Hemorrhoidal illness represents one of the most common medical conditions in man. The most recent statistics indicate a prevalence of about 25% in the adult population, and higher than 50% for those older than 50. However, the prevalence and incidence are most probably higher, considering the fact that, in certain patients, the illness begins in an asymptomatic fashion.
The origin of hemorrhoidal disease can be either mechanical or vascular (hemodynamic):
According to mechanical theory, the supportive structure of the hemorrhoidal plexus undergoes spontaneous involution which includes excessive laxity and leads to displacement of the internal hemorrhoids. Acute intrarectal or abdominal pressure are worsening factors.
Vascular factors are increasingly recognized as playing an important role in the development of hemorrhoidal disease through alterations of the vascular plexuses and dysfunction of the arteriovenous shunts, the effect of which are amplified, as above, by increased abdominal pressure.
Hemorrhoidal disease is often associated with inflammation. Therefore, the treatment of hemorrhoids has to achieve three objectives: to eliminate mechanical and local triggering factors, to reduce the inflammation, always present in acute manifestations and to reestablish optimal hemodynamic and microcirculatory conditions.
