Hemorrhoids

Cushions of submucosal tissue

containing venules, arterioles, and
smooth muscle fibers that are located
in the anal canal (Schwartz)
Swollen and inflamed veins around the
anus or in the lower rectum (NIDDK)
Part of the continence mechanism and
aid in complete closure of the anal
canal at rest (Schwartz)
Brunicardi FC. Schwartzs principles of surgery. 10th Ed. USA: McGraw-Hill Education; 2015
National Institute of Diabetes and Digestive and Kidney Diseases. Hemorrhoids. NIH publication.
2010 (cited 2017 Mar 29). 11(3021):1-5 (Available from: https://www.niddk.nih.gov/-/
media/22C3E16BCDC64F13B58DD6DCB844428A.ashx)
 Netter FH. Atlas of
human anatomy. 6th
Ed. Philadelphia:
Saunders Elsevier;
2014
 Netter FH. Atlas of
human anatomy. 6th
Ed. Philadelphia:
Saunders Elsevier;
2014
 Putz, R., Pabst, R., Putz, R.
Bedoui, S. Sobotta Atlas of
human anatomy. 14th ed.
Munchen: Elsevier, Urban &
Fischer; 2009
Putz, R., Pabst, R., Putz, R. Bedoui,
S. Sobotta Atlas of human
anatomy. 14th ed. Munchen:
Elsevier, Urban & Fischer; 2009
 Putz, R., Pabst, R., Putz, R.
Bedoui, S. Sobotta Atlas of
human anatomy. 14th ed.
Munchen: Elsevier, Urban &
Fischer; 2009
 Pathophysiology of Hemorrhoid
Varicose veins in the anal canal
Sliding anal canal lining
The supporting tissues of the anal cushions
disintegrate or deteriorate
Abnormal downward displacement of the anal
cushions venous dilatation
The anal cushions show significant pathological
changes: abnormal venous dilatation, vascular
thrombosis, degenerative process in the
collagen fibers and fibroelastic tissues, distortion
and rupture of the anal subepithelial muscle

Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. 2012 (cited
2017 Mar 29). 18(17):2009-2017 (Available from: http://
www.wjgnet.com/esps/DownLoadFile.aspx?Type=Digital&SubType=1&DOI=10.3748%2Fwjg. v18.i17.2009&FilePa
 Thomson and Corman :

1. Deterioration of the anchoring connective

tissue, as described by Thomson.
2. Downward displacement or prolapse of
the hemorrhoidal tissue.
3. Abnormal distention of the arteriovenous
anastomoses within the cushions.
4. Abnormal dilatation of the veins of the
internal hemorrhoidal venous plexus.

Ganz RA. Perspective in clinical gastroenterology and hepatology. Clinical Gastroenterology And
Hepatology. 2013 (cited 2017 Mar 29). 11:593-603 (Available from:
http://www.nghd.pt/nghd/images/treatmet_of_hemorroides_clin.gast.hepat._jun.pdf)
 Studies...
The terminal branches of the superior rectal
artery supplying the anal cushion in patients with
hemorrhoids had a significantly larger diameter,
greater blood flow, higher peak velocity and
acceleration velocity
Hemorrhoids contained remarkably dilated, thin-
walled vessels within the submucosal
arteriovenous plexus, with absent or nearly-flat
sphincter-like constriction on the vessels (Aigner
et al)
Resting anal pressure in patients with
nonprolapsing or prolapsing hemorrhoids was
much higher than in normal subjects, whereas
there was no significant change in the internal
sphincter thickness (Sun et al)
Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. 2012 (cited
2017 Mar 29). 18(17):2009-2017 (Available from: http://
www.wjgnet.com/esps/DownLoadFile.aspx?Type=Digital&SubType=1&DOI=10.3748%2Fwjg. v18.i17.2009&FilePa
Classification
 Townsend CM, Beauchamp RD, Evers BM,
Mattox KL. Sabiston textbook of surgery. 20th
Ed. Philadelphia: Elsevier; 2017
Lohsiriwat V. Hemorrhoids: from basic
pathophysiology to clinical management.
World J Gastroenterol. 2012 (cited 2017 Mar
29). 18(17):2009-2017 (Available from:
http://www.wjgnet.com/esps/DownLoadFile
.aspx?Type=Digital&SubType=1&DOI=10.374
8%2Fwjg. v18.i17.2009&FilePath=Pub%5C10
.3748%5Cv18%5Ci17%5CWJG-18-2009.pdf
)
Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston textbook of surgery. 20th Ed. Philadelphia: Elsevier;
2017
Brunicardi FC. Schwartzs principles of surgery.
10th Ed. USA: McGraw-Hill Education; 2015
Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston textbook of surgery. 20th Ed. Philadelphia: Elsevier;
2017
Brunicardi FC. Schwartzs
principles of surgery. 10th
Ed. USA: McGraw-Hill
Education; 2015
 Townsend CM, Beauchamp
RD, Evers BM, Mattox KL.
Sabiston textbook of
surgery. 20th Ed.
Philadelphia: Elsevier; 2017
 Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. 2012 (cited
2017 Mar 29). 18(17):2009-2017 (Available from: http://
www.wjgnet.com/esps/DownLoadFile.aspx?Type=Digital&SubType=1&DOI=10.3748%2Fwjg. v18.i17.2009&FilePa