Do patients with haemorrhoids have pelvic floor denervation?

Area of Science:

• Colorectal Surgery
• Neurogastroenterology
• Pelvic Floor Disorders

Background:

• Straining at stool is associated with hemorrhoids, rectal prolapse, and fecal incontinence.
• Rectal prolapse and neurogenic fecal incontinence often involve perineal descent and pudendal neuropathy.

Purpose of the Study:

• To investigate whether patients with hemorrhoids exhibit signs of pudendal nerve damage.
• To compare anal manometry, perineal descent, and pudendal nerve function in hemorrhoid patients versus controls.

Main Methods:

• Anal manometry, perineal descent measurement, and pudendal nerve terminal motor latency (PNTML) were performed.
• Single-fibre EMG of the external anal sphincter was conducted in 16 hemorrhoid patients and 20 controls.
• Key parameters assessed included pressures, perineal position, PNTML, and external anal sphincter fibre density.

Main Results:

• No significant differences in anal manometry pressures or wave activity were found between groups.
• Hemorrhoid patients showed significantly greater perineal descent at rest and during straining.
• A trend towards higher PNTML and significantly higher fibre density in the external anal sphincter was observed in the hemorrhoid group.

Conclusions:

• Patients with hemorrhoids are more prone to abnormal perineal descent.
• Evidence suggests a higher likelihood of associated pudendal neuropathy in individuals with hemorrhoids.
• These findings highlight potential nerve involvement and altered pelvic floor biomechanics in hemorrhoid sufferers.