Causative factors in relation to piles can mainly be divided into two categories
1. Idiopathic Causes
2. Secondary Causes
1) Idiopathic Causes :
It is very difficult to pin point the evident causes resulting into venous obstruction (varicosity) for the production of piles. However, a good number of factors can be considered/enumerated which are of importance as contributing agents in the causation of haemorrhoids.
I. Hereditory :
Some defect in the venous structure has been held responsible e.g. Congenital weakness of the walls of vein, abnormal large arterial supply to rectal plexus, in the formation of haemorrhoids, which has further been supported by the appearance of this disease in many or all the family members.
II. Constipation :
Straining in constipated persons results in the engorgement of the internal haemorrhoidal plexus, giving rise to the disease piles.
III. Diarrhoea And Dysentary :
When associated with much tenesmus, may have the similar effects.
IV. Faulty Habits Of Defaecation :
These are equally responsible in the formation of piles. This act of habits could be explained as instead of having a smooth easy daily motion within a few minutes changing to an habitory of protracted straining.
V. Dietary Habits :
Elimination of cereal fibres from the diet results considerably in the delay of the faecal transit time in the bowel, there by giving rise to the high incidence of chronic constipation and ultimately haemorrhoids.
VI. Anatomical Factors :
Radicals of the superior rectal veins remain unsupported in the rectum [sub-mucous connective tissue]. These veins are liable to constriction by the muscular tissue results constriction during defaecation, hence, may result into haemorrhoids. It is also important to note that these veins have no valves.
2) Secondary Cause :
Factors encountered under this heading have a definite organic obstruction in the portal circulation interfering with the venous return from the superior haemorrhoidal veins.
I. Portal Obstruction :
Portal obstruction is said to be an etiological factor in haemorrhoidal disease because the superior haemorrhoidal vein is tributary to the portal venous system resulting to portal obstruction. This can be due to the increased tension within the haemorrhoidal plexus there by coming in the way of drainage of the haemorrhoidal plexus into the canal system
.
II. Pregnancy And Abdominal Tumours :
Gradual and steady increased pressure of the frequent womb over the common iliac veins ultimately result into an increased pressure within all their tributaries, which ultimately involves the middle and inferior haemorrhoidal veins tributaries of hypogastric (iliac internal ) Further, either directly or indirectly increased pressure in superior haemorrhoidal vein may involve the entire haemorrhoidal plexus which ultimately becomes a rich source for the development of haemorrhoids.
