Hemorrhoids pathophysiology
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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 are developed due to combination of genetic predisposition (weak rectal veins) and following 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.
- 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 which occur in the rectal wall - known as portocaval anastomoses.[1]
- Additional factors that can influence the course of hemorrhoids (mostly by increasing rectal vein pressure), especially for those with a genetic predisposition, are obesity and a sedentary lifestyle.
- Increased straining during bowel movements, (e.g. constipation, diarrhea) may lead to hemorrhoids. [2]
- Pregnancy causes hypertension and increases strain during bowel movements, and thus hemorrhoids are often associated with pregnancy.
- Excessive consumption of alcohol or caffeine can both cause hemorrhoids.[3]
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Food
- Dehydration can cause a hard stool or chronic constipation which can lead to hemorrhoidal irritation.
- An excess of lactic acid in the stool, a product of excessive consumption of dairy products such as cheese, can cause irritation and a reduction of consumption can bring relief.
- Vitamin E deficiency is also a common cause.
- Food considered "probiotic", such as yogurt with active culture, may help keep the gut functioning normally and thus help prevent flare-ups, as will the consumption of fruit.
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.[4][5]
- In 1987, an Israeli physician, Dr. Berko Sikirov, published a study testing this hypothesis by having hemorrhoid sufferers convert to squat toilets.[6] 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 is silent regarding the therapeutic value of squatting.
Gross pathology
- External hemorrhoids appear on inspection of the anal verge as skin tags or prolapsed veins either strangulated or free.
- Internal hemorrhoids appear as bluish bulging of the veins in the mucosa.
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References
- ↑ "Causes of Hemorrhoids". Mayo Clinic. Nov 28, 2006. Retrieved 2007-12-07.
- ↑ 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.