Download PDF
CC BY-NC-ND 4.0 · Journal of Coloproctology 2022; 42(03): 228-233
DOI: 10.1055/s-0042-1754383
Original Article

Doppler Ultrasound Testing Suggests Hemorrhoids in Females may be a Consequence of Impaired Blood Flow Associated with Pelvic Organ Prolapse

Traian Enache 
1   Obstetrics and Gynecology Department, Clinical Hospital of Obstetrics and Gynecology Prof. Dr. Panait Sîrbu, Bucharest, Romania
,
Diana Elena Soare 
1   Obstetrics and Gynecology Department, Clinical Hospital of Obstetrics and Gynecology Prof. Dr. Panait Sîrbu, Bucharest, Romania
› Author Affiliations Funding No financial support has been received.
› Further Information
   Permissions and Reprints

Abstract

Background It has been observed that there is a high incidence of hemorrhoids in female patients with pelvic organ prolapse. Also, in these patients, hemorrhoidal disease improves after the surgical correction of the pelvic organ prolapse.

Objective Our hypothesis was that a cause-effect relationship between pelvic organ prolapse, and hemorrhoids might be the key. The objective of this study was to find an element which connects these two conditions.

Study Design We conducted a pilot study which consisted of two parts. An initial part, in which we asked several patients with grades III and IV pelvic organ prolapse and hemorrhoids, who have undergone surgery for prolapse, to determine the impact of the surgical restoration of the prolapsed organs on their hemorrhoidal disease. For the second part, on several patients with uncorrected uterine prolapse grades III and IV, we determined the resistive index of the hemorrhoidal branches within the rectal wall before and after manual reduction of the prolapse.

Results First, more than 50% of patients who underwent uterine prolapse correction described an improvement of their hemorrhoidal disease of over 50%. Second, the resistive index of the hemorrhoidal branches was significantly lower after manual reduction of the prolapse. We consider that obstructed veins due to pelvic organ prolapse might induce the dilation of the hemorrhoids. The direct measurement of the resistive index of the hemorrhoidal branches allows us to directly assess the increased resistance in the rectal vascular system.

Conclusion Venous stasis and impaired vascular flow might be the pathophysiological explanation for the association between pelvic organ prolapse and hemorrhoids. In these patients, the pathogenic treatment should aim at the restoration of a normal blood flow (prolapse surgical cure) instead of focusing on hemorrhoids only.

Keywords

pelvic organ prolapse - hemorrhoids - surgery - resistive index - venous flow

Statement

The aim of this study was to find an explanation for the high incidence of hemorrhoids in female patients with high-grade POP and for the rapid improvement of the hemorrhoidal disease after prolapse surgery.


The study has the following key findings: hemorrhoidal disease improves significantly after POP surgery and venous flow is improved within the rectal wall after the reduction of the prolapse, which indicates that POP can be considered an etiological factor for hemorrhoidal disease.


Our findings can lead to a new approach involving hemorrhoidal treatment in female patients, such as excluding or surgically correcting POP before addressing the hemorrhoidal disease.


Consent

Informed consent and ethics committee approval have been received.




Publication History

Received: 25 April 2022

Accepted: 07 June 2022

Article published online:
20 July 2022

© 2022. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Lee KY, Lee JI, Park YY. et al. Hemorrhoids Are Associated with Urinary Incontinence. J Womens Health (Larchmt) 2020; 29 (11) 1464-1468 DOI: 10.1089/jwh.2019.8168.
    CrossrefPubMedGoogle Scholar
  • 2 Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol 2012; 18 (17) 2009-2017 DOI: 10.3748/wjg.v18.i17.2009.
    CrossrefPubMedGoogle Scholar
  • 3 Sun Z, Migaly J. Review of Hemorrhoid Disease: Presentation and Management. Clin Colon Rectal Surg 2016; 29 (01) 22-29 DOI: 10.1055/s-0035-1568144.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Petros PE, Ulmsten UI. An integral theory and its method for the diagnosis and management of female urinary incontinence. Scand J Urol Nephrol Suppl 1993; 153: 1-93
    Google Scholar
  • 5 Paradisi G, Petros P. Cure of hemorrhoids following a TFS posterior sling and TFS perineal body repair—A case report. Pelviperineology 2010; 29: 62-63
    Google Scholar
  • 6 Abendstein B, Petros PE, Richardson PA, Goeschen K, Dodero D. The surgical anatomy of rectocele and anterior rectal wall intussusception. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19 (05) 705-710
    CrossrefPubMedGoogle Scholar
  • 7 Abendstein B, Brugger C, Furtschegger A, Rieger M, Petros P. Role of the uterosacral ligaments in the causation of rectal intussusception, abnormal bowel emptying and fecal incontinence. A prospective study. Pelviperineology 2015; 34: 2-20
    Google Scholar