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How are haemorrhoids treated?
Treatment is dependent on the stage of the disease (Recommendations of the German Society of Coloproctology). There are basically non-surgical (conservative) and surgical treatment options. Treatment-related links: recommendations at http://www.awmf-leitlinien.de/, Society of Coloproctology: www.koloproktologie.org/dgk/etap/
a) General measures:
The following measures are useful in order to avoid haemorrhoids and to aid treatment: - high-fibre diet
- adequate fluid intake in the form of drinks such as water
- marked straining on defecation to be avoided
- laxatives not to be used
- appropriate anal hygiene (no soap, wet wipes or cosmetics, just lukewarm water)
- careful drying of the anal region without rubbing
b) Non-surgical treatment options:
The aim is to control the broad spectrum of symptoms such as pain, burning, itching, inflammation, swelling and discharge. These treatments are used for all grades of haemorrhoids. They often contain local anaesthetics, astringents, Escherichia coli culture suspensions and anti-inflammatories.
Depending on the site of the inflammation, the products are prescribed as creams, ointments, suppositories and suppositories with gauze inserts (“anal tampon suppositories”). Ointments have a more solid consistency and are highly suitable for dry skin. In comparison, creams are more fluid. Suppositories or tampon suppositories are inserted into the rectum and are used preferably for inflammation in the rectum or the anal canal. Tampon suppositories are particularly suitable for the anal canal, so that the suppository remains in the anal canal after insertion and does not slip deep into the rectum. It is important to note that the measures can only treat the symptoms of haemorrhoidal disease and can only have a sustained action against haemorrhoids in the early stages.
One common side effect of the products is burning after application, although this is usually attributable to the irritated skin. A further problem is development of a “contact allergy” (type IV sensitisation) to the diverse ingredients of haemorrhoidal ointments, creams or suppositories. Such an allergy may develop both to the active ingredient and to excipients. Contact allergies to the active ingredient bufexamac are common. Compared with control groups, patients with anogenital skin disorders show a higher prevalence of sensitisation at 3.5%.
Products containing corticosteroids should only be used short-term under specialist supervision so as to avoid the chronic occurrence of characteristic side effects such as thinning of the skin or vascular fragility.
The products most commonly used worldwide are as follows.
Internationally leading topical products in treating haemorrhoidal disease
Main drug active substance*
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Tradename*
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1. Products without corticosteroid
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squalus carchorious, hamamelis, glycerol,
phenylephrine, cacao butter and others |
Preparation H
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bufexamac, cinchocaine, lidocaine, bismuth,
titanium
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Faktu
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tribenoside, lidocaine
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Procto-Glyvenol, Borraza G
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ruscogenin, trimebutine
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Proctolog
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zinc, peru balsam, bismuth, lidocaine,
pramocaine, boric acid, hamamelis
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Anusol
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titanium, zinc, lidocaine
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Titanoreine
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policresulen, cinchocaine
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Proctyl
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nitroglycerine
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Nitrong
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cinchocaine
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DoloPosterine
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2 Products with corticosteroid
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hydrocortisone, Escheria coli
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Posterisan
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hydrocortisone, cinchocaine
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Proctosedyl
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hydrocortisone, lidocaine
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Borraginol
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hydrocortisone, pramocaine
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Proctofoam, Pramosone
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diflucortolone, lidocaine
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Neriproct
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hydrocortisone, lidocaine
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Xyloproct
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prednisolone, cinchocaine
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Scheriproct
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fluocortolone, cinchocaine
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Ultraproct
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fluocortolone, lidocaine
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Doloproct
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* drug active substances and tradenames
may vary from country to country
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Supplementary local treatment options: - antiseptic sitz baths, e.g. with potassium permanganate or tannins in lukewarm water for approximately 10 minutes
c) Surgical treatment options
The surgical treatments should be performed by dermatologists, surgeons or gastroenterologists with proctological experience. Most procedures are performed on an outpatient basis without anaesthesia with the aid of a proctoscope. After all procedures, the patient may temporarily experience light anal bleeding and possibly pain and rectal urgency for 1 – 5 days.- Sclerotherapy (similar to the procedure for varicose veins of the legs):
for haemorrhoids of grade I and above, injection of sclerosants (e.g. polidocanol 0.3 ml) can be performed with proctoscopic guidance approximately 5 – 7 times at 2 – 3-week intervals. An inflammatory reaction with scarring then results in “shrinkage” of the haemorrhoids.
- Rubber band ligation:
for haemorrhoids of grade II and above, a small rubber band can be placed in the region of the haemorrhoidal nodules with proctoscopic guidance every 3 – 4 weeks. The ligated tissue falls off and is excreted with the stool.
- Haemorrhoidectomy:
for large grade III or IV haemorrhoids, surgical removal of the enlarged haemorrhoidal nodules is usually performed by a surgeon under general anaesthesia or “regional anaesthesia” (spinal anaesthesia).
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