Skip to main content
SpringerLink
Log in

The pathogenesis of Hemorrhoids

  • Published:
Diseases of the Colon & Rectum

Abstract

The structure of the anal canal was examined in histology slides. Hemorrhoids are normal features of the human anatomy. They are pads that bulge into the lumen. Hemorrhoids have three parts: 1) the lining, which can be mucosa or anoderm; 2) the stroma with blood vessels, smooth muscle, and supporting connective tissue; and 3) the anchoring connective tissue system, which secures the hemorrhoids to the internal sphincter and the conjoined longitudinal coat. The anchoring and supporting connective tissue system deteriorates with aging. The hemorrhoids not only bulge, but descend into the lumen. This becomes observable in the third decade of life, with individual differences. The veins become distended as they lose their support. The descended loose lining becomes more sensitive to pressure from straining and to trauma from the stool. There can be a stasis in the veins, with clot formations and swelling or erosions of the lining, with bleeding. The hemorrhoids become symptomatic.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Stelzner F. Die Hämorrhoiden und andere Krankheiten des Corpus cavernosum recti und des Analkanals. Dtsch Med Wchnschr 1963;88:689–96.

    CAS  Google Scholar 

  2. Thomson WH. The nature of haemorrhoids. Br J Surg 1975; 62:542–52.

    PubMed  CAS  Google Scholar 

  3. Burkitt DP. Hemorrhoids, varicose veins and deep vein thrombosis: epidemiologic features and suggestive causative factors. Can J Surg 1975;18:483–8.

    PubMed  CAS  Google Scholar 

  4. Brondel H, Gondran M. Facteurs pre disposants lies a l'hérédité et a la profession dans la maladie hémorroï daire. Arch Fr Mal App Dig 1976;65:541–50.

    PubMed  CAS  Google Scholar 

  5. Haas PA, Fox TA Jr. The importance of the perianal connective tissue in the surgical anatomy and function of the anus. Dis Colon Rectum 1977;20:303–13.

    PubMed  CAS  Google Scholar 

  6. Haas PA, Fox TA Jr. Age-related changes and scar formations of the perianal connective tissue. Dis Colon Rectum 1979;23:160–9.

    Google Scholar 

  7. Haas PA, Haas GP, Schmaltz S, Fox TA. The prevalence of hemorrhoids. Dis Colon Rectum 1983;26:435–39.

    Article  PubMed  CAS  Google Scholar 

  8. Ackerman LV, Butcher HR. Surgical pathology. 3rd ed. St. Louis: CV Mosby, 1969.

    Google Scholar 

  9. Anderson WA. Pathology 5th ed. St. Louis: CV Mosby, 1966.

    Google Scholar 

  10. Graham-Stewart CW. What causes hemorrhoids? A new theory of etiology. Dis Colon Rectum 1963;6:333–44.

    PubMed  CAS  Google Scholar 

  11. Burkitt DP, Graham-Stewart CW. Haemorrhoids—postulated pathogenesis and proposed prevention. Postgrad Med J 1975; 51:631–6.

    Article  PubMed  CAS  Google Scholar 

  12. Jacobs DM, Bubrick MP, Onstad GR, Hitchcock CR. The relationship of hemorrhoids to portal hypertension. Dis Colon Rectum 1980;23:567–9.

    PubMed  CAS  Google Scholar 

  13. Hirschowitz B. Medical Grand Rounds, University of Alabama Center. South Med J 1969;62:266–74.

    Google Scholar 

  14. Swart B. Überlegungen zur Genese typischer Kollateralkreisläufe bei portalem Hochdruck und deren röntgenologisch-klinische Symptomatologie. Radiologe 1968;8:73–83.

    PubMed  CAS  Google Scholar 

  15. Miles WE. Observations upon internal piles. Surg Gynecol Obstet 1919;29:497–506.

    Google Scholar 

  16. Thulesius O, Gjöres JE. Arterio-venous anastomoses in the anal region with reference to the pathogenesis and treatment of hemorrhoids. Acta Chir Scand 1973;139:476–8.

    PubMed  CAS  Google Scholar 

  17. Wilson PM. Anorectal closing mechanisms. S Afr Med J 1977; 51:802–8.

    PubMed  CAS  Google Scholar 

  18. Gass OC, Adams J. Hemorrhoids: etiology and pathology. Am J Surg 1950;29:40–3.

    Article  Google Scholar 

  19. Jackson CC, Robertson E. Etiologic aspects of hemorrhoidal disease. Dis Colon Rectum 1965;8:185–9.

    PubMed  CAS  Google Scholar 

  20. Tagart REB. Haemorrhoids and palpable ano-rectal lesions. Practitioner 1974;212:221–38.

    PubMed  CAS  Google Scholar 

  21. Strehler BL. Time, cells and aging. New York: Academic Press, 1963:138–45.

    Google Scholar 

  22. Bornstein P. Disorders of connective tissue function and the aging process: a synthesis and review of current concepts and findings. Mech Agein Dev 1976;5:305–14.

    Article  CAS  Google Scholar 

  23. Fine J, Lawes CHW. On the muscle fibers of the anal submucosa with special reference to the pecten band. Br J Surg 1940;27:723–7.

    Google Scholar 

  24. Collopy BT. Internal haemorrhoids: observations on their nature and classification in relation to their management. Aust NZ J Surg 1980;50:167–9.

    CAS  Google Scholar 

  25. Nesselrod JP. Hemorrhoids (letter to Editor). Arch Surg 1974; 109:458.

    PubMed  CAS  Google Scholar 

  26. McGivney J. A reevaluation of etiologic factors of hemorrhoidal disease. Ariz Med 1967;24:333–6.

    PubMed  CAS  Google Scholar 

  27. Hansen HH. Neue Aspekte zur Pathogenese und Therapie des Hämorrhoidalleidens. Dtsch Med Wchnschr 1977;102:1244–8.

    Article  CAS  Google Scholar 

  28. Lord PH. Approach to the treatment of anorectal disease with a special reference to hemorrhoids. Surg Annu 1977;9:195–9.

    PubMed  CAS  Google Scholar 

  29. Eisenhammer S. Internal anal sphincterotomy plus free dilatation versus anal stretch with special criticism of the anal stretch procedure for hemorrhoids: the recommended modern approach to hemorrhoid treatment. Dis Colon Rectum 1974;17:493–522.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Henry Ford Hospital, 2799 West Grand Boulevard, 48202, Detroit, Michigan

    Peter A. Haas M.D., Thomas A. Fox Jr. M.D. & Gabriel P. Haas M.D.

Authors
  1. Peter A. Haas M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas A. Fox Jr. M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gabriel P. Haas M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Read at the meeting of the American Society of Colon and Rectal Surgeons, San Francisco, California, May 2 to 6, 1982.

About this article

Cite this article

Haas, P.A., Fox, T.A. & Haas, G.P. The pathogenesis of Hemorrhoids. Dis Colon Rectum 27, 442–450 (1984). https://doi.org/10.1007/BF02555533

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02555533

Key words

Search

Navigation