The evaluation and physiologic assessment of hemorrhoidal disease: a review

Abstract

The term hemorrhoids in generally used to describe "symptomatic hemorrhoids". A Medline review of the literature on anatomy, physiology and post-hemorrhoidectomy changes was performed and summarized in this review.

Anatomical branches of the superior rectal artery in the distal rectum

“…When nonsymptomatic it is referred to by the term ‘anal cushions’ which consist of vascular tissue in a stroma of connective tissue and smooth muscle fibres within the anal canal. The anal cushions fulfil four main functions [4]. By their approximation they contribute to anal canal closure and thus continence; they provide 15–20% of resting anal pressure; they protect the sphincter mechanism during evacuation and they form a compressible lining, facilitating closure of the anal canal.…”

Can the procedure for prolapsing hemorrhoids (PPH) be done twice? Results of a porcine model

“…For instance, staple line bleeding was reported in £ 70% of patients undergoing PPH [24], whereas it is uncommon in excision hemorrhoidectomy [5]. Some cases of prolonged postoperative anal pain were also reported following PPH [7], although the reason for this pain is not known and this observation has not been replicated in other randomized controlled trials.…”

Pathologie hémorroïdaire : de la physiopathologie à la clinique

“…Des études sur cadavres ont d'ailleurs montré que la configuration classique décrite ci-dessus en trois paquets ne concernait que moins de 20 % des sujets [1]. On ignore la fonction précise des hémorroïdes, mais elles jouent très certainement un rôle dans la continence fine, notamment en assurant 15 à 20 % de la pression anale de repos [2]. Les hémorroïdes sont considérées comme pathologiques lorsqu'elles deviennent symptomatiques ou cliniquement parlantes.…”