Anal pressure measurements in the study of hemorrhoid etiology and their relation to treatment

Abstract

The etiology of hemorrhoids has been explained in the past based on anatomic principles, but this study examines the relationship of resting anal pressures to hemorrhoid etiology in 38 patients with hemorrhoids and 29 controls with no perianal symptoms. Three months after treatment by elastic band ligation, anal pressures were again measured in the hemorrhoid group. Anal pressures were significantly higher in the hemorrhoid group before treatment (102 +/- 26.33 mmHg) as compared with the controls (76.75 +/- 19.56 mmHg) (P less than .001). Three months following elastic band ligation there was a small drop in anal pressure (100 +/- 26.84 mmHg) but it remained significantly higher than the control group. There was also a significant correlation between symptoms and level of anal pressures. The results indicate that persons with hemorrhoids have higher anal pressures than controls. Elastic band ligation relieves the symptoms but should not affect the anal sphincter pressure. The fact that the anal pressures remained high after treatment could imply that higher pressures are an etiologic component in the formation of hemorrhoids.

The Vascular Nature of Hemorrhoids

“…Resting pressure measurements of the anal sphincter in patients with hemorrhoids provided strong evidence for an existing correlation between the development of hemorrhoids and the increased internal anal sphincter pressure. [7][8][9][10]12,[21][22][23][24] The raised pressures have been discussed controversially as being an etiologic factor rather than a consequence of hemorrhoidal piles. 7,24 Our investigation of the vascularity of the CCR revealed significant changes in the arterial inflow of the CCR in patients with hemorrhoids.…”

Pathophysiology of Hemorrhoidal Disease

“…These patients had a fall in their resting pressures following treatment for the hemorrhoids, but still remained higher than asymptomatic controls. The magnitude of the pressure elevation did not correlate with the duration of symptoms or degree of prolapse [9,10,11,12]. …”

The evaluation and physiologic assessment of hemorrhoidal disease: a review

“…Their prevalence varies between 0% and 100% [8,18]. Like slow waves, they persist even after general anesthesia and skeletal muscle relaxation [21], but disappear after sphincterotomy [13]. Although Kerremans [18] demonstrated abnormal spiking activity on internal sphincter electromyography in only one patient, in a larger series, Farouk et al [22] found no difference between patients and control subjects.…”

“…Prolapsing hemorrhoids are associated with lower resting pressures than are non-prolapsing hemorrhoids [8][9][10]. The pressure reverts to normal after hemorrhoidectomy [6,[11][12], although not after rubber band ligation [9,13] or cryosurgery [5]. Perhaps this may explain why hemorrhoidectomy relieves symptoms more effectively than does rubber band ligation [14].…”