Most experts believe that hemorrhoids are the result of a variety of factors acting over time. And how do they cause hemorrhoids to occur?
He is a foreigner, 55 years old, a famous American pianist, who was invited to perform in Beijing. Two days before the performance stopped by to learn more about Beijing’s culture and see the sights. After running all day on the first day, he suddenly had a problem at night, with unbearable anal pain that made it impossible to move. The organizers were afraid of delaying the performance and sent him to the hospital overnight. I took a look at the swollen purple bumps around the anus, and the anus was so squeezed that I couldn’t see it – a mixed hemorrhoid was embedded and had to be operated on immediately, otherwise there was a possibility of necrosis. I prepared a thin hollow pad for the pianist to put on the seat, and he played three pieces in a row without looking like he had just had surgery, and the performance was a great success! The long walk and overexertion caused an acute attack of hemorrhoids in him.
This acute attack of hemorrhoids is predominantly thrombosed external hemorrhoids or inflammatory external hemorrhoids, this is an extreme example, in fact most hemorrhoids will have a slow formation process.
There is no universally accepted theory about the formation of hemorrhoids, and most experts believe that hemorrhoids are the result of a variety of factors acting over time. And how do they cause hemorrhoids to occur? I believe that hemorrhoids are like balloons that are blown up.
How do hemorrhoids form? –Balloons that are “blown up
We all blow up balloons, and to blow up a balloon there must be several prerequisites and one cannot be missing.
1, to keep blowing into the air, the harder, the more gas blown in, the larger the balloon.
2, can not be broken, the leakage of gas is greater than the gas blown into the balloon, the balloon will not be blown.
3, the pressure outside the balloon can not be too large, if we put the balloon in a wine bottle to blow, certainly not blow.
On the contrary, if the balloon continues to rise, the atmospheric pressure is getting smaller and smaller, even if not blowing, the balloon will also become larger.
So what is the relationship between the onset of hemorrhoids and this blowing balloon in the end? Let’s take a look at what the “balloon” near the anus is.
In the anorectum near the distribution of two vascular network, respectively, the rectal plexus at the lower end of the rectum and the anal plexus at the edge of the anus, these two venous plexus is like two balloons. Normally they bear the local venous blood recycling in the anorectum, but under the action of some factors they become bigger and they become hemorrhoids. Internal hemorrhoids are formed when the rectal plexus is overexpanded, external hemorrhoids are formed when the anal plexus is overexpanded, and mixed hemorrhoids are formed when both plexuses are dilated at the same time. Here’s a look at how these two “balloons” are “blown” up.
1, into the “gas” excessive
Here the “gas” refers to the supply of rectal and anal local arterial blood.
(1) arterial blood vessels dense
There are three arteries supplying rectal blood, namely the middle sacral artery, the superior rectal artery and the inferior rectal artery, all of which come from the abdominal aorta, the largest blood vessel in the abdominal cavity. Among these three branches, the most important one is the superior rectal artery, which runs through the whole rectum from top to bottom and forms three densely distributed areas in the left middle, right front and right back of the lower rectum (3, 7 and 11 o’clock in the truncated position); these three blood vessels are like three mouths blowing “air” to the rectal plexus continuously and forcefully. If there is a problem with venous reflux, the local veins will be “blown” large, forming internal hemorrhoids. Most of the internal hemorrhoids we see clinically are located in these three areas, so these three areas are also known as the mother hemorrhoid area.
(2) Spicy diet stimulation
We all know that you can get hemorrhoids from eating too much spicy food, but what causes it is not known.
It turns out that spicy foods can increase the local blood supply. Normally, the transition between arteries and veins is through a capillary network, but there is a large number of direct arteriovenous anastomoses localized in the lower rectum and anus. Because these pathways are not always open, the local area does not present an abnormal blood supply. When suddenly ingesting a lot of spicy food, the capsaicin and other ingredients contained in it will stimulate these pathways and make them open, leading to an increase in local blood supply, thus “blowing” the large local venous plexus to form hemorrhoids.
2, out of the “gas” blocked
The “gas” here refers to the reflux of venous blood. For the local venous plexus, if the amount of blood in is greater than the amount out, it is possible to make it expand to form hemorrhoids, just like a leak-free balloon is easy to be blown up. Obstruction of venous blood return is the most important factor in the development of hemorrhoids.
(1) Sphincter obstruction
Veins in the return path to traverse the rich group of anal sphincter muscles, even in the resting state the internal sphincter will maintain a certain tension, not to mention that these muscles will continue to repeatedly contract during defecation; if stimulated by inflammation, the internal sphincter will also spasm. Therefore, the sphincter becomes one of the most important obstacles to venous return.
(2) Vascular defects
There are venous valves in other parts of the body, and the function of these valves is similar to that of the mitral and tricuspid valves in the heart, which can keep the blood flowing in one direction. There is no such valve in the lower rectal vein, which leads to a lack of power and protection for the forward flow of blood in the vein, easily causing local blood stagnation.
(3) Position defect
People are in upright position, and the anus is located at the lowermost end of the entire body cavity, where the pressure is greatest. The anal vein has to return to the lungs, and the rectal vein has to return to the liver, both of which belong to swimming against the current. If there is not enough power it is easy to stay in the local area and increase the burden of local blood vessels.
(4)Bad body position
All three of these obstacles belong to their own problems, providing the possibility of hemorrhoids, but it is not true that with these three points you will definitely develop hemorrhoids, the incidence of hemorrhoids is not to the extent of 100%. These are arguably only internal causes, and the eventual formation of hemorrhoids requires the action of external causes.
The most important of the many external factors is the position, squatting and sitting puts the anal venous reflux in a more unfavorable situation. Therefore squatting down to defecate, squatting down to work, squatting down to sit in the bath and so on time should not be too long. Sitting for a long time also, like professional drivers, IT personnel, a sitting is not moving for hours, the risk of hemorrhoids will greatly increase.
(5) Forceful bowel movements
When we are constipated, we will force to defecate, and at this time we will hold our breath, the diaphragm will drop, and the abdominal pressure will instantly and dramatically increase, making venous return more difficult. At the same time, the dry and hard stool will squeeze the blood vessels, resulting in obstruction of blood return.
(6) Pregnant women
The uterus is tightly connected to the rectum and is located in front of it. When the fetus grows gradually, the uterus slowly becomes larger and compresses the rectum, causing difficulties in venous reflux. According to incomplete statistics, the incidence of hemorrhoids in pregnant women is more than 30% higher than in the rest of the population.
(7) Disease compression
Lower abdominal tumor, hypertension, cirrhosis of liver, chronic inflammation of anorectum, etc. are all factors of venous reflux obstruction.
3.Extra-tubular pressure drop
When releasing the balloon, the balloon will become larger and larger as it continues to rise. This is because the more you go into the air, the lower the atmospheric pressure, then in order to maintain the balance of internal and external pressure, the balloon will become larger. The same is true for changes in the size of venous vessels, which expand because the pressure outside the tube drops.
(1) Submucosal laxity of the rectum
The rectal plexus is located in the submucosa of the rectum, and the surrounding tissues are very lax. If the mucosa is lax, the extravascular restriction factor disappears, and it will easily dilate to form hemorrhoids when it encounters some triggers.
(2)Excessive defecation state
Normally, the internal anal sphincter maintains a certain tension, and the veins here are generally difficult to expand due to the restriction of this tension. But when defecating, the anal sphincter is in a relaxed state, the venous plexus here will expand, and over time the elasticity decreases and cannot be retracted to become hemorrhoids.
(3) Damaged sphincter relaxation
We find severe hemorrhoids in many people with damaged anal sphincter, such as post-anal fistula and congenital absence of anal sphincter. The reason for this is because of a decrease in anal canal pressure and a relative increase in intravenous pressure, resulting in vasodilation.