Hemorrhoids pathophysiology: Difference between revisions
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==Overview== | ==Overview== | ||
Hemorrhoids | Hemorrhoids develop due to a combination of [[genetic predisposition]] (weak rectal [[veins]]) and certain diet and defecation habits. | ||
==Pathophysiology== | ==Pathophysiology== | ||
* The pathophysiology of hemorrhoids includes [[genetic predisposition]] (weak rectal vein walls and/or valves), straining during [[Defecation|bowel movements]], and too much pressure on the rectal veins due to poor muscle tone or poor posture.<ref name="pmid28567655">{{cite journal |vauthors=Guttenplan M |title=The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist |journal=Curr Gastroenterol Rep |volume=19 |issue=7 |pages=30 |year=2017 |pmid=28567655 |doi=10.1007/s11894-017-0574-9 |url=}}</ref> | * The pathophysiology of hemorrhoids includes [[genetic predisposition]] (weak rectal [[vein]] walls and/or [[anal valves|valves]]), straining during [[Defecation|bowel movements]], and too much pressure on the rectal [[veins]] due to poor [[muscle tone]] or poor posture.<ref name="pmid28567655">{{cite journal |vauthors=Guttenplan M |title=The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist |journal=Curr Gastroenterol Rep |volume=19 |issue=7 |pages=30 |year=2017 |pmid=28567655 |doi=10.1007/s11894-017-0574-9 |url=}}</ref> | ||
* Similarly, sitting for prolonged periods of time can cause hemorrhoids. | * 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]] | * [[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]].<ref>{{cite web |title=Causes of Hemorrhoids |url=http://www.mayoclinic.com/health/hemorrhoids/DS00096/DSECTION=3 |date=Nov 28, 2006 |publisher=Mayo Clinic |accessdate=2007-12-07}}</ref> | ||
* Additional factors that can influence the course of hemorrhoids (mostly by increasing rectal vein pressure), especially for those with a genetic predisposition, [[obesity]] and a [[sedentary lifestyle]].<ref name="pmid17074235">{{cite journal |vauthors=Huang YT |title=[Consideration on the pathogenesis of hemorrhoids] |language=Chinese |journal=Zhonghua Wai Ke Za Zhi |volume=44 |issue=15 |pages=1019–21 |year=2006 |pmid=17074235 |doi= |url=}}</ref><ref name="pmid3265119">{{cite journal |vauthors=Le Quellec A, Bories P, Rochon JC, Garrigues JM, Poirier JL, Michel H |title=[Portal hypertension and hemorrhoids. Cause effect relationship?] |language=French |journal=Gastroenterol. Clin. Biol. |volume=12 |issue=8-9 |pages=646–8 |year=1988 |pmid=3265119 |doi= |url=}}</ref> | * 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]].<ref name="pmid17074235">{{cite journal |vauthors=Huang YT |title=[Consideration on the pathogenesis of hemorrhoids] |language=Chinese |journal=Zhonghua Wai Ke Za Zhi |volume=44 |issue=15 |pages=1019–21 |year=2006 |pmid=17074235 |doi= |url=}}</ref><ref name="pmid3265119">{{cite journal |vauthors=Le Quellec A, Bories P, Rochon JC, Garrigues JM, Poirier JL, Michel H |title=[Portal hypertension and hemorrhoids. Cause effect relationship?] |language=French |journal=Gastroenterol. Clin. Biol. |volume=12 |issue=8-9 |pages=646–8 |year=1988 |pmid=3265119 |doi= |url=}}</ref> | ||
* Increased straining during bowel movements | * 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]] | * [[Pregnancy]] can cause [[hypertension]] and increases strain during bowel movements, so hemorrhoids are often associated with pregnancy. | ||
* Excessive consumption of [[alcohol]] or [[caffeine]] can both 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> | * Excessive consumption of [[alcohol]] or [[caffeine]] can both 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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===Food=== | ===Food=== | ||
* [[Chronic constipation]] can cause hemorrhoidal irritation due to hard stools.<ref name="pmid17074235" /> | * [[Chronic constipation]] can cause hemorrhoidal irritation due to hard stools.<ref name="pmid17074235" /> | ||
* An excess of [[lactic acid]] in the stool, a product of excessive consumption of dairy products such as cheese, can cause irritation | * 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. | ||
* | * Probiotic foods such as yogurt with active culture, and the consumption of fruit may help keep the gut functioning normally and help prevent flare-ups. | ||
=== Use of unnatural "sitting" toilets === | === Use of unnatural "sitting" toilets === | ||
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* In 1987, an Israeli physician, Dr. Berko Sikirov, published a study testing this hypothesis by having hemorrhoid sufferers convert to [[squat toilets]].<ref name="pmid3623887">{{cite journal |author=Sikirov BA |title=Management of hemorrhoids: a new approach |journal=Isr. J. Med. Sci. |volume=23 |issue=4 |pages=284–6 |year=1987 |pmid=3623887 |doi=}}</ref> 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. | * In 1987, an Israeli physician, Dr. Berko Sikirov, published a study testing this hypothesis by having hemorrhoid sufferers convert to [[squat toilets]].<ref name="pmid3623887">{{cite journal |author=Sikirov BA |title=Management of hemorrhoids: a new approach |journal=Isr. J. Med. Sci. |volume=23 |issue=4 |pages=284–6 |year=1987 |pmid=3623887 |doi=}}</ref> 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. | * No follow-up studies have ever been published. | ||
* The American Society of Colon & Rectal Surgeons | * The American Society of Colon & Rectal Surgeons has not published any recommendations regarding the therapeutic value of squatting. | ||
==Gross pathology== | ==Gross pathology== | ||
* External hemorrhoids appear on inspection of the [[anal verge]] as skin tags or | * External hemorrhoids appear on inspection of the [[anal verge]] as [[skin tags]] or strangulated or free prolapsed veins. | ||
* Internal hemorrhoids appear as bluish | * Internal hemorrhoids appear as bluish bulgings of the [[veins]] in the [[mucosa]]. | ||
{| class="wikitable" | {| class="wikitable" | ||
![[Image:By Dr. Joachim Guntau - www.Endoskopiebilder.de, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=18660152.JPG|center|300px|thumb|By Dr. Joachim Guntau - www.Endoskopiebilder.de, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=18660152]] | ![[Image:By Dr. Joachim Guntau - www.Endoskopiebilder.de, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=18660152.JPG|center|300px|thumb|By Dr. Joachim Guntau - www.Endoskopiebilder.de, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=18660152]] | ||
Revision as of 12:58, 7 August 2017
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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 both cause hemorrhoids.[6]
{{#ev:youtube|QKndv13bXHA}}
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.
- Probiotic foods such as yogurt with active culture, and the consumption of fruit may help keep the gut functioning normally and help 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.