[Hemorrhoids. Etiopathogenesis and therapeutic inferences]

Etiopathoganeic and physiopathological conceptions of hemorrhoidal illness underline the importance of the mechanical factor in hemorrhoidal prolapse, arteriovenous shunts of sections of circulatory blockage, in surface mucous in hemorrhoidal bleeding; the role of shunts in mid-channel mucous, in neuro-vegetative dependence in the regulation of pressure and flow; the clinical factor manifest in the appearance of hemorrhoidal disorders, muscular straining, notably in constipation, genital phases, and stress-linked disorders. The therapeutic possibilities determined by these factors are clear: the advantage of a medical treatment that will link the correction of transit disorders, alimentary regularity, decongestive action of the venotropes, the value of instrumental ambulatory therapy such as sclerotherapy, elastic dressings, controlled freezing in the cases of proctorrhagia and limited prolapse. It is quite clear that the most radical treatment of hemorrhoids is surgery, as long as it is complete, and high up, which can be achieved by the techniques that treat separate clusters, with or without sphincterectomy.