What are hemorrhoids and what is their relationship to the portal venous system?

New concepts of the pathophysiology of hemorrhoids have been defined during the past eight or more years, yet medical education at the undergraduate and graduate levels has not kept pace with the newer concepts. The traditional concepts are being perpetuated in all medical dictionaries and in most textbooks of surgery, medicine, anatomy, and pathology. Hemorrhoids are not varicosities, but rather are vascular cushions composed of arterioles, venules, and arteriolar-venular communications which slide down, become congested and enlarged, and bleed. The pathogenesis begins in the fibromuscular supporting layer in the submucosa, above the vascular cushions. The bright red bleeding, which accompanies hemorrhoidal disease, is arteriolar in origin. Portal hypertension has been shown not to be the cause of hemorrhoids. The use of rubber bands, sclerosing solutions, cryosurgery, or the infra-red beam in the early stages of hemorrhoidal disease can take care of prolapse and bleeding and can prevent the development of third and fourth degree hemorrhoids.