HEMORRHOID DISEASE: DIAGNOSIS TREATMENT AND COMPLICATION MANAGEMENT

Hemorrhoidal_Disease_Bahadir_Egekapak

PATHOPHYSIOLOGY OF HEMORRHOIDAL DISEASES

Onur Coşkun

Ankara Etlik City Hospital, Department of General Surgery, Ankara, Türkiye

Coşkun O. Pathophysiology of Hemorrhoidal Diseases. In: Ege B, editor. Hemorrhoidal Disease: Diagnosis, Treatment and Complication Management. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.23-28.

ABSTRACT

Hemorrhoidal diseases have their earliest references in ancient biblical texts, as well as writings from Egypt, Greece, and Babylon, with Hippocrates contributing a significant treatise on the pathophysiology and treatment of hemorrhoidal disorders. Throughout history, numerous scholars have endeavored to elucidate the pathophysiology of this symptomatic condition. Despite these efforts, the physiopathology of hemorrhoidal diseases has not been completely clarified. Hemorrhoidal diseases are among the most prevalent ano-rectal conditions, defined as the symptomatic enlargement and displacement of the vascular cushions distally. This condition impacts millions globally, posing significant medical and socioeconomic challenges. Many factors have been implicated in its etiology, with major contributors including constipation and prolonged defecation. Key findings associated with this disease feature abnormal dilation and distortion of the vascular structures, distortion of the supporting connective tissue, inflammatory reactions, and vascular hyperplasia. The etiology and pathophysiology of hemorrhoidal diseases remain inadequately understood, necessitating further advanced research. In the past decade, significant findings related to its anatomy and histopathology have emerged; however, the interrelationships between these findings remain unclear. A fundamental issue underlying this confusion is the uncertainty regarding whether the obtained findings represent primary causes of the disease or secondary effects. The epidemiology of hemorrhoidal disease, mechanisms by which asymptomatic hemorrhoids transition into symptomatic conditions, and optimal approaches according to disease stages are still not comprehensively understood. Discussions continue regarding the histological changes in patients, the physiological mechanisms at play, and their associations with the portal venous system. While the starting and ending points of the disease remain somewhat ambiguous, the widely accepted mechanism explains the displacement of hemorrhoidal cushions with connective tissue towards the distal region, ultimately leading to structural deterioration of the connective tissue. This process decreases venous return from the sinusoidal structures, resulting in congestion within the dilated plexuses.

Keywords: Hemorrhoid; Physiopathology; Defecation; Congestion; Constipation

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