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Itis not known why hemorrhoids enlarge. There are several theoriesabout the cause, including inadequate intake of fiber, prolongedsitting on the toilet, and chronic straining to have a bowel movement(constipation). None of these theories has strong experimentalsupport. Pregnancy is a clear cause of enlarged hemorrhoids though,again, the reason is not clear. Tumors in the pelvis also causeenlargement of hemorrhoids by pressing on veins draining upwards fromthe anal canal.
Sittingfor long periods of time can start the hemorrhoid process. One theoryproposes that it is the shearing (pulling) force of stool,particularly hard stool, passing through the anal canal that dragsthe hemorrhoidal cushions downward. Increased straining during bowelmovements caused by constipation or diarrhea may lead to hemorrhoids.It is thus a common condition due to constipation caused by waterretention in women experiencing premenstrual syndrome ormenstruation.
Anothertheory suggests that with age or an aggravating condition, thesupporting tissue that is responsible for anchoring the hemorrhoidsto the underlying muscle of the anal canal deteriorates. With time,the hemorrhoidal tissue loses its mooring and slides down into theanal canal.
Hypertension,particularly portal hypertension, can also cause hemorrhoids becauseof the connections between the portal vein and the vena cava whichoccur in the rectal wall -- known as portocaval anastomoses.Pregnancy may lead to hypertension and increase strain during bowelmovements, so hemorrhoids are often associated with pregnancy.
Onephysiological fact that is known about enlarged hemorrhoids that maybe relevant to understanding why they form is that the pressure iselevated in the anal sphincter, the muscle that surrounds the analcanal and the hemorrhoids. The anal sphincter is the muscle thatallows us to control our bowel movements. Obesity can be a factor byincreasing rectal vein pressure. Poor muscle tone or poor posture canresult in too much pressure on the rectal veins.
Itis not known, however, if this elevated pressure precedes thedevelopment of enlarged hemorrhoids or is the result of thehemorrhoids. Perhaps during bowel movements, increased force isrequired to force stool through the tighter sphincter. The increasedshearing force applied to the hemorrhoids by the passing stool maydrag the hemorrhoids downward and enlarge them.
Cigarettesmoking during bowel movements, may worsen hemorrhoid, may lead tosevere internal bleeding of veins inside rectum area. Both can causediarrhea. Note that caffeine ingestion increases blood pressuretransiently, but is not thought to cause chronic hypertension.
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