Microbial community and hemorrhoids

What are hemorrhoids and what causes and risk factors promote them

Hemorrhoids are not a disease in the strict sense, but well-vascularized cushions in the rectum. They perform an important function in the fine sealing of the anal canal. Only when these vascular cushions become enlarged, displaced, or permanently stressed do symptoms arise, which are referred to as hemorrhoidal disease.

How do hemorrhoidal complaints arise?

In most cases, a chronic pressure and strain situation in the rectum is the cause of the development of hemorrhoids. Repeated strong straining during bowel movements, unfavorable stool consistency, or prolonged stool retention in the rectum increase the pressure on the vascular structures. Over time, this can lead to an enlargement and dysfunction of the hemorrhoidal cushions.

Central Causes at a Glance

The main causes can be summarized functionally:

• Chronic constipation with hard stool
• Irregular bowel movements or frequent straining
• Changes in stool consistency, for example due to dietary factors.
• Prolonged sitting, especially on the toilet
• Increased pressure in the abdominal cavity, for example due to overweight or pregnancy.

Medical Classification

Hemorrhoids do not arise suddenly and are not the result of individual dietary mistakes. Rather, they develop over a longer period through the interaction of several risk factors. A sustainable approach accordingly aims to reduce stressful factors, especially through stable stool regulation and relief of the rectum.

What is the significance of stool regulation for the rectum?

The rectum does not primarily "suffer" from diseases, but from unfavorable emptying conditions. Stool regulation determines whether the rectum is relieved or permanently overloaded.

The rectum as a load sensor

The rectum is not a digestive organ but a sensitive storage and control area. It does not respond to nutrients but to pressure, stretching, friction, and time. This is exactly where stool regulation comes into play.

• How often stool is evacuated
• how long the stool remains in the rectum
• and how much pressure is needed during evacuation determines whether the rectum remains functionally stable or becomes irritated.

These three factors determine whether the rectum remains functionally stable or becomes irritated.

What specifically happens with disturbed stool regulation

Stool regulation does not work abstractly but mechanically:

• Too hard stool → increased straining pressure → overstretching of mucosa and vascular cushions
• Too soft or frequent stool → moist, irritation-prone environment → mucosal stress
• Irregular bowel movements → changing strain → lack of tissue adaptation

The rectum is the section that cannot compensate for these strains but directly "takes the hit."

Disturbed stool regulation is not a diagnosis but one of the most relevant functional risk factors for:

• Hemorrhoids
• Mucous membrane irritations
• Anal burning and itching
• proctological complaint courses

It acts as an enhancer, not as the sole cause.

How does the gut microbiome affect stool consistency?

Cause → Process → Result

Cause: The gut microbiome determines how food residues are further processed in the large intestine after the actual digestion is complete.

Process: In the large intestine, gut bacteria metabolize indigestible components. In doing so, they influence three crucial factors of stool consistency:

• Water binding in the intestinal contents
• Gas formation and volume
• Structure and lubricity of the stool

Depending on the composition and activity of the microbiome, more or less water is bound, and the stool becomes firmer, softer, or irregularly shaped.

Result: An balanced microbiome generally promotes evenly shaped, well-lubricated stool, while a disturbed microbial balance can be associated with hard, lumpy, or inconsistent stool.

Two typical scenarios from practice

Scenario 1: Reduced microbial activity

• Less bacterial fermentation
• Reduced water binding

→ Dry, hard stool

When microbial activity in the large intestine is reduced, indigestible food components are only partially processed further. As a result, less water can be bound in the intestinal contents, causing the stool to thicken increasingly. The reduced bacterial fermentation also changes the structure of the stool, making it firmer and drier. Consequently, the mechanical resistance during bowel movements increases, often requiring stronger straining. This means increased stress on the mucous membrane and vascular structures in the rectum, especially if this condition persists over a longer period.

Scenario 2: Imbalanced Microbiome

• Uneven metabolic processes
• Fluctuating water distribution

→ Alternation between hard and soft stool

An imbalanced gut microbiome leads to uneven microbial metabolic processes. Some bacterial groups are overrepresented while others are missing. This destabilizes the regulation of water retention and stool structure. This can cause phases of very firm stool to alternate with phases of softer or mushy stool. Such fluctuations pose a particular challenge for the rectum, as the mucosa and tissue cannot adapt to consistent strain conditions. The result is increased sensitivity of the rectal area, even if no independent disease is present.

Both situations increase the mechanical strain during defecation – especially for the rectum.

Why the microbiome is not a "stool maker"

The functional distinction is important:

The gut microbiome does not produce stool but modulates its properties. Diet, fluid intake, and bowel movement remain central factors; the microbiome acts as a regulatory background influence.

Rectum-relevant consequence

Since stool consistency is primarily determined,

• how strongly it must be pressed
• how much friction is generated
• how long the stool remains in the rectum

the gut microbiome acts indirectly but decisively on the strain of the rectum.

What is the connection between gut flora and chronic constipation?

There is a reciprocal relationship between chronic constipation and gut flora. A disturbed gut flora can exacerbate constipation and intestinal sluggishness, while persistent constipation in turn impairs the microbial balance in the gut.

There is a functional connection, but no simple cause-and-effect mechanism.

Chronic constipation usually does not arise from a single trigger. The gut flora does not act as the sole cause but as an amplifying or stabilizing factor within a cycle that increasingly complicates stool evacuation.

Exactly how the gut flora is involved in the constipation process is not yet fully understood.

In the large intestine, the gut flora influences how intensively indigestible food residues are further processed. If microbial activity is reduced or imbalanced, these processes slow down. The intestinal contents remain longer in the large intestine, causing more water to be withdrawn from the stool. The result is a firm, dry stool that is difficult to transport further.

At the same time, the gut flora indirectly influences intestinal movement through microbial metabolic products. If this signaling balance is disturbed, the natural propulsion of intestinal contents can become sluggish. The result is a prolonged transit time, which further exacerbates constipation.

The vicious cycle of chronic constipation

Chronic constipation often develops into a self-perpetuating cycle: slowed stool transit changes the intestinal environment. This unfavorable environment, in turn, impairs the gut flora, which further intensifies stool hardening. Over time, the intestine adapts to this situation, weakening the natural urge to evacuate.

Significance for the rectum

For the rectum, chronic constipation means a permanent mechanical strain. Hard stool and repeated straining increase pressure on the mucous membrane and vascular structures. Even if the gut flora is not the primary cause of constipation, it contributes to the consolidation and chronicity of this strain.

Functional Classification

It is important to make a factual distinction: The gut flora is not a trigger in the medical sense but modulates stool consistency and intestinal movement. A disturbed gut flora can worsen or maintain existing constipation but is not responsible for every form of chronic constipation.

How are inflammations in the rectum connected to an imbalance of microbes?

Inflammations in the rectum are often associated with a disturbed microbial balance. This makes the mucosal environment more sensitive. While the microbiome does not directly cause inflammations, it is crucial for how resilient the rectum is to everyday stresses.

When the balance is lost

A microbial imbalance in the gut not only affects digestion and the consistency of the stool but can also significantly increase the sensitivity of the rectum to stimuli. Inflammations in the rectum rarely occur in isolation but often develop on the basis of a permanently disturbed local intestinal environment.

The role of the intestinal environment in the rectum

The rectum is particularly susceptible to changes in the intestinal environment because its mucous membrane regularly comes into contact with concentrated intestinal contents. If the microbial balance is disturbed, the composition and properties of the stool as well as the chemical conditions in the rectum change. This can lead to the mucous membrane becoming less resistant to mechanical and chemical stimuli.

Microorganisms as indirect influencing factors

A microbial imbalance does not necessarily mean the presence of "harmful germs" but often an imbalance of functionally important bacterial groups. This can weaken regulatory processes that normally contribute to mucosal stability. The result is increased susceptibility to irritation, where even everyday stresses like bowel movements or moisture can promote inflammatory reactions.

Inflammatory reactions are a protective mechanism

Inflammations in the rectum are initially a defense and protective reaction of the body. However, with persistent microbial imbalance, these reactions are repeatedly triggered without sufficient recovery phases. This can lead to chronic irritation states characterized by burning, a feeling of pressure, or increased mucosal sensitivity.

Differentiation from specific diseases

Not every inflammatory reaction in the rectum is a sign of an independent disease, such as infectious or chronic inflammatory proctitis. Often, these are functional inflammatory processes favored by an unfavorable intestinal environment, stool problems, or mechanical stress. Persistent or increasing symptoms should always be medically evaluated.

Contextual classification

A microbial imbalance does not act as the sole trigger in the rectum but as an amplifier of inflammatory processes. In combination with hard stool consistency, frequent straining, or moisture, it can contribute to the consolidation of inflammatory irritation states.

How does the gut microbiome affect mucous membrane irritations in the rectum?

The gut microbiome influences mucosal irritations not directly but through the intestinal environment and the characteristics of the stool. A stable microbial balance helps keep the mucosa resilient and reduces functional irritation states in the rectum. 

From the microbiome to the mucosa – a chain of irritation

Mucosal irritations in the rectum usually do not arise from single triggers but from a functional chain of irritation, often beginning with the gut microbiome. The microbiome does not act directly as harmful but influences the conditions under which the mucosa is stressed or protected.

Step 1: Microbial balance and intestinal environment

A balanced gut microbiome contributes to a stable intestinal environment. When this balance is disturbed, the composition and properties of the intestinal contents change. These include, among other things, the pH value, water retention, and the chemical composition of the stool. These factors determine how irritating or non-irritating the contact between stool and mucosa is.

Step 2: Mucosa as a contact surface

The mucosa in the rectum is constantly exposed to mechanical and chemical influences. If the gut environment is unfavorable, the mucosa becomes more susceptible to micro-irritations – even during everyday stresses such as bowel movements or prolonged contact with moisture. This can weaken the mucosa's natural protective function.

Step 3: Irritation instead of inflammation

Mucosal irritations are not automatically inflammatory diseases. They are often functional irritation states characterized by burning, itching, or an unpleasant feeling of pressure. A microbial imbalance can promote these irritation states by lowering the mucosa's irritation threshold.

Why the microbiome is not a direct trigger

The medical distinction is important:

The gut microbiome does not cause mucosal irritations in the sense of a disease. Rather, it acts as a modulator that determines how resilient the mucosa is to mechanical, chemical, and moisture-related stresses.

Significance for the rectum

Since the rectum is the section where stool is temporarily stored, changes in the gut microbiome have particularly noticeable effects here. A persistently unfavorable gut environment can lead to more frequent or prolonged mucosal irritations, even if no specific disease is present.

What is the connection between diet, gut flora, and proctological complaints?

Proctological complaints are usually the result of an interplay between nutrition, microbiome, and stool regulation and cannot be attributed to a single trigger. While nutrition and the microbiome do not cause proctological diseases in the strict sense, they significantly influence how much strain the rectum experiences. Thus, they act as relevant accompanying and amplifying factors in the symptomatology.

Three levels – one functional connection

Proctological complaints rarely occur in isolation. In many cases, nutrition, gut microbiome, and rectal strain act as interconnected levels that influence each other and can either intensify or alleviate symptoms.

Level 1: Nutrition as a starting point

Nutrition lays the foundation for the intestinal contents that reach the rectum. The type, composition, and regularity of food influence stool volume, water content, and slipperiness. A low-fiber, unbalanced diet favors hard or irregular stools, while an adapted diet can contribute to more stable evacuation conditions.

Level 2: Microbiome as a mediating instance

The gut microbiome further processes food residues and determines how stool is structured and regulated. A balanced microbial activity supports a stable gut environment, while an imbalance can destabilize stool characteristics. The microbiome does not cause disease but modulates the functional conditions in the gut.

Level 3: The rectum as a point of strain

The rectum is the section that directly experiences the functional consequences of diet and microbiome. An unfavorable stool consistency, frequent straining, or an irritable gut environment can lead to increased mechanical and chemical stress on the mucous membrane. This can promote proctological complaints such as burning, itching, a feeling of pressure, or hemorrhoidal symptoms.

What role do fermented foods play in sensitive rectum?

For a sensitive rectum, it is not crucial whether fermented foods are "good or bad," but rather how they affect stool consistency and personal discomfort.

Weighing options instead of blanket recommendations

For a sensitive rectum, fermented foods are neither fundamentally problematic nor automatically helpful. What matters is how they affect stool behavior and the local gut environment and how well they are individually tolerated.

Potential benefits from a functional perspective

Fermented foods already bring microbially pre-processed structures. In combination with an adapted diet, they can help ensure that stools are more evenly formed and easier to evacuate. A stable stool consistency reduces the mechanical strain on the rectum and can thus indirectly alleviate irritation.

In addition, fermented foods influence the gut environment, which affects the rectum. A more balanced environment can make the mucous membrane less susceptible to friction, moisture, and chemical stimuli.

Possible challenges with a sensitive rectum

At the same time, fermented foods contain organic acids and active metabolic products that can be perceived as irritating by sensitive individuals. In particular, heavily fermented products or larger quantities can lead to increased bowel urgency, softer stools, or a burning sensation in the rectum for some affected people.

A sensitive rectum usually does not react to the food itself, but to the changed stool consistency or evacuation frequency.

Individual Tolerance as a Guiding Principle

For a sensitive rectum, fermented foods should therefore be introduced slowly, in small amounts, and well distributed throughout daily life. Mildly fermented varieties are often better tolerated than strongly matured products. Careful self-observation is important to recognize how bowel movements and rectal sensation develop.

Functional Classification

Fermented foods are not a treatment for rectal complaints. However, they can – if individually well tolerated – be part of a diet that functionally relieves the rectum by contributing to more stable stool conditions.

What does comprehensive support for hemorrhoids mean?

Holistic support for hemorrhoids means relieving causes, functionally protecting the rectum, and specifically complementing local measures – instead of treating symptoms in isolation. Hemorrhoids are a proctological condition that should be medically supervised. Holistic measures – consisting of stool regulation, gut-friendly nutrition, lifestyle adjustments, and local mucous membrane care with medical products such as CANNEFF® SUP – are understood as a supportive overall concept, not as a substitute for medical therapy.

It is not a single measure, but an interplay.

Hemorrhoids cannot be influenced long-term by a single approach. Holistic support therefore starts where the symptoms arise: with stool regulation, relief of the rectum, and protection of the mucous membrane. The goal is to reduce stressful factors and support the natural functions of the rectum.

1. Functional Relief through Stool Regulation

A consistent and well-tolerated stool consistency is the most important foundation for this. It reduces straining, shortens evacuation time, and lowers pressure on the vascular cushions. Here, diet, fluid intake, and a regular toilet routine act as central adjustment points.

2. Consideration of the Intestinal Environment and the Microbiome

The gut microbiome influences stool form and ensures that the intestinal environment remains low in irritation. A balanced diet, possibly supplemented with well-tolerated fermented foods, can help reduce functional stress in the rectum without being understood as a therapy.

3. Local Support of the Rectal Mucosa

In addition to functional measures, local care and regeneration of the mucosa play an important role. Conventional medical products are used here.

CANNEFF® SUP suppositories with CBD and hyaluronic acid are used supportively to moisturize, protect, and promote the regeneration of the rectal mucosa. Hyaluronic acid helps bind moisture, while CBD has anti-inflammatory properties. The application is local and complements dietary and lifestyle measures without replacing them.

4. Lifestyle as a Stabilizing Factor

Regular exercise, stress-reducing routines, and avoiding prolonged sitting – especially on the toilet – have a supportive effect. They help reduce venous congestion in the rectum and prevent further functional stress.

How can the intestinal flora be stabilized and ailments reduced through prevention?

Prevention of rectum-related complaints means stabilizing the gut flora and reducing functional strains early on – before symptoms develop or become chronic.

Prevention Begins Before the Symptom

Proctological complaints usually develop gradually. Therefore, prevention does not start only with pain or visible changes but with stabilizing functional basics, especially the gut flora and stool regulation.

The Preventive Lever: a Stable Intestinal Environment.

A balanced gut flora ensures that intestinal contents are processed evenly and the stool is neither too hard nor irritating. This reduces mechanical stress in the rectum. In this context, prevention does not mean "intervention" but avoiding stress before it occurs.

Three Preventive Levers in Everyday Life

1. Regularity instead of perfection: A stable rhythm in meals and bowel movements supports intestinal motility and prevents stool from staying too long in the colon.

2. Do not irritate the gut flora, but support it: A fiber-rich and well-tolerated diet forms the basis. Fermented foods can have a complementary effect – individually adjusted – as long as they stabilize stool consistency and do not cause irritation.

3. Relieve the rectum early: Even without acute complaints, it is worthwhile to avoid straining, prolonged sitting on the toilet, and changing stool conditions. Prevention here mainly means avoiding stressful habits.

What Prevention Is Not

Prevention does not mean continuous use of products or self-treatment of possible diseases. It neither replaces medical diagnosis nor therapy but aims to minimize functional risk factors before complaints arise or become chronic.

Sources:

Wastyk, H. C., Fragiadakis, G. K., Perelman, D., Dahan, D., Merrill, B. D., Yu, F. B., Topf, M., Gonzalez, C. G., Van Treuren, W., Han, S., Robinson, J. L., Elias, J. E., Sonnenburg, E. D., Gardner, C. D., & Sonnenburg, J. L. (2021). Gut-microbiota-targeted diets modulate human immune status. Cell, 184(16), 4137–4153.e14. https://doi.org/10.1016/j.cell.2021.06.019

Hooper, L. V., Littman, D. R., & Macpherson, A. J. (2012). Interactions between the microbiota and the immune system. Science (New York, N.Y.), 336(6086), 1268–1273. https://doi.org/10.1126/science.1223490

de Vos, W. M., Tilg, H., Van Hul, M., & Cani, P. D. (2022). Gut microbiome and health: mechanistic insights. Good, 71(5), 1020–1032. https://doi.org/10.1136/gutjnl-2021-326789

David, L. A., Maurice, C. F., Carmody, R. N., Gootenberg, D. B., Button, J. E., Wolfe, B. E., Ling, A. V., Devlin, A. S., Varma, Y., Fischbach, M. A., Biddinger, S. B., Dutton, R. J., & Turnbaugh, P. J. (2014). Diet rapidly and reproducibly alters the human gut microbiome. Nature, 505(7484), 559–563. https://doi.org/10.1038/nature12820

Sonnenburg, E. D., Smits, S. A., Tikhonov, M., Higginbottom, S. K., Wingreen, N. S., & Sonnenburg, J. L. (2016). Diet-induced extinctions in the gut microbiota compound over generations. Nature, 529(7585), 212–215. https://doi.org/10.1038/nature16504

Cryan, J. F., & Dinan, T. G. (2012). Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour. Nature reviews. Neuroscience, 13(10), 701–712. https://doi.org/10.1038/nrn3346

Foster, J. A., Rinaman, L., & Cryan, J. F. (2017). Stress & the gut-brain axis: Regulation by the microbiome. Neurobiology of stress, 7, 124–136. https://doi.org/10.1016/j.ynstr.2017.03.001

Palm, N. W., de Zoete, M. R., & Flavell, R. A. (2015). Immune-microbiota interactions in health and disease. Clinical immunology (Orlando, Fla.), 159(2), 122–127. https://doi.org/10.1016/j.clim.2015.05.014

Zmora, N., Zilberman-Schapira, G., Suez, J., Mor, U., Dori-Bachash, M., Bashiardes, S., Kotler, E., Zur, M., Regev-Lehavi, D., Brik, R. B., Federici, S., Cohen, Y., Linevsky, R., Rothschild, D., Moor, A. E., Ben-Moshe, S., Harmelin, A., Itzkovitz, S., Maharshak, N., Shibolet, O., … Elinav, E. (2018). Personalized Gut Mucosal Colonization Resistance to Empiric Probiotics Is Associated with Unique Host and Microbiome Features. Cell, 174(6), 1388–1405.e21. https://doi.org/10.1016/j.cell.2018.08.041

Sharkey, K. A., & Wiley, J. W. (2016). The Role of the Endocannabinoid System in the Brain-Gut Axis. Gastroenterology, 151(2), 252–266. https://doi.org/10.1053/j.gastro.2016.04.015

Minichino, A., Jackson, M. A., Francesconi, M., Steves, C. J., Menni, C., Burnet, P. W. J., & Lennox, B. R. (2021). Endocannabinoid system mediates the association between gut-microbial diversity and anhedonia/amotivation in a general population cohort. Molecular psychiatry, 26(11), 6269–6276. https://doi.org/10.1038/s41380-021-01147-5

Srivastava, R. K., Lutz, B., & Ruiz de Azua, I. (2022). The Microbiome and Gut Endocannabinoid System in the Regulation of Stress Responses and Metabolism. Frontiers in cellular neuroscience, 16, 867267. https://doi.org/10.3389/fncel.2022.867267