Anal manometric findings before and after hemorrhoidectomy: a preliminary report

A difference of opinion exists as to whether patients with symptomatic hemorrhoids, patients after hemorrhoidectomy, and patients with no hemorrhoids have different anal physiologies.

Twenty-four patients with symptomatic hemorrhoids undergoing hemorrhoidectomy were investigated using anorectal manometry. There were 12 male and 12 female patients with a mean age of 42 years (range: 23 to 72 years). The anorectal manometry was performed one day before the operation and 8 to 12 weeks after the operation. Another normal group, comprised of 138 volunteers, was included and matched for age and gender.

The anorectal inhibitory reflex was present in all the normal group (NG), symptomatic hemorrhoid (SH), and post-hemorrhoidectomy (PH) patients. No major incontinence was noted clinically. The mean resting pressure (MRP) in the SH group (mean: 84.5 +/- 28.7 cmH2O, range: 26 to 166 cmH2O) was significantly greater than in the NG (mean: 74.4 +/- 14.9 cmH2O, range: 61 to 116 cmH2O) and the PH groups (mean: 63.7 +/- 23.6 cmH2O, range: 20 to 116 cmH2O) (p = 0.032 and 0.005, respectively). After hemorrhoidectomy, the MRP was significantly decreased compared to the normal group (p = 0.018). The other manometric data showed no statistical change in these three groups.

The results indicate that persons with SH have a higher MRP than normal. Overactivity of the internal sphincter muscle may be a cause rather than a result of symptomatic hemorrhoids. Compared with the SH and normal groups, the MRP was significantly decreased to prevent recurrent symptomatic hemorrhoids in the PH group. Though the MRP was significantly decreased, no major incontinence was noted after hemorrhoidectomy, and this might be due to the increase in rectal compliance and mean squeeze pressure.