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What causes hemorrhoids?

A new theory of etiology


There are two main types of hemorrhoids—vascular and mucosal. Vascular piles, occurring most commonly in young men, are caused by straining at defecation, when the anal sphincter relaxes, subjecting the anorectal tissues to a high pressure gradient. The superior hemorrhoidal plexus is filled initially by blood which is forced at very high pressure from the superior rectal venous radicles lying in the lower part of the ampulla of the rectum. Distention of the plexus is limited and is confined to the veins of the upper part of the anal canal by a tube-valve mechanism which also has a similar, but less direct, effect on the inferior rectal veins.

Mucosal piles, usually found in pregnant women and the aged, are caused by deterioration of the function of the anal sphincter muscle.

There is no evidence that any other etiologic factor is of significance in the causation of piles.

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  1. Alberti, M.: Tractatus de Haemorrhoidibus. Halae, 1722.

  2. Allingham, W. and H. W. Allingham: Diagnosis and Treatment of Diseases of the Rectum. Ed. 6, London, Baillière, Tindall and Cox, 1896.

    Google Scholar 

  3. Avicenna: Liber Canonis de Medicinis Cordialibus et Cantica. Folio, Venet, apud. Juntas, 1595, Liber 3, p. 353.

  4. Bacon, H. E.: Anus, Rectum, Sigmoid Colon. Philadelphia, J. B. Lippincott Company, 1949, vol. 1, p. 445.

  5. Best, C. H. and N. B. Taylor: The Physiological Basis of Medical Practice: A Text in Applied Physiology. Ed. 5, Baltimore, The Williams & Wilkins Company, 1950, p. 583.

    Google Scholar 

  6. Bodenhamer, W.: A Theoretical and Practical Treatise on the Hemorrhoidal Disease Giving Its History, Nature, Causes, Pathology, Diagnosis and Treatment. New York, William Wood & Company, 1884, 307 pp.

    Google Scholar 

  7. Copeland, T.: Diseases of the Rectum. Ed. 2, London, J. Callow, 1814.

    Google Scholar 

  8. Creamer, B.: Unpublished data.

  9. Creamer, B., G. K. Harrison and J. W. Pierce: Further observations on the gastro-esophageal junction. Thorax14: 132, 1959.

    PubMed  CAS  Article  Google Scholar 

  10. Dale, W. A.: Ligation of the inferior vena cava for thromboembolism. Surgery43: 24, 1958.

    PubMed  CAS  Google Scholar 

  11. Dupuytren, G.: Leçons orales de clinique chirurgicale. Bruxelles, Dumont, 1836, vol. 1, p. 168.

    Google Scholar 

  12. Duret: Recherches sur la pathogénie des hémorrhoïdes. Arch. gen. Med.144: 641, 1879.

    Google Scholar 

  13. Floyd, W. F. and E. W. Walls: Electromyography of the sphincter ani externus in man. J. Physiol.122: 599, 1953.

    PubMed  CAS  Google Scholar 

  14. Gass, O. C. and J. Adams: Hemorrhoids: Etiology and pathology. Am. J. Surg.79: 40, 1950.

    PubMed  Article  CAS  Google Scholar 

  15. Gaston, E. A.: The physiology of fecal continence. Surg., Gynec. & Obst.87: 280, 1948.

    CAS  Google Scholar 

  16. Graham-Stewart, C. W.: Haemorrhoids and carcinoma of the rectum. Surg., Gynec. & Obst.115: 89, 1962.

    CAS  Google Scholar 

  17. Hartmann, H. and E. Lieffring: Note sur re rôle du bacterium coli commune dans certaines affections de l’anus. Bul. Soc. anat. Paris7: 69, 1893.

    Google Scholar 

  18. Hartmann, H. and E. Lieffring: Nouvelle contributions à l’étude du rôle du bacterium coli dans les affections de la région anorectale. Bull. Soc. anat. Paris7: 161, 1893.

    Google Scholar 

  19. Hill, J. R., M. L. Kelley, Jr., J. F. Schlegel and C. F. Code: Pressure profile of the rectum and anus of healthy persons. Dis. Colon & Rectum3: 203, 1960.

    Article  CAS  Google Scholar 

  20. Hiller, R. I.: Internal hemorrhoids: Their pathogenesis and the rationale of injection therapy. Am. J. Surg.16: 64, 1932.

    Article  Google Scholar 

  21. Le Dran, H. F.: The Operations in Surgery of Monsieur Le Dran (translated by T. Gataker). London, Hitch and J. Dodsley, 1749, p. 173.

    Google Scholar 

  22. de Montègre, A. F. J.: Des hémorrhoïdes, ou traité analytique de toutes les affections hémorrhoïdales. Ed. 2, Paris, 1830.

  23. Morgagni, G. B.: Seats and Causes of Diseases (1749). Letter 32, Article 10 (translated by Benjamin Alexander). London, A. Millar, 1769, vol. 2, p. 105.

    Google Scholar 

  24. Nesselrod, J. P.: Clinical Proctology. Ed. 2, Philadelphia, W. B. Saunders Company, 1957, 296 pp.

    Google Scholar 

  25. Parks, A. G.: The surgical treatment of haemorrhoids. Brit. J. Surg.43: 337, 1956.

    PubMed  Article  CAS  Google Scholar 

  26. Pennington, J. R.: A Treatise on the Diseases and Injuries of the Rectum, Anus and Pelvic Colon. Philadelphia, P. Blakiston’s Son & Co., 1923, 933 pp.

    Google Scholar 

  27. Petit, J. L.: Traité des maladies chirurgicales et des opérations. Paris. Mequignon, 1790, vol. 2, p. 70.

    Google Scholar 

  28. Quénu, E.: Etude sur les hémorrhoïdes: Anatomie pathologique. Rev. chir., Paris13: 169, 1893.

    Google Scholar 

  29. Quénu, E. and H. Hartmann: Chirurgie du rectum. Anatomie; exploration; rectites; blenorrhagie; syphilis, tuberculose; abcès; fistules; rétrécissements; hémorrhoïdes: ulcérations. Paris, G. Steinheil, 1895, 460 pp.

    Google Scholar 

  30. Récamier, C. A.: Essai sur les hémorrhoïdes. Paris, Brosson, 1800.

    Google Scholar 

  31. Stahl, G. E.: Medicinae dogmatico—systematicae (1707), sectio 2, 1. 159, in his Theoria Medica Vera, 1708; Halae.

  32. Taylor, F. W.: Portal tension and its dependence on external pressure. Ann. Surg.140: 652, 1954.

    PubMed  Article  CAS  Google Scholar 

  33. Turell, R.: Treatment in Proctology. Baltimore, Williams & Wilkins, 1949, p. 114.

    Google Scholar 

  34. Turell, R.: Present status and modern treatment of hemorrhoids. New York J. Med.56: 2245, 1956.

    PubMed  CAS  Google Scholar 

  35. Verneuil: L’anatomie des hémorrhoïdes. Bull. Soc. anat. Paris30: 175, 1855.

    Google Scholar 

  36. Verneuil: L’anatomie pathologique des hémorrhoïdes. Bull. Soc. anat. Paris30: 191, 1855.

    Google Scholar 

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Abridgment of thesis accepted by the University of London in partial fulfillment of the requirements for the degree of Master of Surgery.

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Graham-Stewart, C.W. What causes hemorrhoids?. Dis Colon Rectum 6, 333–344 (1963).

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  • Anal Sphincter
  • Anal Canal
  • Hemorrhoid
  • External Sphincter
  • Mucosal Prolapse