Hemorrhoids are one of the most common chronic diseases in proctological practice, and the views on its pathomorphology have fundamentally changed in recent decades. Previously, this disease was interpreted as a simple varicose vein dilation, but now it is considered a complex degenerative-inflammatory disease of the anorectal cavernous structures, connective tissue, and musculo-ligamentous apparatus. This article analyzes modern pathomorphological aspects of hemorrhoids, microcirculatory disorders, inflammatory and degenerative processes, and their clinical significance.

hemorrhoids, pathomorphology, cavernous structures, connective tissue, microcirculation, inflammation.

Corman M.L. Colon and Rectal Surgery. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2013.

Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World Journal of Gastroenterology. 2012;18(17):2009–2017.

Madoff R.D., Fleshman J.W. Clinical practice. Hemorrhoids. New England Journal of Medicine. 2004;371(10):944–951.

Sun Z., Migaly J. Review of hemorrhoid disease: presentation and management. Clinics in Colon and Rectal Surgery. 2016;29(1):22–29.

Riss S., Weiser F.A., Schwameis K., et al. The prevalence of hemorrhoids in adults. International Journal of Colorectal Disease. 2012;27(2):215–220.

Haas P.A., Fox T.A., Haas G.P. The pathogenesis of hemorrhoids. Diseases of the Colon & Rectum. 1984;27(7):442–450.

Thomson W.H.F. The nature of haemorrhoids. British Journal of Surgery. 1975;62(7):542–552.

Lunniss P.J., Mann C.V. Classification of hemorrhoidal disease. Surgical Clinics of North America. 2002;82(6):1153–1167.

Aigner F., Bodner G., Gruber H., et al. The vascular nature of hemorrhoids. Diseases of the Colon & Rectum. 2006;49(5):698–704.

Giordano P., Gravante G., Sorge R., et al. Long-term outcomes of hemorrhoidal disease. Colorectal Disease. 2009;11(7):712–716.

Parks A.G. The surgical treatment of hemorrhoids. British Journal of Surgery. 1956;43(180):337–351.

Sánchez C., Chinn B.T. Hemorrhoids. Clinics in Colon and Rectal Surgery. 2011;24(1):5–13.

Shafik A. Role of connective tissue changes in the pathogenesis of hemorrhoids. International Surgery. 1996;81(1):94–97.

Sneider E.B., Maykel J.A. Diagnosis and management of symptomatic hemorrhoids. Surgical Clinics of North America. 2010;90(1):17–32.

Abramowitz L., Batallan A. Epidemiology of hemorrhoidal disease. Journal of Visceral Surgery. 2012;149(1):e3–e8.

Ganz R.A. The evaluation and treatment of hemorrhoids. Clinical Gastroenterology and Hepatology. 2013;11(6):593–603.

Milligan E.T.C., Morgan C.N. Surgical anatomy of the anal canal. The Lancet. 1937;230(5959):1119–1124.

Lohsiriwat D., Lohsiriwat V. Hemorrhoids: a review of current treatment options. World Journal of Gastroenterology. 2015;21(31):9245–9252.

Ortiz H., Marzo J. Hemorrhoidal disease: pathophysiology and treatment. Annals of Gastroenterology. 2014;27(3):207–215.

Acheson A.G., Scholefield J.H. Management of hemorrhoids. BMJ. 2008;336(7640):380–383.