Consequently, the term “internal hemorrhoids” does not signify a state of disease if viewed in its strict literal definition. The normal internal hemorrhoidal plexus consists of 3 soft engorgements, referred to as anal cushions or “hemorrhoids”. The anatomical boundary that divides the internal from the external hemorrhoidal plexus is the dentate line. Internal hemorrhoids arise from the internal hemorrhoidal plexus, while external hemorrhoids arise from the external plexus. Hemorrhoids are normal structures of the human body. Normal anatomy and histology of hemorrhoids The purpose of this manuscript is to dispel these legends and to provide a well-documented account of the etiopathogenesis of internal hemorrhoidal disease. Additionally, real life has proven that significant parts of the accepted wisdom regarding hemorrhoids are in fact clinical misunderstandings and personal beliefs passed on from one unsuspecting generation to the next. Moreover, a detailed search in the literature regarding the anatomy and histology of hemorrhoidal tissue and the relationship between hemorrhoids and the portal venous system returns conflicting information. Many other factors need more investigation: for instance, the epidemiology of the disease, the optimal therapy for every single stage of hemorrhoids, and an explanation for the transition of asymptomatic hemorrhoids to symptomatic.
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Pathophysiology is not the sole aspect of hemorrhoids to lack full elucidation. Despite numerous efforts, the true etiopathogenesis of hemorrhoidal disease still remains elusive. Many surgeons have tried to derive conclusions based on operative findings. Many physicians have tried to detect and describe the precise pathophysiological events of symptomatic disease. Hippocrates approached the pathophysiology and the treatment of the disease in his treatise “On Hemorrhoids”.
Primitive references are found in the Old Testament and in Egyptian, Babylonian and Greek written sources. Hemorrhoidal disease has been recorded through centuries of history. If doctors can understand the pathophysiology of hemorrhoidal disease, they will be able to clarify the nature of the associated symptoms and complications and to make the correct therapeutic decision. Returning to basic medical sciences, this mini-review focuses on internal hemorrhoids and aims to define the histology and anatomy of the normal and abnormal internal hemorrhoidal plexus and to encourage clinicians to comprehend the pathophysiology of the disease. Hemorrhoids are classified as internal or external and are viewed as a disease when they become symptomatic. Individual beliefs and historical legends, accompanied by undocumented theories, have established and perpetuated the confusion regarding the mechanisms leading to the development of the disease and the rules governing its treatment.
Despite centuries’ of attempts to shed light on its pathophysiology, to cure those affected and to improve sufferers’ quality of life, many aspects of the disease remain elusive. Hemorrhoidal disease is a fairly common and debilitating clinical entity.
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