CAUSES AND RISK FACTORS OF HEMORRHOIS

Causes

Common causes:

• Hemorrhoidal bulging and distension into the lumen of the anal canal results from deterioration of connective tissue that supports hemorrhoids and occurs as a normal part of aging
• Conditions that increase intraabdominal pressure may accelerate deterioration of supporting connective tissue and prolapse of the anal canal, which is known as the sliding anal canal theory. Vessels become distended as they lose support

Serious causes:

• Any cause of portal hypertension such as cirrhosis can worsen hemorrhoidal vein pressure. A misconception is that rectal varices are a cause of hemorrhoidal disease. In patients with liver disease, varices may occur because of the dual blood supply to the rectum. When viewed endoscopically, rectal varices occur in the rectum and hemorrhoids are located in the anus. In such cases, treatment of the liver disease and portal system decompression is the primary goal

Risk factors

• Increased abdominal pressure as a result of ascites or pregnancy
• Diarrhea
• Pregnancy
• Childbirth is associated with thrombosed and prolapsed hemorrhoids
• Heavy lifting
• Prolonged sitting
• Conditions resulting in Valsalva maneuver such as chronic cough, straining related to constipation, or prostatism
• Anal intercourse

Associated disorders

• Anal fissures may occur simultaneously as the risk factors are similar
• Pruritis ani, or perianal itching, occurs as a result of perianal wetness from prolapse or difficult hygiene. Additionally, some hemorrhoidal creams and suppositories may worsen this symptom

Screening

Not applicable.

Primary prevention

Summary approach

Dietary modifications and high-fiber and high-fluid diets are the best measures for hemorrhoid prevention.

Preventive measures

• Patients should be advised to eat a diet high in fiber, low in fat, and to drink fluids liberally
• Patients should be advised to avoid anal intercourse or limit partners to minimize anorectal complications