Bei einer entsprechenden krankhaften Vergrößerung der Hämorrhoiden, dem sog. Hämorrhoidalleiden, kommt es zu Beschwerden wie Juckreiz, Brennen, Bluten und Nässen.
Sie können nach außen treten, doch schmerzhaft sind vergrößerte Hämorrhoiden in den seltensten Fällen.
Bei der Perianalthrombose oder auch Analvenenthrombose handelt es sich um ein Blutgerinnsel. Viele Patienten halten den schmerzenden Knoten am Afterrand für eine im Volksmund benannte „äußere Hämorrhoide”. Dieser Ausdruck ist jedoch irreführend und hat mit den echten Hämorrhoiden (s.o.) nichts zu tun.
Ursachen
Die Ursache ist in den meisten Fällen ein durch Überdruck eingerissenes Blutgefäß am Afterrand. Perianalthrombosen entstehen oft durch die Stuhlentleerung unter Pressen, können aber auch durch die Schwangerschaft, Entbindung, Husten, schweres Heben und Tragen verursacht werden.
Symptome
Meist macht sich eine Perianalthrombose als plötzlich aufgetretener, schmerzhafter Knoten am Afterrand bemerkbar. Dabei kann die Größe erheblich variieren, von sehr kleinen Knoten bis hin zu pflaumengroßen Gebilden. So kommt es bei der Perianalthrombose durch das eingerissene Blutgefäß zu einer entsprechenden Einblutung unter der Haut wie bei einem „blauen Fleck” (Hämatom). Die überdehnte Haut sorgt wiederum für die eigentlichen Schmerzen. Das eingelaufene Blut verleiht dem Knoten seine blaue Färbung.
Therapie
Kleine Perianalthrombosen können mit Hilfe von schmerz- und entzündungshemmenden Salben behandelt werden. Das vollkommene Verschwinden des Knotens kann hierbei zwischen einigen Tagen und mehreren Wochen andauern. Größere Perianalthrombosen können in örtlicher Betäubung eröffnet und die Blutgerinnsel entfernt werden. Ob dabei eine einzelne Entfernung der Blutgerinnsel erfolgt oder eine komplette Entfernung des gesamten Areals mit dem zuführenden Gefäß erfolgen muss, um ein wiederholtes Auftreten so gut wie möglich zu vermeiden, entscheidet sich nach dem persönlichen Schmerzempfinden und nach beruflicher oder privater Lebenssituation des Patienten.
Es muss darauf geachtet werden, dass nicht in dem gesamten Geschehen vergrößerte Hämorrhoiden beteiligt sind, da diese unter Umständen mitbehandelt werden sollten.
Die Wundheilung wird durch richtiges Stuhlentleerungsverhalten, anale Hygiene, richtige Wundversorgung, adäquate Ernährung und körperliche Aktivität günstig beeinflusst.
Komplikationen
Unbehandelt können sich in Folge der starken Hautüberdehnung vergrößerte, teilweise sehr störende Hautlappen (sog. Marisken) am After bilden. Eine Hautentzündung im Afterbereich lässt sich dabei selbst unter Verwendung von Intimseifen und Feuchttüchern kaum vermeiden.
Fazit
Melden Sie sich bei jeder ungewöhnlichen Knotenbildung, denn
nicht jeder Knoten am After ist „nur” eine Hämorrhoide.
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