Hemorrhoids pathophysiology: Difference between revisions
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==Overview== | ==Overview== | ||
Revision as of 15:47, 16 June 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
Pathophysiology
The pathophysiology of hemorrhoids include 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. Hypertension, particularly in the portal vein, 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] Both can cause diarrhea. Alcohol can also cause alcoholic liver disease leading to portal hypertension. Caffeine on the other hand can cause general hypertension.
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. This chart summarizes the results.
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.