The internal sphincter and Lord's procedure for haemorrhoids

Abstract

Anal pressure and motility have been measured in 56 patients with haemorrhoids and 40 asymptomatic subjects. The anal pressure of patients with haemorrhoids (93-6 cm H2O) was very significantly higher than that of the controls (66-8 cm H2O; P less than 0-001). Ultra-slow pressure waves (amplitude 25-100 cm H2O, frequency 0-9-1-6/min) were present in 39 per cent of patients with haemorrhoids, but in only 7-5 per cent of the controls (P less than 0-001). Ultra-slow waves are present under anaesthesia with the voluntary muscles paralysed and are associated with the highest anal pressure, and so, represent abnormal activity of the internal anal sphincter. Measurements after anal dilatation showed complete abolition of ultra-slow wave activity and a very significant drop in pressure. One year after dilatation 19 patients had a mean anal pressure of 62 cm H2O. Very good results were obtained unless the haemorrhoids were so large that they prolapsed at times other than defaecation. Lord's procedure is a rational treatment since it corrects an underlying overactivity of the internal sphincter.

Japanese Practice Guidelines for Anal Disorders I. Hemorrhoids

“…There are many studies that suggest the etiology as spasms of the internal anal sphincter. In a study that compared the resting pressure of a group of hemorrhoid patients with a control group, the resting pressure was higher in the hemorrhoid group 13,14) . Hemorrhoid patients could be further divided into two distinct groups, males with resting pressure levels higher than the control group who complained of bleeding and discomfort, and females with resting pressure lower than the control group who reported prolapsing 15) .…”

To Compare the Outcome of Minor Anorectal Surgeries Under Local Anesthesia Versus Spinal Anesthesia

“…There have been attempts to modify the surgical technique, such as using diathermy [4], a harmonic scalpel [5], or Ligasure [6] (Valleylab, Boulder, US) for the excision of hemorrhoids. Surgical or medical means to reduce the sphincter muscle spasm have also been tried to reduce postoperative pain [7][8][9]. Different forms of analgesia and anesthesia have also been used [10,11].…”

Internal sphincter and the nature of haemorrhoids.

“…An internal sphincter abnormality may be an aetiological factor in some patients but there must be other factors as well. Straining at stool may determine whether bleeding or prolapse is the predominant symptom.The internal sphincter is overactive in some patients with haemorrhoids (Kerremans, 1969;Hancock and Smith, 1975). This is in evidence by an increased resting anal pressure and the presence of ultra slow pressure waves (0-6-1 9/min).…”

“…This is in evidence by an increased resting anal pressure and the presence of ultra slow pressure waves (0-6-1 9/min). This activity when present is abolished by anal dilatation (Hancock and Smith, 1975) with relief of symptoms, so it seems possible that a sphincter abnormality is related to the development of symptoms in patients with haemorrhoids.The clinical picture produced by haemorrhoids is very variable, and, in order to investigate this possible relationship, an attempt was made to correlate internal sphincter function with symptoms and appearances in series of patients with haemorrhoids. …”

“…The internal sphincter is overactive in some patients with haemorrhoids (Kerremans, 1969;Hancock and Smith, 1975). This is in evidence by an increased resting anal pressure and the presence of ultra slow pressure waves (0-6-1 9/min).…”