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Hemorrhoidal disease is a fairly common and debilitating clinical entity. Individual beliefs and historical legends, accompanied by undocumented theories, have established and perpetuated the confusion regarding the mechanisms leading to the development of the disease and the rules governing its treatment. Hemorrhoids are classified as internal or external and are viewed as a disease when they become symptomatic. Returning to basic medical sciences, this mini-review focuses on internal hemorrhoids and aims to define the histology and anatomy of the normal and abnormal internal hemorrhoidal plexus and to encourage clinicians to comprehend the pathophysiology of the disease. If doctors can understand the pathophysiology of hemorrhoidal disease, they will be able to clarify the nature of the associated symptoms and complications and to make the correct therapeutic decision. Hemorrhoidal disease has been recorded through centuries of history.
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Pathophysiology of internal hemorrhoids

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Hemorrhoids - Symptoms and causes - Mayo Clinic

Hemorrhoids are swollen veins in your lower rectum. Internal hemorrhoids are usually painless, but tend to bleed. External hemorrhoids may cause pain. Hemorrhoids HEM-uh-roids , also called piles, are swollen veins in your anus and lower rectum, similar to varicose veins. Hemorrhoids can develop inside the rectum internal hemorrhoids or under the skin around the anus external hemorrhoids. Nearly three out of four adults will have hemorrhoids from time to time. Hemorrhoids have a number of causes, but often the cause is unknown.
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Rectal venous plexus

The rectal venous plexus or hemorrhoidal plexus surrounds the rectum , and communicates in front with the vesical venous plexus in the male, and the vaginal venous plexus in the female. A free communication between the portal and systemic venous systems is established through the rectal venous plexus. This allows administration of some medications normally given by mouth to be given rectally, while still bypassing first pass metabolism. Examples include rectal Diazepam and orally dissolving medications.
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The superior rectal vein , or superior hemorrhoidal vein , connects veins surrounding the rectum to the inferior mesenteric vein. The inferior mesenteric vein brings blood from the large intestines to the splenic vein. Blood in the spleen travels to the liver.
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