The internal sphincter and Lord's procedure for haemorrhoids

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Physiology

Background:

• Hemorrhoids are a common condition often associated with increased anal pressure.
• The role of internal anal sphincter (IAS) overactivity in hemorrhoid pathophysiology requires further investigation.

Purpose of the Study:

• To investigate anal pressure and motility in patients with hemorrhoids.
• To evaluate the effect of anal dilatation on anal pressure and IAS activity.
• To assess the long-term outcomes of Lord's procedure for hemorrhoid treatment.

Main Methods:

• Measurement of anal pressure and motility in 56 hemorrhoid patients and 40 controls.
• Analysis of ultra-slow pressure waves indicative of IAS activity.
• Assessment of anal pressure and wave activity post-anal dilatation.
• One-year follow-up of patients treated with Lord's procedure.

Main Results:

• Hemorrhoid patients demonstrated significantly higher anal pressure (93.6 cm H2O) compared to controls (66.8 cm H2O).
• Ultra-slow waves, associated with IAS overactivity, were found in 39% of hemorrhoid patients versus 7.5% of controls.
• Anal dilatation led to complete abolition of ultra-slow waves and a significant pressure drop.
• One year post-dilatation, mean anal pressure decreased to 62 cm H2O, with good outcomes unless prolapse was severe.

Conclusions:

• Elevated anal pressure and IAS overactivity are significant findings in hemorrhoid patients.
• Anal dilatation is an effective treatment, normalizing anal pressure and motility.
• Lord's procedure addresses the underlying IAS overactivity, proving a rational therapeutic approach for hemorrhoids.