usually occurs as a single event.

Marisci are relatively harmless phenomena, namely thickened folds of skin in or around the anus, which can occur singly or repeatedly. They are usually skin-coloured to dark, soft to the touch and look like sacs or skin lobules. Normally they do not cause any pain or discomfort, but as they make cleaning the anus more difficult, they can occasionally cause itching and, in severe cases, inflammation.

An anal fissure is a longitudinal tear in the anal canal or sphincter muscle. Although it often looks very fine on the outside, it can go very deep and cause severe pain, especially during bowel movements, when cleaning after a bowel movement or when showering. However, no tissue protrudes outwards and there is no feeling of a foreign body, so an anal fissure can be clearly distinguished from haemorrhoids.

Haemorrhoids cause a distinct foreign body sensation. They usually develop over a longer period of time and are not necessarily painful. The most noticeable symptom is often persistent and intense itching. There may be bleeding during or after a bowel movement, which is not necessarily painful. Oozing and stool smearing are the cause of permanent hygienic discomfort and can easily lead to inflammation. In this condition, haemorrhoids are almost permanently painful.

Causes and development of haemorrhoids

The most common causes of haemorrhoids are:

Chronic constipation

It is often caused by a combination of a low-fibre diet, low fluid intake and a lack of physical activity, exacerbated by a sedentary lifestyle.

Incorrect toilet habits

Hectic visits to the toilet, frequent, forceful pushing during bowel movements, especially in an unfavourable sitting position - can put excess pressure on the rectal area. People with chronic constipation are particularly at risk.

Overloading the pelvic floor

Lifting heavy loads incorrectly, being overweight and/or a weak pelvic floor favour the development of haemorrhoids.

Weak connective tissue

Another possible cause is inherited varicose veins, which can also appear in other parts of the body.

Frequent diarrhoea or frequent use of laxatives

These can lead to excessive expansion of the haemorrhoidal cushion and thus increase the risk of haemorrhoidal disease.

Pregnancy and childbirth

Women have an increased tendency to develop haemorrhoids due to their hormonal situation and the natural stresses and strains during this time. For more information, see Haemorrhoids after pregnancy and childbirth.

Prevention and home remedies for haemorrhoids

To prevent haemorrhoids and to support their treatment, your diet should be rich in fibre to promote healthy, regular digestion. Dietary fibre consists mainly of indigestible carbohydrates found in plant-based foods such as fruit, vegetables and wholegrains and helps to prevent digestive problems.

An adequate fluid intake of around 2 to 3 litres per day, primarily in the form of water, ensures a soft stool consistency and facilitates smooth bowel movements.

Correct toilet habits are also important. Avoid straining or applying pressure, instead, try to generate the pushing force from your abdomen. Breathe in deeply and push the air downwards. The correct posture, with a rounded back and feet flat on the floor, will help. If this is not possible due to your height, use a footstool. Rather than the upright, “civilised” sitting position, the posture should be as close as possible to the natural squatting position which is optimal for defecation.

Anal hygiene after a bowel movement should be thorough and carried out in two steps: After dry pre-cleaning with gentle toilet paper, it is essential to follow up with moist cleansing. Use a fresh flannel each day and a mild, skin-friendly cleansing lotion instead of wet wipes. This helps to prevent irritation and inflammation. If needed, a healing ointment or haemorrhoid cream can be applied afterwards.

Suitable household remedies are:

• Naturopathic suppositories
• Ointments containing witch hazel (Hamamelis).

Additional support for severely swollen or inflamed haemorrhoids:

• Cool sitz baths with sea salt or oak bark
• Curd compresses
• Decongestant nasal spray, as it reduces swelling

The above measures can serve both as effective prevention and as supportive care for treating existing haemorrhoids at home. In addition to suppositories, ointments and medication, various other helpful aids are available. If you are unsure, it is best to consult a doctor to determine whether haemorrhoids are present and whether self-treatment is appropriate.

Effective aids for your own treatment: “Viball®” and “FMS dilators”

• To clarify: dilators and dilatators mean the same thing, both terms are in use.

With our medical products FMS Dilators and Viball® medical kegel balls, you can effectively support the self-treatment of haemorrhoids. Both product lines are certified medical devices with clinically proven benefits.

FMS dilators: ideal for repositioning and cooling

Theros® FMS dilators are high-quality dilation tools made from highly durable borosilicate glass. FMS dilators are used for vaginal or rectal treatment of various diseases or problems in women, men and transgender people such as vaginismus, anal spasms, prostate problems and many more.

The ultra-smooth, cooling material allows for particularly gentle yet effective application.

FMS dilators are ideal aids for reduction (the manual repositioning of haemorrhoids). The wide range of sizes and fine gradations allow for optimal adaptation to the individual rectal anatomy, ensuring the best possible outcome in the treatment of grade 1 to grade 5 haemorrhoids.

Application

Repositioning can be performed using a dilator from 20 mm in diameter upwards, with experience with rectal insertion and also considerably more. The cooled dilator should be carefully inserted with medical lubricants and left in the rectum for approx. 10 minutes. Using a dilator set is especially effective, as the size can be precisely adjusted to match both the level of discomfort and the individual anatomy.

Sizes from around 30 mm can be transformed into drip-free, sustainable cooling devices by filling them with cellulose and water after a few hours in the fridge. By cooling the inside of the body directly, inflammation or swelling subsides quickly and reduction becomes more effective and extensive.