HEMORRHOIDS

The term "hemorrhoid" comes from ancient Greek (haima = blood and thoos = leakage) hence being literally translated as "hemorrhage", in relation to the most important symptom in this condition.

Though the disorder has been known even to the ancients (Hippocrates, Celse, Äeticus cured hemorrhoids using cauterization or ligatures), they were still many controversies regarding this condition.

What are hemorrhoids ?

The hemorrhoids were classically described as variceal dilations (just like the varices of the lower limbs) of the anorectal veins; it is nowadays considered that the existence of such anal venous dilations (and especially of the internal haemorrhoidal plexus) is a naturally-occurring morphologic phenomenon, since these venous dilations are constantly found in all humans, known as the "physiological hemorrhoids" with a crucial role in sealing the opening of the anal duct, and hence in the fine continence of flatulence.

Why does the disorder occur in them ?

It is deemed that these haemorrhoidal dilations anatomically normal become pathological (that is, a disease), only if they are clinically manifested with signs, symptoms and complications occurring as a consequence of the interaction with pathogen factors (that is, factors leading to the disease); such pathogen factors may be functional, infectious, dysmetabolic or dysendocrine.

Based on these assertions it is deemed that under the influences of such various pathogens there is an alteration of the structure and nutrition of the haemorrhoidal vein walls leading to the transformation of the normal venous dilations (physiological) into pathological dilations (diseased), considering their number, diameter and convergence.

As a result there are disorders of the local blood supply, and mainly stasis (stagnation of the blood), which aggravates secondarily the venous wall lesions, accentuating the dilation, and also favor bleeding and thrombosis (clotting of the stagnated blood), leading to the apparition of signs and complications of haemorrhoidal disease (bleeding, prolapse, leaks, etc.).

How do hemorrhoids occur ?

The internal haemorrhoidal physiological dilations (normal) are fixed and kept in their normal position (3-4 cm inside the anal duct) by a muscular/fibrous/elastic tissue which often degenerates with advancing age.

This trend was noted starting at the third decade (after the age of 30 years).

The deterioration of the sustaining tissue leads to an abnormal laxity (mobility) of the main sustention of hemorrhoids, no longer attached to profound structures in the anal duct.

The hemorrhoids may hence "move" when the pressure within the rectum increases (constipation, difficult defecation). The tissue gets broken in the maximal fixation point, so that the hemorrhoids are permanently prolapsed ("fallen") in the anal duct.

The prolapse is actually one of the characteristic symptoms of the disease.

Secondarily, the prolapse leads to the distention of the vascular component, leading to increases in the size of hemorrhoids.

Finally the mobilization and distention lead to friability of the mucosa covering the internal haemorrhoidal plexus; it may easily break especially when constipated, leading to bleeding. The second symptom of hemorrhoids is actually this bleeding.

The genetic determination (“family inheritance”) of the degeneration of the supporting tissues of internal hemorrhoids might plausibly explain why there is an increased incidence of hemorrhoids in certain families.

Why are the symptoms intermittent ?

The natural history of the hemorrhoid disorder includes intermittent “silent” intervals and intervals characterized by specific symptoms.

There is no precise correlation between the size of hemorrhoids and their clinical echo, since large hemorrhoids may evolve with no symptoms while smaller hemorrhoids may be responsible for major bleeding and discomfort.

The occasional aggravation of physiopathological (constipation, spice and alcohol abuse, etc.) and vascular mechanisms leading to the intermittence of clinical symptoms in hemorrhoid disorders might also be explained by the over-addition of inflammation usually associated to the acute disorder. These inflammatory disorders result in the known symptom association (pain, edema, bleeding), making the patient seek medical advice.

The various favoring factors randomly interfering in variable quantities lead to the intermittent symptoms and to acute aggravations, like for instance the haemorrhoidal crisis.