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All seven Medical Spheres ›Enlarged haemorrhoids are very common and no reason to put up with symptoms for long. Which treatment is right depends on the severity: from softer stools and rubber band ligation to surgery.
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Typical values from the clinics. You will discuss your personal plan at your consultation.
Haemorrhoidal disease
Everyone has haemorrhoids. They are cushions of blood vessels with a good blood supply at the junction between the rectum and the anus, which, together with the sphincter muscle, provide a fine seal for the bowel. Haemorrhoidal disease is only present when these cushions become permanently enlarged and cause symptoms – which affects around one in two adults at some point in their lives.
Typical signs are bright red traces of blood on the toilet paper, itching, burning, weeping or a feeling of a foreign body. Enlargement is favoured above all by heavy straining due to constipation, a low-fibre diet, long periods of sitting, excess weight and lack of exercise, as well as by pregnancy, weak connective tissue and age.
Four grades are distinguished. At grade I, the cushions are enlarged but not visible from the outside. At grade II, they protrude when straining and retract by themselves. At grade III, they no longer slide back on their own but can be pushed back; at grade IV, they are permanently prolapsed. The grade determines the path: from self-help to a procedure.
Not every complaint at the anus is haemorrhoidal disease. A sudden, painful lump is often an anal vein thrombosis; stabbing pain when passing stools points more to a small tear in the lining, an anal fissure. Blood can also indicate other, sometimes more serious diseases of the bowel. That is why any bleeding should be checked by a doctor once – with an examination that is usually simpler than feared.
The treatment
Soft stools that pass without straining take pressure off the cushions. Fibre, enough fluids and exercise are the basis of any treatment.
At grades I and II, enlarged cushions are usually treated during the consultation, either by sclerotherapy or by tying them off with a small rubber band – without anaesthesia.
At grades III and IV, surgery is usually needed. HAL-RAR ties off the supplying arteries and lifts prolapsed tissue back into place without removing it.
The path
First, it is established whether haemorrhoids really are behind the symptoms and which grade is present. Then the decision on treatment is made.
Symptoms, bowel habits, previous illnesses and medication – blood thinners, for example – are discussed without haste. Questions that may seem embarrassing have their place here too.
Inspection, careful palpation and usually a proctoscopy, in which the anal canal is examined with a small instrument. This takes only a few minutes.
If the cause of bleeding is not clear, a colonoscopy complements the examination to rule out other conditions.
In sclerotherapy, an injected agent makes the cushions shrink; in ligation, the tied-off tissue falls off by itself after a few days. Several sessions are sometimes needed.
At grades III and IV, under anaesthesia, as HAL-RAR or as removal of the excess tissue, usually with one to two nights in hospital.
Soft stools and gentle cleansing with clear water support healing. Follow-up appointments at the outpatient clinic monitor progress.
Statutory insurance or self-pay
Statutory health insurance
German statutory health insurance covers assessment and medically necessary treatment – from the examination through sclerotherapy and ligation to surgery. For this, patients with statutory health insurance are treated at the Bürgerspital, the hospital at this location that is included in the state hospital plan.
A referral is usually needed for the consultation; appointments are available by arrangement.
Private insurance or self-pay
For privately insured patients, medically necessary treatment is likewise covered by their health insurance.
Privately insured and self-pay patients can choose the Main-Tauber-Klinik as well as the Bürgerspital – a private clinic embedded in the Bürgerspital. For self-pay patients, the costs depend on the findings and the procedure.
Specialists
In Wertheim, proctology is part of the Department of Surgery: consultations, outpatient procedures and operations are in the hands of the general and abdominal surgeons. The location is shown under each name.
Locations
Each clinic shows on its own website how the treatment works there.
Germany
The Bürgerspital is included in the state hospital plan and treats patients with statutory and private insurance alike; the Main-Tauber-Klinik embedded within it is a private clinic for privately insured and self-pay patients.
Frequently asked questions
It is generally easy to tolerate and over within a few minutes. The examination takes place in a private setting, and any tension you feel is taken into account.
With any visible bleeding, persistent itching or weeping, palpable lumps, and if symptoms last longer than two to three weeks despite self-help. Severe pain or larger amounts of blood should be seen by a doctor promptly.
They can relieve itching and burning for a while, but they do not shrink the enlarged cushions. Anyone who keeps reaching for them over several weeks should have the cause clarified by a specialist.
Using a small instrument, a rubber band is placed around the enlarged cushion above the pain-sensitive zone. A feeling of pressure or of a foreign body in the first few days is common; when the tissue falls off, there may be slight bleeding. Heavier bleeding is rare and should be seen by a doctor immediately.
An operation in which no tissue is removed. An ultrasound probe (Doppler) locates the arteries that supply the cushions; they are tied off with a stitch (HAL). At the same time, prolapsed tissue is gathered up and moved back into place (RAR). The procedure is performed under anaesthesia.
Possible risks include bleeding, pain when passing stools in the first few days, temporary difficulty passing urine and inflammation. Narrowing of the anus or a weakening of fine continence are rare. Which risks matter in the individual case is discussed before the procedure.
Yes – more often after ligation and HAL-RAR than after removal of the tissue. Keeping stools soft, not straining and avoiding long periods of sitting lowers the risk.
Yes, if it is medically necessary – for patients with statutory and private insurance alike, and regardless of whether the treatment involves sclerotherapy, banding or surgery.
Further reading
In-depth articles from the group's clinics.
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Reviews
CGCE GroupVerified
5,888 reviews on ProvenExpert
This was the best decision I have ever taken for myself. The whole experience has changed my life for the better. From the first consultation I felt welcomed and treated very well. I did not feel alone during the journey because the team were just a WhatsApp away and they made regular check-ups on me. Thank you for everyone at the hospital from the staff to the doctors, you are all amazing.
Weight Doctors South AfricaWow, was für ein erster Eindruck! Dr. Frank Gruner, dessen Professionalität von jahrelanger Erfahrung zeugt, war äußerst verständlich und menschlich (was mir sehr wichtig war). Er verstand meine Bedürfnisse, und seine Erklärungen und Anweisungen entsprachen genau meinen Vorstellungen. Die Patientenberaterin Jennifer war mit ihrem Charme ebenfalls eine große Hilfe und erklärte mir alles Notwendige und den weiteren Ablauf. Auch die Mitarbeiter am Empfang waren sehr höflich und freundlich. Ich melde mich nach der Operation mit meinen Eindrücken zurück. Vielen Dank an alle!
Westfalenklinik Fachklinik für Plastische und Ästhetische Chirurgie · Original in GermanIch habe eine Unterlidstraffung machen lassen und bin mit dem Ergebnis sehr zufrieden. Mein Dank geht vor allem an Frau Dr. Simidjiiska für ihre Fürsorge, Kompetenz und Empathie. Aber auch das gesamte Team der Klinik macht einen hervorragenden Job!
Westfalenklinik Fachklinik für Plastische und Ästhetische Chirurgie · Original in GermanIch bin rundum begeistert von meiner Erfahrung in dieser Haartransplantationsklinik. Von der ersten Kontaktaufnahme bis zur Nachsorge war alles hervorragend organisiert und professionell. Das gesamte Team war unglaublich freundlich, hilfsbereit und zuvorkommend. Man hat sich jederzeit gut aufgehoben und ernst genommen gefühlt. Besonders positiv fand ich, dass sich alle Mitarbeiter ausreichend Zeit genommen haben, um meine Fragen zu beantworten und jeden Schritt verständlich zu erklären. Auch der Service war erstklassig. Die Organisation, die Betreuung vor und nach dem Eingriff sowie die Kommunikation waren wirklich hervorragend. Das gesamte Team hat einen sehr kompetenten und gleichzeitig menschlichen Eindruck gemacht. Die Klinik selbst ist modern, sauber und sehr gut ausgestattet. Während der Behandlung wurde äußerst sorgfältig und professionell gearbeitet, und ich hatte zu jedem Zeitpunkt das Gefühl, in guten Händen zu sein. Ein großes Dankeschön an das gesamte Team für die tolle Betreuung und den freundlichen Umgang! Ich kann die Klinik absolut weiterempfehlen und bin mit meiner bisherigen Erfahrung sehr zufrieden. Wer Wert auf Professionalität, Qualität und einen hervorragenden Service legt, ist hier meiner Meinung nach bestens aufgehoben.
Westfalenklinik Fachklinik für Plastische und Ästhetische Chirurgie · Original in GermanBisher war es nur ein Beratungsgespräch aber es war sehr gut.
Weight Doctors Group · Original in GermanIch fand, dass der Arzt gut und verständlich erklärt hat. Ich habe diese Woche noch einen Termin in einer anderen Klinik, da ich mich gründlich informieren möchte; auch der Preis wird dabei eine Rolle spielen – darüber bin ich ganz offen.
QUOLE Medisch Centrum · Original in GermanHervorragende Behandlung. Von der ersten Beratung bis zur Nachsorge hat mir Dr. Koch stets ein sehr gutes Gefühl vermittelt. Ich litt jahrelang unter einer echten Gynäkomastie, nach der OP kann sich das Ergebnis sehen lassen, mein Selbstbewusstsein ist endlich zurückgekehrt. Ich kann die Alster Klinik jedem empfehlen, der schon lange mit dem Gedanken spielt sich operieren zu lassen.
Alster-Klinik Hamburg · Original in GermanDr. Schubert gab mir das Gefühl, in genau der richtigen Praxis zu sein für mein Anliegen. Ich habe mich beim Beratungsgespräch sehr wohl gefühlt und verstanden gefühlt.
Alster-Klinik Hamburg · Original in GermanÜber die ehrliche Einschätzung
Alster-Klinik Hamburg · Original in GermanIch habe mich sehr wohl geführt, das Gespräch war sehr gut, die Ärztin hat mir sehr ausführlich alles erklärt und bin mit einem sehr guten Gefühl nach Hause gegangen.
Westfalenklinik Fachklinik für Plastische und Ästhetische Chirurgie · Original in GermanIch bin eine sehr ängstliche Person. Bei Herrn Dr. Neis habe ich mich sofort wohlgefühlt. Behandlungsgespräche, Umgang, Freundlichkeit – es passt alles. Ich kann ihn ohne Bedenken und Einschränkung nur weiter empfehlen. Dankeschön Herr Dr. Neis für die tolle Arbeit.
CGCE Group · Original in GermanDr. Klarner ist sehr nett, hat mich sehr gut beraten und aufgeklärt. Ich hab mich gut aufgehoben gefühlt, vielen Dank!
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