Hemorrhoids pathophysiology: Difference between revisions
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* Increased straining during bowel movements (e.g. [[constipation]], [[diarrhea]]) may lead to hemorrhoids.<ref name="titleHemorrhoids during pregnancy: Treatment options - MayoClinic.com">{{cite web |author=Harms R |title=Hemorrhoids during pregnancy: Treatment options |url=http://www.mayoclinic.com/health/hemorrhoids-during-pregnancy/AN01720 |date=Nov 3, 2007 |publisher=MayoClinic |accessdate=2007-11-28}}</ref> | * Increased straining during bowel movements (e.g. [[constipation]], [[diarrhea]]) may lead to hemorrhoids.<ref name="titleHemorrhoids during pregnancy: Treatment options - MayoClinic.com">{{cite web |author=Harms R |title=Hemorrhoids during pregnancy: Treatment options |url=http://www.mayoclinic.com/health/hemorrhoids-during-pregnancy/AN01720 |date=Nov 3, 2007 |publisher=MayoClinic |accessdate=2007-11-28}}</ref> | ||
* [[Pregnancy]] can cause [[hypertension]] and increases strain during bowel movements, so hemorrhoids are often associated with pregnancy. | * [[Pregnancy]] can cause [[hypertension]] and increases strain during bowel movements, so hemorrhoids are often associated with pregnancy. | ||
* Excessive consumption of [[alcohol]] or [[caffeine]] can | * Excessive consumption of [[alcohol]] or [[caffeine]] can cause hemorrhoids.<ref name="titleHemorrhoids">{{cite web |author=Burney RE |title=Hemorrhoids |url=http://www.med.umich.edu/1libr/aha/aha_hem_crs.htm |date=November 2005 |publisher=University of Michigan Health System |accessdate=2007-11-28}}</ref> | ||
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* An excess of [[lactic acid]] in the stool, a product of excessive consumption of dairy products such as cheese, can cause [[irritation]]. A reduction of consumption of these foods can bring relief. | * An excess of [[lactic acid]] in the stool, a product of excessive consumption of dairy products such as cheese, can cause [[irritation]]. A reduction of consumption of these foods can bring relief. | ||
* [[Vitamin E]] deficiency is also a common cause. | * [[Vitamin E]] deficiency is also a common cause. | ||
* | * Consuming probiotic foods such as yogurt with active culture or consuming fruit may help keep the gut functioning normally and prevent flare-ups. | ||
=== Use of unnatural "sitting" toilets === | === Use of unnatural "sitting" toilets === | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]
Overview
Hemorrhoids develop due to a combination of genetic predisposition (weak rectal veins) and certain diet and defecation habits.
Pathophysiology
- The pathophysiology of hemorrhoids includes genetic predisposition (weak rectal vein walls and/or valves), straining during bowel movements, and too much pressure on the rectal veins due to poor muscle tone or poor posture.[1]
- Similarly, sitting for prolonged periods of time can cause hemorrhoids.
- Portal hypertension can also cause hemorrhoids because of the connections between the portal vein and the vena cava that occur in the rectal wall, known as portocaval anastomoses.[2]
- Additional factors that can influence the course of hemorrhoids (mostly by increasing rectal vein pressure), especially for those with a genetic predisposition, include obesity and a sedentary lifestyle.[3][4]
- Increased straining during bowel movements (e.g. constipation, diarrhea) may lead to hemorrhoids.[5]
- Pregnancy can cause hypertension and increases strain during bowel movements, so hemorrhoids are often associated with pregnancy.
- Excessive consumption of alcohol or caffeine can cause hemorrhoids.[6]
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Food
- Chronic constipation can cause hemorrhoidal irritation due to hard stools.[3]
- An excess of lactic acid in the stool, a product of excessive consumption of dairy products such as cheese, can cause irritation. A reduction of consumption of these foods can bring relief.
- Vitamin E deficiency is also a common cause.
- Consuming probiotic foods such as yogurt with active culture or consuming fruit may help keep the gut functioning normally and prevent flare-ups.
Use of unnatural "sitting" toilets
- Based on their very low incidence in the developing world, where people squat for bodily functions, hemorrhoids have been attributed to the use of the unnatural "sitting" toilet.[7][8]
- In 1987, an Israeli physician, Dr. Berko Sikirov, published a study testing this hypothesis by having hemorrhoid sufferers convert to squat toilets.[9] Eighteen of the 20 patients were completely relieved of their symptoms (pain and bleeding) with no recurrence, even 30 months after completion of the study.
- No follow-up studies have ever been published.
- The American Society of Colon & Rectal Surgeons has not published any recommendations regarding the therapeutic value of squatting.
Gross pathology
- External hemorrhoids appear on inspection of the anal verge as skin tags or strangulated or free prolapsed veins.
- Internal hemorrhoids appear as bluish bulgings of the veins in the mucosa.
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References
- ↑ Guttenplan M (2017). "The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist". Curr Gastroenterol Rep. 19 (7): 30. doi:10.1007/s11894-017-0574-9. PMID 28567655.
- ↑ "Causes of Hemorrhoids". Mayo Clinic. Nov 28, 2006. Retrieved 2007-12-07.
- ↑ 3.0 3.1 Huang YT (2006). "[Consideration on the pathogenesis of hemorrhoids]". Zhonghua Wai Ke Za Zhi (in Chinese). 44 (15): 1019–21. PMID 17074235.
- ↑ Le Quellec A, Bories P, Rochon JC, Garrigues JM, Poirier JL, Michel H (1988). "[Portal hypertension and hemorrhoids. Cause effect relationship?]". Gastroenterol. Clin. Biol. (in French). 12 (8–9): 646–8. PMID 3265119.
- ↑ Harms R (Nov 3, 2007). "Hemorrhoids during pregnancy: Treatment options". MayoClinic. Retrieved 2007-11-28.
- ↑ Burney RE (November 2005). "Hemorrhoids". University of Michigan Health System. Retrieved 2007-11-28.
- ↑ Sikirov BA (1989). "Primary constipation: an underlying mechanism". Med. Hypotheses. 28 (2): 71–3. PMID 2927355.
- ↑ Sikirov D (2003). "Comparison of straining during defecation in three positions: results and implications for human health". Dig. Dis. Sci. 48 (7): 1201–5. PMID 12870773.
- ↑ Sikirov BA (1987). "Management of hemorrhoids: a new approach". Isr. J. Med. Sci. 23 (4): 284–6. PMID 3623887.