Login Register Cart 0
Generic placeholder image

Reviews on Recent Clinical Trials

Editor-in-Chief

ISSN (Print): 1574-8871
ISSN (Online): 1876-1038

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Review Article

Anatomy, Physiology and Pathophysiology of Haemorrhoids

Author(s): Francesco Pata*, Alessandro Sgró, Francesco Ferrara, Vincenzo Vigorita, Gaetano Gallo and Gianluca Pellino

Volume 16, Issue 1, 2021

Published on: 06 April, 2020

Page: [75 - 80] Pages: 6

DOI: 10.2174/1574887115666200406115150

Price: $65

Abstract

Background: Haemorrhoidal Disease (HD) is a frequent anal disorder and one of the most common findings identified at the colorectal clinic. This article aims to provide an overview of the anatomy, physiology and pathophysiology of haemorrhoids and haemorrhoidal disease.

Introduction: Internal haemorrhoids are vascular cushions located in the anal canal, above the dentate line and covered by columnar epithelium. They contribute to the faecal continence and the sensitivity of the anal canal. The enlargement and/or sliding of haemorrhoidal tissue produce symptoms and complications, the so-called haemorrhoidal disease.

Methods: A systematic research was realized, looking at the best evidence in literature, searching PubMed, Embase, Cochrane library and the most renowed textbooks of colorectal surgery from January 1980 to January 2020.

Result: Aetiology and pathophysiology of HD are still controversial, but multifactorial. Disruption of stromal scaffolding, enlargement of vascular component, elevated anal pressure and rectal redundancy represent key events in the development and complications of the disease. Local inflammation may also play a role. Goligher’s classification remains the most widely used. Thorough patient history and examination are paramount to diagnose HD, excluding other anal or colonic pathologies.

Conclusion: Several aspects of etiopathogenesis and pathophysiology remain controversial. Further studies are needed to obtain a better understanding of the disease.

Keywords: Haemorrhoidal disease, anatomy, pathophysiology, haemorrhoids, physiology, anal disease, haemorrhoids.

« Previous Next »
Graphical Abstract

[1]
Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part II: Lower gastrointestinal diseases. Gastroenterology 2009; 136(3): 741-54.
[http://dx.doi.org/10.1053/j.gastro.2009.01.015] [PMID: 19166855]
[2]
Gallo G, Martellucci J, Sturiale A, et al. Consensus statement of the Italian society of colorectal surgery (SICCR): Management and treatment of hemorrhoidal disease. Tech Coloproctol 2020; 24(2): 145-64.
[http://dx.doi.org/10.1007/s10151-020-02149-1] [PMID: 31993837]
[3]
Gallo G, Sacco R, Sammarco G. Epidemiology of Hemorrhoidal Disease. Hemorrhoids Coloproctology. Cham: Springer 2018; pp. 3-7.
[http://dx.doi.org/10.1007/978-3-319-53357-5_1]
[4]
Ellesmore S, Windsor AC. Surgical history of haemorrhoids. Surgical treatment of haemorrhoids. London: Springer 2002; pp. 1-4.
[http://dx.doi.org/10.1007/978-1-4471-3727-6_1]
[5]
Practice parameters for the treatment of hemorrhoids. Dis Colon Rectum 1990; 33: 992-3.
[http://dx.doi.org/10.1007/BF02139115]
[6]
Kaidar-Person O, Person B, Wexner SD. Hemorrhoidal disease: A comprehensive review. J Am Coll Surg 2007; 204(1): 102-17.
[http://dx.doi.org/10.1016/j.jamcollsurg.2006.08.022] [PMID: 17189119]
[7]
Rubbini M, Ascanelli S. Classification and guidelines of hemorrhoidal disease: Present and future. World J Gastrointest Surg 2019; 11(3): 117-21.
[http://dx.doi.org/10.4240/wjgs.v11.i3.117] [PMID: 31057696]
[8]
Selvaggi F, Pellino G, Sciaudone G, Candilio G, Canonico S. Development and validation of a practical score to predict pain after excisional hemorrhoidectomy. Int J Colorectal Dis 2014; 29(11): 1401-10.
[http://dx.doi.org/10.1007/s00384-014-1999-3] [PMID: 25155619]
[9]
Selvaggi F, Pellino G, Sciaudone G. Surgical treatment of recurrent prolapse after stapled haemorrhoidopexy. Tech Coloproctol 2014; 18(9): 847-50.
[http://dx.doi.org/10.1007/s10151-014-1180-6] [PMID: 24957359]
[10]
Jacobs D. Clinical practice. Hemorrhoids. N Engl J Med 2014; 371(10): 944-51.
[http://dx.doi.org/10.1056/NEJMcp1204188] [PMID: 25184866]
[11]
Banov L Jr, Knoepp LF Jr, Erdman LH, Alia RT. Management of hemorrhoidal disease. J S C Med Assoc 1985; 81(7): 398-401.
[PMID: 3861909]
[12]
Sun Z, Migaly J. Review of Hemorrhoid Disease: Presentation and Management. Clin Colon Rectal Surg 2016; 29(1): 22-9.
[http://dx.doi.org/10.1055/s-0035-1568144] [PMID: 26929748]
[13]
Hardy A, Cohen CR. The acute management of haemorrhoids. Ann R Coll Surg Engl 2014; 96(7): 508-11.
[http://dx.doi.org/10.1308/003588414X13946184900967] [PMID: 25245728]
[14]
Sammarco G, Trompetto M, Gallo G. Thrombosed external haemorrhoids: A Clinician’s Dilemma. Rev Recent Clin Trial 2019.
[15]
Cintron JR, Abcarian H. Benign Anorectal: Hemorrhoids.The ASCRS Textbook of Colon and Rectal Surgery. New York, NY: Springer 2007.
[http://dx.doi.org/10.1007/978-0-387-36374-5_11]
[16]
Aigner F. Hemorrhoids.Coloproctology. 2nd ed. 37-46.
[17]
Stelzner F. The corpus cavernosum recti. Dis Colon Rectum 1964; 7: 398-9.
[http://dx.doi.org/10.1007/BF02616852] [PMID: 14202628]
[18]
Sanchez C, Chinn BT. Hemorrhoids. Clin Colon Rectal Surg 2011; 24(1): 5-13.
[http://dx.doi.org/10.1055/s-0031-1272818] [PMID: 22379400]
[19]
Loder PB, Kamm MA, Nicholls RJ, Phillips RK. Haemorrhoids: Pathology, pathophysiology and aetiology. Br J Surg 1994; 81(7): 946-54.
[http://dx.doi.org/10.1002/bjs.1800810707] [PMID: 7922085]
[20]
Aigner F, Gruber H, Conrad F, et al. Revised morphology and hemodynamics of the anorectal vascular plexus: impact on the course of hemorrhoidal disease. Int J Colorectal Dis 2009; 24(1): 105-13.
[http://dx.doi.org/10.1007/s00384-008-0572-3] [PMID: 18766355]
[21]
Peery AF, Sandler RS, Galanko JA, et al. Risk factors for hemorrhoids on screening colonoscopy. PLoS One 2015; 10(9): e0139100.
[http://dx.doi.org/10.1371/journal.pone.0139100] [PMID: 26406337]
[22]
Riss S, Weiser FA, Schwameis K, Mittlbock M, Stift A. Haemorrhoids, constipation and faecal incontinence: Is there any relationship? Colorectal disease: The official journal of the Association of Coloproctology of Great Britain and Ireland 2011; 13(8): e227-33.
[http://dx.doi.org/10.1111/j.1463-1318.2011.02632.x]
[23]
Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology 1990; 98(2): 380-6.
[http://dx.doi.org/10.1016/0016-5085(90)90828-O] [PMID: 2295392]
[24]
Johanson JF, Sonnenberg A. Constipation is not a risk factor for hemorrhoids: A case-control study of potential etiological agents. Am J Gastroenterol 1994; 89(11): 1981-6.
[PMID: 7942722]
[25]
Yamana T. Japanese practice guidelines for anal disorders I. Hemorrhoids. J Anus Rectum Colon 2018; 1(3): 89-99.
[http://dx.doi.org/10.23922/jarc.2017-018] [PMID: 31583307]
[26]
Acheson RM. Haemorrhoids in the adult male; a small epidemiological study. Guys Hosp Rep 1960; 109: 184-95.
[PMID: 13681216]
[27]
Prasad GC, Prakash V, Tandon AK, Deshpande PJ. Studies on etiopathogenesis of hemorrhoids. Am J Proctol 1976; 27(3): 33-41.
[PMID: 937530]
[28]
Avsar AF, Keskin HL. Haemorrhoids during pregnancy. J Obstet Gynaecol 2010; 30(3): 231-7.
[http://dx.doi.org/10.3109/01443610903439242] [PMID: 20373920]
[29]
Åhlund S, Rådestad I, Zwedberg S, Edqvist M, Lindgren H. Haemorrhoids - A neglected problem faced by women after birth. Sex Reprod Healthc 2018; 18: 30-6.
[http://dx.doi.org/10.1016/j.srhc.2018.08.002] [PMID: 30420084]
[30]
Gojnic M, Dugalic V, Papic M, Vidaković S, Milićević S, Pervulov M. The significance of detailed examination of hemorrhoids during pregnancy. Clin Exp Obstet Gynecol 2005; 32(3): 183-4.
[PMID: 16433160]
[31]
Hosking SW, Smart HL, Johnson AG, Triger DR. Anorectal varices, haemorrhoids, and portal hypertension. Lancet 1989; 1(8634): 349-52.
[http://dx.doi.org/10.1016/S0140-6736(89)91724-8] [PMID: 2563507]
[32]
Goenka MK, Kochhar R, Nagi B, Mehta SK. Rectosigmoid varices and other mucosal changes in patients with portal hypertension. Am J Gastroenterol 1991; 86(9): 1185-9.
[PMID: 1882798]
[33]
Nasseri YY, Krott E, Van Groningen KM, et al. Abnormalities in collagen composition may contribute to the pathogenesis of hemorrhoids: Morphometric analysis. Tech Coloproctol 2015; 19(2): 83-7.
[http://dx.doi.org/10.1007/s10151-014-1238-5] [PMID: 25381456]
[34]
Willis S, Junge K, Ebrahimi R, Prescher A, Schumpelick V. Haemorrhoids - a collagen disease? Colorectal Dis 2010; 12(12): 1249-53.
[http://dx.doi.org/10.1111/j.1463-1318.2009.02010.x] [PMID: 19614671]
[35]
el-Gendi MA, Abdel-Baky N. Anorectal pressure in patients with symptomatic hemorrhoids. Dis Colon Rectum 1986; 29(6): 388-91.
[http://dx.doi.org/10.1007/BF02555054] [PMID: 3709317]
[36]
Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol 2012; 18(17): 2009-17.
[http://dx.doi.org/10.3748/wjg.v18.i17.2009] [PMID: 22563187]
[37]
Mott T, Latimer K, Edwards C. Hemorrhoids: Diagnosis and Treatment Options. Am Fam Physician 2018; 97(3): 172-9.
[PMID: 29431977]
[38]
Serra R, Gallelli L, Grande R, et al. Hemorrhoids and matrix metalloproteinases: A multicenter study on the predictive role of biomarkers. Surgery 2016; 159(2): 487-94.
[http://dx.doi.org/10.1016/j.surg.2015.07.003] [PMID: 26263832]
[39]
Lohsiriwat V. Anatomy, Physiology, and Pathophysiology of Hemorrhoids. In: Ratto C., Parello A., Litta F.Hemorrhoids Coloproctology. Cham: Springer 2018; pp. 3-7.
[http://dx.doi.org/10.1007/978-3-319-53357-5_2]
[40]
Margetis N. Pathophysiology of internal hemorrhoids. Ann Gastroenterol 2019; 32(3): 264-72.
[PMID: 31040623]
[41]
Goligher JC. Surgery of the Anus, Rectum and Colon. 4th ed. Ballierè Tindal London 1980.
[42]
Sakr M, Saed K. Recent advances in the management of hemorrhoids. World J Surg Proced 2014; 4(3): 55-65.
[http://dx.doi.org/10.5412/wjsp.v4.i3.55]
[43]
Cocorullo G, Tutino R, Falco N, et al. The non-surgical management for hemorrhoidal disease. A systematic review. G Chir 2017; 38(1): 5-14.
[http://dx.doi.org/10.11138/gchir/2017.38.1.005] [PMID: 28460197]
[44]
David E. Beck DE, John L Rombeau JL, Stamos MJ, Nasseri Y The ASCRS Manual of Colon and Rectal Surgery. 1st ed. New York: Springer-Verlag, New York 2009; pp. 232-.
[45]
Sena G, Gallo G, Vescio G, et al. Excisional Haemorrhoidectomy: Where Are We?. Rev Recent Clin Trials 2020. [published online ahead of print, 2020 Mar 19
[http://dx.doi.org/10.2174/1574887115666200319153439]
[46]
Pata F. Pruritus Ani: the neglected stepchild of coloproctology www.siccr.org2017.

Rights & Permissions Print Cite
Article Metrics
232
© 2024 Bentham Science Publishers | Privacy Policy