Objectives: The literature lacks enough research about the condition of the anal sphincters in patients with hemorrhoids. The aim of this study was to assess the thickness of internal and external anal sphincters (EAS) in patients with hemorrhoids using 3-dimensional endoanal ultrasonography. Materials and Methods: This cross-sectional study non-randomized comparative study included 75 patients with internal hemorrhoids of 3rd and 4th degree and 75 healthy individuals as a control group. Endoanal ultrasound examination was done for all participants. The mean thickness of the internal anal sphincter (IAS) and EAS was measured (in mm) at the mid part of the anal canal at rest and during straining (pushing). Results: Concerning IAS, its thickness during rest was apparently higher in the hemorrhoids group compared to the control group (p=0.071), and comparable in the two groups during push (p=0.175), so It did not change significantly with push in the two groups. The hemorrhoids group had significantly thicker EAS compared to the control group during rest and on push (p=0.025, and 0.022, respectively). Pushing resulted in a significant increase in the thickness of EAS in the control group (p=0.004), but not in the hemorrhoids group (p=0.132). Conclusion: In hemorrhoidal disease, IAS and EAS are thickened during rest, but the EAS doesn’t increase in thickness as occurring in control group in face of increased tension inside the anal canal during pushing. This may suggest a new pathophysiology for hemorrhoids as being a mechanism which developed to increase the thickness of the wall to protect anal canal wall from increased tension during push.
Corresponding Author: ELBARMELGI M.|