Pathogenesis (development of disease)
The mechanism in the development of hemorrhoids is the enlargement of the vascular cushions (superior hemorrhoidal plexus or the corpus cavernosum recti) and their prolapse (prolapse) into the anal canal (last section of the rectum) by increased and difficult defecation (defecation). The latter is now being questioned.
Currently, the hemorrhoidal plexus is thought to be progressively displaced distally (“away from the center of the body”) (“sliding anal lining” theory) due to a breakdown of muscular and elastic fibers. However, these processes may also be partly caused by pressing.
Furthermore, reduced stability of the connective tissue could also be responsible for the development of hemorrhoidal disease. Patients with hemorrhoidal disease showed a significantly lower ratio of collagen I/III and thus a less stable connective tissue than in the control group. Collagen type I is a mechanically stable collagen and collagen type III is a fragile collagen.
Note: A much higher proportion of collagen type III was also found in patients with herniation (“hernia sac formation”) or aortic dissection (synonym: aneurysm dissecans aortae; acute splitting (dissection) of the wall layers of the aorta (main artery)).
Etiology (Causes)
Biographic Causes
- Connective tissue insufficiency (connective tissue weakness).
Behavioral causes
- Nutrition
- Incorrect diet – low in fiber and liquid and high in fat.
- Sitting and standing for long periods
- Sitting working posture
- Increased pressing during defecation (during bowel movements) due to constipation (constipation)
- Overweight (BMI ≥ 25; obesity/obesity) – Body mass index correlated significantly with a lower ratio of collagen I to III (p < 0.03)
Disease-related causes
- Constipation
- Portal hypertension (portal hypertension; portal hypertension) – elevation of blood pressure due to liver disease such as cirrhosis – nodular remodeling of the liver with loss of function.
- Sphinctersklerose – rigidity of the sphincter muscle.
- Sphincter spasm (sphincter spasm).
- Tumors in the pelvic area
Other causes
- Pregnancy and childbirth