Hemorrhoids - hemorrhoids - hemorrhoids

Hemorrhoids are a widespread disease, but nobody talks about it.

What are hemorrhoids? 

Hemorrhoids - hemorrhoids - are nodular dilations of the blood vessels in the rectum, which are supplied by a central artery with high blood pressure. Hemorrhoids are not normal anal vessels, which provide cushioning for stool regulation. Hemorrhoids are already worn-out rectal vessels, which can lead to the prolapse of the intestine and thereby to leakage and mucus secretion. As a result, hemorrhoids cause symptoms such as oozing, skin irritation, burning, itching and sometimes bleeding. In technical language, the external hemorrhoids are called “perianal veins”. Perianal thrombosis or anal vein thrombosis is a sudden, painful lump in the rectum that requires immediate medical attention.

Causes of Hemorrhoids

The exact causes of hemorrhoids are not fully understood. The main cause appears to be a sedentary lifestyle and insufficient fiber intake. High-fiber foods like granola, salad, oatmeal, and wheat bran are part of a healthy diet, but not all people follow them. Genetic predispositions can also play a role in the development of hemorrhoids.

Hemorrhoids - before and after pictures

Learn more through pictures as well as before-after pictures about hemorrhoids,  perianal veins, before and after pictures of hemorrhoids laser surgery (LHPC)  and hemorrhoid laser treatment, and Perianal vein laser treatment and Perianal thrombosis laser treatment at the HeumarktClinic in Cologne with Dr. Haffner.  

Symptoms of hemorrhoids?

Hemorrhoids in any form can often cause bleeding and itching in the anal area. There are often problems with bowel movements. Patients with hemorrhoids often have to go to the toilet several times in a row and cannot urinate all at once. Constipation, pressure and pain are also common symptoms. Smearing can also occur, but this is different from fecal incontinence. In the case of haemorrhoids, there is no real fecal incontinence, since the reflexively tense deep sphincter muscle not only prevents the haemorrhoids from protruding, but also protects against fecal incontinence. However, this muscular protection provided by the deep pelvic floor muscles cannot prevent the problem of fine continence at the anal edge. The anal insufficiency in the anal entrance then leads to typical hemorrhoid symptoms such as weeping, itching, burning and smearing. The stuffed "perianal veins" perceived as "varicose veins of the rectum" or external hemorrhoids pose a problem because they can lead to perianal thrombosis or anal vein thrombosis or cause small tears that bleed and are painful and due to the underlying Hemorrhoid disease bad cure.

bleeding from the rectum

According to the S3 guidelines, the most common manifestation of hemorrhoids is bleeding from the rectum. According to the guidelines, the frequency and severity of the bleeding does not follow the staging of hemorrhoids mentioned above. Bleeding from the rectum can occur even with smaller hemorrhoids and rightly alarm patients in the early stages of the hemorrhoid disease. Since nobody wants to live with bleeding from the rectum, treatment, e.g. B. with a laser-based surgery, already indicated for smaller hemorrhoids if they cause bleeding or other symptoms. The hemorrhages from the arterial vascular conglomerates that constitute hemorrhoids are usually bright red. Bleeding can be small, but it can also be very heavy and lead to collapse. Since the human body can always close the rectum thanks to the strong sphincter muscles, the blood initially collects in the ampulla of the rectum. Then it can be passed in larger quantities like dark red stool. Perianal veins that bleed from an anal tear may also bleed dark red. It is important to know that the first symptom of colon and rectal cancer is usually bleeding. Therefore, in the case of bleeding from the rectum, it is urgently necessary to visit a proctologist in Cologne and thus have the fastest diagnosis carried out without time-consuming preparations. All that is required is normal stool evacuation at home before the examination and hygienic cleaning.

Perianal eczema - perianal inflammation

A permanent irritating and toxic skin inflammation on the anus is called perianal eczema. An attentive proctologist recognizes a whitish-reddish discolored skin that shows small to larger wounds and cracks. The perianal skin is swollen, shows increased wrinkling and possibly skin appendages called skin tags. The diagnosis can even be made by the family doctor through a visual examination without further examinations: the attentive doctor sees a whitish-red and coated, sore and wrinkled skin in an area of ​​about 2-6 cm around the rectum. When spreading the anal canal, mucus, moisture, or sometimes stool smearing can be noticed. Some patients use cream all the time. If a patient with creamtem If the rectum comes to the proctologist, this already indicates advanced haemorrhoids.

Anal itching, itching and burning in the rectum

The symptoms of hemorrhoids, such as itching, burning, pain and stinging in the rectum, arise due to anal insufficiency, in which the rectum is unable to close completely and dry. This causes irritation of the skin, similar to a bad flu, where the runny nose severely irritates previously healthy and dry skin. Even if the rectum is not completely closed due to hemorrhoids, it is enough for a little mucus from the anal canal, which is covered with mucous membrane, to constantly get onto the originally dry skin and smear it. This attacks, damages, inflames, and swells the dry, healthy skin in the anal opening, which in turn leads to itching and burning. It is therefore not necessary for "fecal incontinence" to occur in order to feel itching and burning in the rectum. Even if the rectum is able to hold coarse stool, the last centimeter in the anal entrance may not close properly if complete closure is not possible due to prolapsed hemorrhoids. This causes mucus and moisture to escape from the normal mucosa, which in turn causes itching of the outer normal skin, which cannot tolerate the mucus for long periods of time.

incident of hemorrhoids

Goligher's staging of hemorrhoids incorrectly suggests that hemorrhoids cause only one problem, the prolapse. This outdated staging gives the impression that the severity of hemorrhoid disease and associated symptoms is solely related to the degree of internal hemorrhoid prolapse. Protruding external hemorrhoids, thrombosis of external hemorrhoids, anal insufficiency, fine continence disorders, bleeding, moisture and itching as well as skin eczema are not taken into account. Even the S3 guideline in Germany has adopted this outdated staging and suggests surgical indications based on this outdated staging of hemorrhoids. Goligher's staging of hemorrhoids only considers the occurrence of internal hemorrhoids. In proctological clinics, however, patients most often present with a combined occurrence of internal and external hemorrhoids and skin tags, which can be felt as a lump on the anus and interfere with anal hygiene and emptying. When there is thrombosis of the external hemorrhoids or constant irritation of the skin tags at the top of the prolapse, patients often want a gentle and painless removal, regardless of whether the internal hemorrhoids are stage II or III. About 90-95% of patients seek help because of a palpable lump in the rectum that presents as a thrombosed perianal vein. Only about 10% of patients seek help because of prolapsed hemorrhoids that occasionally need to be pushed back with a finger. Skin tags as lumps on the anus are a common reason for a visit to the proctologist, and most patients want treatment without surgery, e.g. B. by laser treatment.

anal tear

Anal tears can result from either severe stretching or, without external trauma, from softened and inflamed perianal skin and mucosa. The tears can appear both in the anal entrance as classic anal tears and as tiny tears and sores around the rectum. The inflamed skin, cracks and wounds are very painful both spontaneously and at the slightest touch. Due to the accumulation of blood in the hemorrhoids and perianal veins, the mucous membrane inflates like a balloon. Then the bloated mucous membrane ruptures just like a balloon when the stool is scratchy. Inflamed and eczematous perianal skin is less resilient than healthy skin. Therefore, hemorrhoids can cause anal tears due to skin damage and the bloated thin anal skin and mucosa. In the HeumarktClinic Proktologie in Cologne, no traumatizing interventions are performed that weaken the sphincter muscle and, according to the proctology information sheets recommended throughout Germany, could even be part of the surgical program for the best proctologists in Cologne. Since an anal tear is not a disease in its own right, but a consequence of hemorrhoids, it should be treated as part of the underlying hemorrhoid disease. And that without cuts, knives or scissors, but with laser radiation in the HeumarktClinic proctology in Cologne. In particular, the incision or cutting of the sphincter muscle recommended in the information sheet and the cutting out of the tear are not recommended.

Pain in the anus and rectum

Hemorrhoids themselves do not cause pain! Our private proctology consultation in Cologne is often attended by patients who are surprised when the proctologist tells them that they have prolapsed hemorrhoids that cause moisture, inflammation, itching and burning and that urgently require invasive treatment. Because hemorrhoids do not cause pain, they are often tolerated even if they have protruded during a bowel movement and occasionally need to be pushed back. Patients get used to the condition of their own rectum, as the condition changes only slowly over many years and can be largely compensated for by the still strong sphincters. It is amazing to the proctologist that many patients are unaware of the eczema and inflammation of the perianal skin. Many people don't seem to care that it sometimes itches, but disappears again with a "good hemorrhoid ointment". Some don't even notice when the inflammation spreads to the tailbone or the front of the scrotum in men, or the vaginal opening in women. Many people don't perceive their addiction to a hemorrhoid cream as an illness, thinking it's just the skin that's itchy a little.

skin tags

Skin tags are skin tags or flaps at the outer anal entrance, in the area of ​​the anus. Unlike mucous membrane appendages or polyps in the intestine or anal canal, skin tags are skin tissue. Skin tags formation can be caused by several factors, including mucosal prolapse, microthrombosis of the perianal veins, or a combination of both. Skin irritation due to moisture and disruption of fine continence also contribute to the formation of skin tags. Skin tags can be bothersome to many people, especially for aesthetic reasons, even if they don't cause pain. If a patient comes to the proctology department in Cologne due to severe pain, 90% of those affected already have severely painful anal tears. As already mentioned, tears do not occur without reason, but are caused by torn perianal veins caused by high tension or damaged, inflamed anal skin in anal insufficiency and hemorrhoids. Sudden pain and the presence of a palpable hemorrhoidal nodule on the rectum indicate thrombosis of hemorrhoids or perianal veins.

Anal spasm and continence disorder

Lord's anal spasm is a classic symptom of hemorrhoids that was treated with an anal dilator in the inventor's time. Anal dilators are still used today when the rectum is so tense that it causes severe pain, sometimes referred to as "proctalgia fugax", and also disrupts rectal emptying. In short, the rectum cannot open properly and therefore cannot empty completely. One might wonder why both anal spasm and anal insufficiency are considered characteristics of hemorrhoids. Are the rectal muscles weak and insufficient or too cramped? The explanation for this is as follows: In proctology in Cologne we do not speak of a sphincter, but of sphincters. The sphincters can be divided into two main muscle groups that have different functions and tasks related to continence:

A/ Fine continence: responsible = superficial sphincter (external sphincter, internal sphincter)

In hemorrhoids, the weakness of the superficial anal muscles can be demonstrated by anal manometry. The reason for this lies in the prolapse of hemorrhoids into the anal canal, as a result of which the anal canal remains partially open and the muscles cannot hold the pressure of the hemorrhoids. This leads to a disturbance of fine continence, characterized by moisture, lubrication and itching. If the hemorrhoids are then removed with laser, HAL, RAR, etc. without incisions, the anal rim can close better and the moisture and itching can stop. Sometimes an additional endo-anal biofeedback training of the anal muscles is required, which is carried out either through pelvic floor exercises or with the help of a stimulation current device.

B/ Coarse continence: responsible = deep sphincters (m. puborectalis, levator ani)

The deep sphincters ensure that the upper part of the rectum is closed reflexively in the event of a hemorrhoid. According to Lord, a permanent cramp and spasm of the deep sphincters with a disturbance in defecation due to the blockage of the anal opening are among the classic symptoms of advanced hemorrhoids, regardless of whether the hemorrhoids can be pushed back with a finger or not. Therapy for advanced haemorrhoids with anal spasm therefore includes stretching of the deep base muscles (levator and puborectalis) and removal of the haemorrhoids as part of a haemorrhoid operation. If this does not bring any improvement in the long term, the HeumarktClinic Proktologie in Cologne offers a special, ultrasound-guided, targeted injection of a muscular relaxant into the deep pelvic floor muscles to relieve the spasm for at least 6 months and enable normal emptying.

anal insufficiency

Anal insufficiency means a disturbance of fine continence. According to the S3 guideline of the German specialist societies for proctology and colo-proctology, prolapsed hemorrhoids lead to a moist and sometimes even fecal secretion, which can initially only be perceived as weeping, but later as stool soiling and can ultimately lead to soiled underwear. The constant moisture irritates the perianal skin. It is somewhat incomprehensible that dry and non-smearing anal hygiene is not a matter of course and that many people do not see stool marks on underwear as an indication that something is wrong with the rectum. The term "anal insufficiency" - disturbance of fine continence - is a foreign word for the general public, which means "it doesn't affect me" because "I can control my stool".

Perianal thrombosis – anal thrombosis

Perianal thrombosis, or anal vein thrombosis, occurs when the stagnant blood clots in the dilated veins at the edge of the anal area. A painful lump forms on the edge of the anus. Sitting and defecating are painful. The perianal thromboses often rupture and bleeding can occur. Pain, palpable lump and bleeding prompt patients to seek urgent medical attention. It is important to know that thrombosis at the anal edge is only an externally visible sign of internal hemorrhoids. In English-speaking countries, a distinction is made between external and internal hemorrhoids, which represent two components of hemorrhoidal disease. Without internal hemorrhoids, external hemorrhoids do not form and there is no thrombosis of the perianal veins in the anal area. Sometimes thrombosis of both internal and external hemorrhoids occurs, which can be extremely painful and require urgent proctological treatment.

What to do with hemorrhoids 

If you have symptoms such as itching, burning, smearing or bleeding in the anal area, you should visit a specialist in proctology in Cologne to have your rectum examined and to have basic diagnostics and cancer screening carried out. After the examination, you can get advice on various treatment methods, including conservative methods such as rubber band ligation, sclerotherapy, freezing, as well as surgical methods such as the HAL method, THD, RAR method, submucosal ligation and ligature excision. In our practice for proctology in Cologne we start the description of the possible therapies with laser therapy because we are convinced that the laser is the best method. With the help of laser technology, an almost painless closure treatment of the hemorrhoids can be carried out without major surgical cuts.

The LHPC – Laser Hemorrhoids Plastic Surgery

We started laser hemorrhoid plastic surgery about three years ago after Dr. (H) Haffner had completed a laser surgery course at Bio-Litec. Initially, we performed the method according to the recommendations on Bio-Litec's LHP website. In the course of the treatments, however, it became clear that the laser beam can and should be used in a more differentiated way in order to achieve even better results. We have modified the method and the tools accordingly. The new method was developed under the brand name Laser Hemorrhoids Plastic Surgery (LHPC). The basis for the LHPC was scientifically developed through animal experimental research in cooperation with the Experimental Surgical Institute of the University of Semmelweis. This is how the new laser method of hemorrhoid surgery came about as LHPC, Laser Hemorrhoids Plastic Surgery in Cologne, which has become the standard therapy for all types and stages of hemorrhoids in our practice.

Advantages of the LHPC:

– No cuts – no wound healing disorders – hardly any pain
– Strengthening instead of weakening the sphincter
– Improved defecation compared to before
– Better continence compared to before
– Immediate social participation

Before the appointment for the LHPC, a preliminary examination is carried out using ultrasound, in which the entire network of arteries and veins is displayed and your specific symptoms are clarified. Laser hemorrhoid plastic surgery is performed on an outpatient basis under short general anesthesia or twilight sleep. Local anesthesia using the tumescent technique is only sufficient for smaller hemorrhoids.

LHP laser haemorrhoidoplasty

The original LHP Laser Haemorrhoidoplasty**** is based on blocking the arteries that supply hemorrhoids in the hope that this will result in the hemorrhoids regressing. One clinical study to the LHP in the USA at ClinicalTrials.gov  at the number NCT03322527 DE PARADES Vincent, MD in 2018 was carried out, but no results are available so far. However, other publications on the LHP have been published with good results. The German S3 guideline, as mentioned in the medical journal, still recommends the traditional knife and scissors surgeries for the treatment of advanced hemorrhoids, as there are still few publications and controlled studies on the laser and radio wave methods, although individual publications and authors report good results . 

HAL, THD and RAR methods

HAL, THD and RAR are proctological treatment methods based on special suturing techniques. The basic idea of ​​all methods is to shrink the hemorrhoids by cutting off the blood supply. In the HAL method, a single artery is located with a Doppler ultrasound probe and tied off with a ligature. With the THD method, all of the important main arteries of the hemorrhoids are tied off in a circular suture along the rectum. The goal of the THD method, as the name suggests, is to desarterialize the hemorrhoids by ligating all major blood vessels. With the RAR method, the hemorrhoids are first stopped as with the HAL method. However, after ligating the main artery, the procedure continues by tying off the hemorrhoidal mass with additional ligatures and tightening the mucosa. RAR ligation and tightening typically involves four main strands of hemorrhoids. In the HeumarktClinic Proktologie in Cologne, all of these suture techniques are used with many years of experience and success. Our experience has shown that combining these methods with laser irradiation of the hemorrhoidal mass is significantly more effective. In summary, it can be said that HAL-RAR-THD in combination with laser is the most effective and gentlest treatment alternative in proctology. No incisions are made, which minimizes the risk of complications.

The sclerotherapy, ligation with rubber bands and freezing

are the most frequently used outpatient treatment methods for hemorrhoids in proctology, both by male and female proctologists in Cologne. These treatments are simple and usually not painful. During sclerotherapy, a sclerosing agent is injected into the tissue of the hemorrhoid, causing it to shrink. However, this method is unsatisfactory for more severe hemorrhoids and relapses can also occur. Rubber band ligation only ties off one point of the hemorrhoid, but this is usually effective. A combination of these methods is used in proctology at the HeumarktClinic in Cologne to optimize success and alleviate side effects. Only one knot is tied and the sclerosing agent is only injected into the tied part in order to avoid side effects such as scarring or stiffening of the healthy intestinal wall. The treated knot is then iced with an ice-cold stick. With this combination, the patients in the HeumarktClinic Proktologie in Cologne have no pain during and after the treatment and only minor side effects such as minimal and extremely rare postoperative bleeding. Complications such as abscesses or fistulas reported by other proctologists have never occurred to us after these treatments.

What is the best ointment for hemorrhoids

The best ointment for hemorrhoids varies depending on individual symptoms and the condition of the anal area. A good hemorrhoid ointment should have a pain-relieving, cooling and calming effect. It may contain natural substances that improve the elasticity of the anal skin and promote wound healing. A good ointment should also act as a lubricant during bowel movements without sticking to underwear. It is important that the ointment does not cause allergic reactions and is neutral.

The manufacturer often offers an applicator that allows the ointment to be gently inserted into the anal canal. The choice between gel, suppository or ointment depends on the individual symptoms, such as pain, bleeding, itching or burning, and the condition of the anal area. There is no universally best ointment for every type and stage of hemorrhoids. It is advisable to seek advice and examination from a proctologist. Ointments are only suitable for relieving the symptoms and cannot cure the hemorrhoids. This is why the advertising slogan “laser is the best hemorrhoid ointment” came about, since laser treatment can effectively reduce hemorrhoids and thus also alleviate typical symptoms.

In summary, ointments help, but laser treatments heal.

When is hemorrhoid surgery indicated? 

The staging of hemorrhoids according to Goligher from 1980, which was previously used to determine the indication for surgery, is outdated. This classification does not take into account all symptoms and degrees of severity of hemorrhoidal disease. It is still recommended that surgery should only be performed on advanced stages III or IV where the hemorrhoid protrudes and needs to be pushed back with a finger. This rigid classification was justified in the past when serious operations were performed with knives and the anesthetics were more risky.

Nowadays, however, more gentle and effective methods such as laser treatments are available. In the HeumarktClinic Proktologie in Cologne, the focus is on the suffering and the symptoms of the patient. The therapy aims to relieve the symptoms, regardless of the stage of the hemorrhoids. Goligher's old staging does not correlate with the symptoms and the level of suffering of the patients. New classifications and treatment alternatives take into account various symptoms such as bleeding, prolapse, thrombosis and skin complications (itching, burning, oozing, eczema) as well as thrombosis of external perianal veins. 

Because the old guidelines and classification of hemorrhoid severity do not cover the symptoms people suffer from, new classifications of hemorrhoid severity (4,5,6,7) would have to be created. The new hemorrhoid severity classifications apply not only to the treatment of internal hemorrhoids, but also to the treatment of "external" hemorrhoids and common symptoms. Bleeding in the past is taken into account, for example, in the "PNR bleed" classification in the degree of severity (7). With BRST staging according to Sobrado (4), new treatment alternatives and important symptoms of advanced hemorrhoids are taken into account for the determination of surgical indications, as follows: bleeding (B), prolapse (P), skin (S) complications and thrombosis consequences (T) of external hemorrhoids.

Laser treatment can effectively treat both internal and external hemorrhoids and prevent complications. It is time that proctology focused on new classifications and gentle treatment methods such as the use of lasers.

Indication for surgery in everyday life

are bleeding, major prolapses or narrowing of the rectum. Anal insufficiency, stool smearing, weeping, burning, perianal eczema, pain, anal tears or thrombosis are also consequences of hemorrhoids. These serious consequences are summarized as "advanced haemorrhoids" and are an absolute indication for surgery. However, the aim of the operation today must be minimally invasive. If hemorrhoids can be removed minimally invasively, without major risks using laser or other methods, then other, earlier methods are no longer necessary.

Alternatively have to

Sclerotherapy or rubber band ligation of hemorrhoids

be considered, however, their effects do not reach the effectiveness of hemorrhoid surgery and are thus insufficient for the definitive cure of severe advanced hemorrhoidal disease. According to the literature, the non-surgical methods also have serious side effects.

Hemorrhoids and thrombosis in pregnancy

The cause is existing internal hemorrhoids, which are under high congestion pressure during pregnancy. Prolapse and thrombosis are the consequences. Therapy for thrombosis in pregnancy is always individual and depends on who is treating the pregnant woman, the experience of the proctologist and how many days are left until the due date. Anesthetics are generally not permitted and no narcotic painkillers may be given. How should a severely painful thrombosis be removed? In response to this difficult question, we can only share our treatment regimen and experience: thrombosis usually causes severe suffering during pregnancy and would be both very disturbing and painful at birth. We therefore try to help the pregnant woman with a gentle, minimally invasive operation. This requires the ability to use painless local anesthesia without anesthetics. Secondly, there must be no bleeding, no secondary bleeding and as little pain as possible after the operation. For this purpose, we offer the laser-assisted removal of pregnancy thrombosis from a mini incision, which causes only minimal postoperative pain, which experience has shown is tolerable. Complications are unlikely. However, we advise against major haemorrhoid interventions; these should be done after birth.

What to do if you have external hemorrhoids?

External hemorrhoids are hemorrhoids Veins outside the anus affect, which is why the external hemorrhoids are called pianal veins. These hemorrhoids can bleeding, Cracks and itching and above all often perianal thrombosis / anal vein thrombosis cause. The external hemorrhoids cannot be obliterated or tied off because they lead to the acute complication - thrombosis. The external hemorrhoids can only be partially excised, affecting smaller rays of external hemorrhoids/perianal veins. However, this is very painful. The best, complete and permanent removal of perianal veins - external hemorrhoids - takes place with laser at the HeumarktClinic. The HeumarktClinic specializes in the laser removal of external and internal hemorrhoids without cuts or great pain. In the case of thrombosis of external hemorrhoids/perianal veins, the laser method is also the best if you want to have the perianal veins completely removed. However, smaller thromboses can also resolve spontaneously but can also recur if the perianal veins/external hemorrhoids are not removed. Affected people are then accompanied throughout their lives by recurring perianal thrombosis from the perianal veins that have not been removed.

Cost of Hemorrhoid Treatments

All examinations and therapies are liquidated in the proctology department of the HeumarktClinic in Cologne according to the fee schedule. Unfortunately, there is no exact descriptive number for hemorrhoid laser surgery in the table of fees. Therefore, the practice uses number 2886 with its surcharges, which stands for similar services to laser therapy for similar blood vein tumors in the fee schedule and, according to the statement by the German Medical Association for laser irradiation of blood veins, is correct. How much of this is covered by health insurance varies in each case. You will receive a cost estimate from us for the hemorrhoid laser surgery, which you can discuss with your insurance company and obtain a cost commitment. The GOÄ bill is paid by self-paying or demanding statutory insured persons themselves; in the case of privately insured people, much of this is reimbursed by private health insurance.

Find out more and make an appointment for a consultation by phone at: (0221) 257 2976 or by Online appointment booking - also outside of office hours. Contact by email here.

Literature:

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Terminology:

* HAL method= Hemorrhoid artery ligation according to Morinaga 

**THD method= Transanal Haemorrhoidal Arteries Ligation – advanced Morinaga method

***RAR method =Clinical.Trials.gov Clinical Trial #  NCT01301209, 

****LHP  = Laser Hemorrhoidoplasty : https://clinicaltrials.gov/ct2/show/NCT03322527 Study by DE PARADES Vincent, MD for stage 2 and 3 hemorrhoids 

*****LHPC = Laser Hemorrhoids Plastic Surgery – This by Dr. (H) Haffner (Cologne) applied modified laser skeletal procedures to all stages of hemorrhoids. Animal experiments and clinical data are available. Used with good results in over 500 haemorrhoid surgeries with a low complication rate, outpatient, with hardly any pain.