Hemorrhoids
Alexander Liss
Symptoms of Hemorrhoids were identified
long ago, sufferers are ready to pay well for its cure, but neither cure nor a
satisfactory explanation of this phenomenon is known.
Many describe Hemorrhoids as bulging of
veins in anal area; when it is inside (internal Hemorrhoids), it is not
painful, but outside (external Hemorrhoids) it could be painful. The picture
could be complicated with prolapse of the rectum.
During defecation, these bulged veins could be damaged.
Bulged veins expand during defecation and
often shrink soon after that. It is not clear what causes such expansion and
contraction. If it is high blood pressure in them, then why it does not cause
immediate outflow of blood via system of veins?
Hemorrhoids
sufferers sometimes observe arterial blood in their stool, which should not be
in veins.
Hence,
limiting explanation to veins is unrealistic.
Some
define Hemorrhoids as dilated arteriovenous complexes
and explain it with the vascular cushion theory:
"Anatomically,
anal cushions exist within the submucosa of the anal
canal; they contain blood vessels (e.g. arterioles, venules,
arteriolar-venous shunts), muscle, and connective
tissue. These vascular cushions, found at the anorectal
junction above the dentate line, are anatomically normal. The vascular cushions
are present in adults, in children, and even in the embryo. Apparently, the
distal displacement of these cushions by loss of their supportive structure
leads to hemorrhoids, which may prolapse, bleed, or thrombose."
"Loss
of the supportive structure" is a theme of some other current theories.
Symptoms
of Hemorrhoids often appear and disappear for awhile only to come back later.
Sometimes they disappear for good, especially when they appear as a side-effect
of pregnancy. How could this be with a permanent disorder of veins or
supportive structure?
One crucial element is absent in currently
accepted theories of Hemorrhouids.
There
are (circular) sphincter muscles, which are present in anorectal
area. When sphincter squeezes the rectum, it squeezes arteries and veins.
Many questions can be answered from
analysis of dynamics of blood flow in presence of arteriovenous
complexes in a sphincter area, when a part of arteriovenous
complex is cut off the rest of it by muscle fibers of the sphincter.
The
phenomena could not be explained only with actions of veins. Let say, a
contracted sphincter cuts off a part of the network of veins from the rest of
veins. While blood in this cut-off part of the network should be under elevated
pressure, which could cause some bulging, this causes only insignificant
bulging. To explain large bulging one needs a source of high blood pressure –
arteries.
The
phenomena could not be explained with static model either. If one adopts a
static model, then there should be no blood flow in a cut-off area and hence no
bulging.
Note
that when the strength of the sphincter’s squeeze is large, the static model
describes situation well enough ant there should be no bulging.
However
there is an important example, which shows that there are cases, where bulging
appears and this bulging has to be explained not with static but with dynamic
model of blood flow.
Sphincter
muscles cut blood flow to a penis and this causes erection - bulging of
arteries and veins, not absence of blood flow, as the static model would
suggest.
How
does cutting off a part of an arteriovenous complex
by pressing muscles leads to pumping of blood in this cut-off area?
There
are pressure waves in arteries. When pressure of blood can overcome squeeze of
the muscles, blood is pushed into the segregated area of the arteriovenous complex. This critical condition could occur
in some periods during the cycle of arterial heartbeat, when the strength of
muscles squeeze is in a particular range.
What
about blood outflow from this cut-off area?
There
are pressure waves in veins also. When difference in pressure of blood in the segregated
area and in outside veins can overcome the squeeze of the muscles, the blood
outflow occurs. This could occur in some periods during the cycle of arterial
heartbeat, when the strength of muscles squeeze is in a particular range.
When
overall blood inflow exceeds blood outflow, the bulging occurs. The degree of
bulging is limited by the maximum level of blood pressure in a pressure waves
in arteries.
In
anal area there is one exacerbating factor. One group of veins in this area
leads to the liver and blood in them has higher pressure.
When
this type of veins drains the segregated area, it is less likely that blood
outflow from segregated area occurs.
This
dynamic model, which takes in consideration various pressure waves in blood
vessels and their interaction with muscles, explains many phenomena of
Hemorrhoids:
·
bulging
of vessels,
·
arterial
blood in stool,
·
worsening
of symptoms of Hemorrhoids with elevation of arterial blood pressure (with
higher pressure, more blood is pumped into the segregated area),
·
temporary worsening of symptoms of Hemorrhoids with
strenuous physical activity (it temporary increases blood pressure).
It
explains also increase in bulging of vessels during defecation. First, muscles
of sphincter partially relax and in some areas this could lead to emergence of
the critical condition, where strength of muscles contraction is less than peak
of arterial blood pressure wave. In turn, it leads to emergence of bulging,
where it was not present before. Second, there is additional squeezing of
vessels by the waste mass from inside the channel, which could cause bulging in
new areas.
The
very fact that arteriovenous complex occurs together
with sphincters in different places in the body leads to a reasonable suspicion
that bulging of vessels generally plays a useful role. A sphincter alone cannot
provide tight closing of a channel. Bulging complements it and provides needed
tight closing. Muscle fibers of a sphincter contract and relax either randomly
or periodically temporarily cutting off small areas of arteriovenous
complex and small bulging appears and disappears
complementing actions of the sphincter.
This
is an efficient mechanism, which should be present in many places of the body:
between esophagus and stomach, between stomach and intestine, at opening of
urethra, at opening of glands, etc.
However,
it works on small bulging existing for short periods. A long-term cutoff and
creation of a segregated area of arteriovenous
complex is impossible under a continuous band of active muscle fibers of a
sphincter.
It
occurs, when there is a gap in a band of muscle fibers of sphincter, vessels
caught in this gap are prone to bulging.
This
could be a real gap or some fibers could be inactive or less active, the result
is the same.
In
addition, it could occur at the edge of a sphincter.
This
explains why various treatments beyond pain relief, ointments helping
defecation or physical removal of parts of arteriovenous
complex do not work.
In
addition, it shows that strenuous activity in small doses is not dangerous in
the majority of cases of Hemorrhoids. Hence, people do not need to stop
physical exercises, because of Hemorrhoids. This is good news, because often it
is recommended to limit physical activity in the case of the Hemorrhoids.
Understanding
of the nature of Hemorrhoids leads to new venues of easing suffering associated
with this disorder.
As
it was mentioned above, during defecation, sphincter relaxes. Sometimes, this
relaxation is only partial, and that could be not sufficient to decrease
existing bulging, and even could cause bulging of vessels in new areas.
In
such case, the channel is still obstructed and there are difficulties of
defecation. When a person pushes waste in spite of obstruction, it sometimes
damages bulged vessels and causes pain. Such damage and pain causes anxiety and
the person increases period between defecations. In turn, waste mass grows
large and dryer and this causes even more damage and pain.
Eventually,
this vicious cycle settles into a persistent combination of Hemorrhoids and
constipation.
One has to make efforts to break this vicious
cycle, where it is most controllable - one has to maintain a normal period
between defecations and has to make process of defecation fast with ointments.
A
radical improvement comes with learning full relaxation of sphincter muscles.
There
are two obstacles on this way - one is anxiety caused by painful experiences
during defecation and another is an objective feeling that on initial stages of
relaxation of sphincter muscles effect is just the opposite - vessels bulge.
One
has to learn how to go beyond initial stages of relaxation to full relaxation
in spite of these negative experiences.
This
requires regular muscle relaxation exercises performed, when the rectum is
empty.
These
exercises could be combined with muscle contraction exercises.
These
exercises could be done, because sphincter in anus is consciously controllable.
More precisely, there is an external layer of muscle fibers in the sphincter –
External Sphincter, which has separate innervations and is consciously
controllable. Actions of these muscles trigger by reflex actions of other
muscles.
Benefits
of such exercises could go well beyond what is expected.
First,
regular exercises give the body experience of behavior, which it will use
automatically, when needed. If there are weakened muscle fibers in the
sphincter, which cause problems, as if there is a gap in a band of muscle
fibers, then these exercises should energize them, and this should improve
overall condition of the Hemorrhoids.
Second,
an exercise of an anal sphincter causes an exercise in other sphincters of the
body. There is a reasonable suspicion that when there are problems with the
sphincter mechanism in the anus there are similar problems in other sphincter
mechanisms of the body. Hence, such exercise could improve state of the body
well beyond its anal area.
As
it was mentioned above, sphincter mechanisms are controlling flow of liquid
through a channel in many areas, and when they do not open sufficiently, it is
manifested in seemingly unrelated symptoms.
It
could be difficulty of urination, because there is a sphincter mechanism at
opening of the urethra. This is a common symptom in aging males.
It
could be difficulties of ejaculation, which is also a common symptom in aging
males (not everyone sees it as a problem, though).
It
could be difficulty of passing processed food and gases from the stomach to the
intestine. This causes movement of gases into the esophagus (burping), and
excessively long stay of food in stomach, which in turn leads to transformation
of sugars into toxins and possibly to other problems.
Channels
of many glands are controlled by sphincters, and when sphincters do not open
well, when needed, this should cause problems.
Only
two sphincters have conscious control - anal and urethral and usually
contraction and relaxation of the urethral sphincter is triggered by similar
actions of the anal sphincter. Hence, exercise of the anal sphincter is a main
way to exercise other sphincters.
Such
exercise makes sense, especially with age.