Hemorrhoids are the most prevalent anal disorder. Hemorrhoids rarely occur in children in their last years, but their incidence increases rapidly with age. Etiology The onset of hemorrhoids is related to anal hygiene and defecation factors, mainly factors that are detrimental to anal health, present in defecation, diet, family life, occupation, etc. The occurrence of hemorrhoids can be caused by cold in the lower back, eating irritating foods, constipation, and straining to defecate.
In men, factors that aggravate hemorrhoids include exertion, alcohol consumption, and irregular life, and in women, pregnancy and childbirth.
Age is also associated with the onset and aggravation of hemorrhoids. The symptoms of hemorrhoids have a tendency to get progressively worse with increasing age. Pregnancy, childbirth, and the onset of hemorrhoids Analysis of pregnancy and childbirth can significantly aggravate hemorrhoids for the following reasons: 1. The compression of the enlarged uterus leads to stagnation of blood in the hemorrhoidal veins: 2. Arterial blood flow increases, and Schottler reported a 25% increase in blood flow in pregnancy. 3. obstruction of bowel movement due to compression of the intestinal canal by the enlarged uterus, hardening of feces and increased straining to defecate; 4. brittle or flaccid tissues in the pelvis, thus prone to injury or inflammation; 5. hormone-related pregnancy hormones such as progesterone and relaxin that dilate blood vessels or soften tissues; 6. changes in dietary activity during pregnancy and lack of exercise leading to blood stasis and constipation that aggravate anal disease. In the middle and late stages of pregnancy, the above tendencies are more pronounced. Therefore, women who are about to be pregnant or in pregnancy, especially those who have previous hemorrhoids, should pay attention to anal hygiene, such as paying attention to keeping the stool open and not overly forceful defecation; eating a high-fiber diet to avoid constipation medicine and avoiding stimulating foods; using laxatives instead of stimulating laxatives; not getting cold below the waist to avoid blood stagnation; and exercising moderately. The etiology of hemorrhoids From early childhood, the submucosal and subcutaneous venous plexuses exist under the mucosa of the rectum and the skin around the anus, respectively, and gradually increase in size to form internal and external hemorrhoids and nuclei, respectively, and develop symptoms. There are three previous theories about the occurrence of nucleus pulposus: varicose veins theory; vascular proliferation theory; and mucosal slippage theory. Thomson’s study of hemorrhoidal tissue in 1975 found a more developed connective tissue around the submucosal vessels in the human rectum, which he called the liner. Thomson referred to this supporting tissue as the lining, which contains the venous plexus and is further supported by the Treitz ligament, which is the ligament between the external longitudinal muscle of the rectum and the levator ani muscle. The Treitz ligament is a thin band of fibrous structures that gradually forms during the descent between the extended internal and external sphincters, runs through the internal sphincter, extends radially along the lower part of the anus, and attaches to the anal epithelium. Thomson proposed the “liner down migration theory”. The submucosal and subcutaneous venous plexus of the anal canal is innate and surrounded by strong connective tissue, which is thick and normal in form and function, so that the plexus does not develop into a venous tumor. As we age, the connective tissue becomes weaker and is destroyed, and over the age of 20 this connective tissue begins to disintegrate and become fractured, and the venous plexus loses its restraint and dilates into hemorrhoids and develops symptoms.