Article

Haemorrhoids are associated with erectile dysfunction: A population-based study

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Abstract

Haemorrhoids are associated with regional vascular abnormalities and rectal pain, which are hypothesized to increase the risk of erectile dysfunction (ED); however, few studies have investigated the association between ED and haemorrhoids. This case-control study aimed to estimate the association between haemorrhoids and ED by using a population-based data in Taiwan. We identified 6 310 patients with ED as cases and randomly selected 31 550 controls. Conditional logistic regression was performed to compute the odds ratio (OR) for having been previously diagnosed with haemorrhoids between cases and controls. The results show that haemorrhoids were found to be present among 1 572 (24.9%) cases and 4 491 (14.20%) controls. The OR for prior haemorrhoids among cases was 1.90 (95% CI = 1.78-2.03) when compared with controls after adjusting for monthly income, geographical location, hypertension, diabetes, coronary heart disease, hyperlipidemia, obesity and alcohol abuse/alcohol dependence syndrome. Younger cases demonstrated a higher risk for prior haemorrhoids when compared with controls. In particular, the adjusted OR among cases <30 years old was 3.71 (95% CI = 2.74-5.02) when compared with controls. We concluded that there was an association between ED and a prior diagnosis of haemorrhoids.

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... association between ED and a prior diagnosis of hemorrhoids; however, this association is not really explained. [8] The localized swelling of the varicose veins around the deep perineum may induce local irritation. Further, these swollen veins and blood vessels in the anal and lower rectum regions lead to disrupted blood flow around the pelvic area. ...
... Further, these swollen veins and blood vessels in the anal and lower rectum regions lead to disrupted blood flow around the pelvic area. This local irritation and disruption or lack of circulation can easily lead to the symptoms of ED. [8] It is unlikely that hemorrhoidectomy (which eliminates hemorrhoids) can be improving ED since this hemorrhoidectomy addressed theoretically as causes of ED against logical sequence. However, to our knowledge, no previous studies have looked at the status of the EF of men posthemorrhoidectomy. ...
... We found that IIEF item scores were not evaluated by other studies such as the one reported by Keller and Lin, [8] who used ICD coding to diagnose ED so that we cannot compare the IIEF item scores in our study by other studies. However, in the surgical group in our study, the average total IIEF score was significantly higher in the hemorrhoidectomy group than controls group, for all items apart of frequency of desire. ...
... if they are aged <40 years and concluded that there was an association between ED and a prior diagnosis of hemorrhoids; however, this association is not really explained. [8] The localized swelling of the varicose veins around the deep perineum may induce local irritation. Further, these swollen veins and blood vessels in the anal and lower rectum regions lead to disrupted blood flow around the pelvic area. ...
... Further, these swollen veins and blood vessels in the anal and lower rectum regions lead to disrupted blood flow around the pelvic area. This local irritation and disruption or lack of circulation can easily lead to the symptoms of ED. [8] It is unlikely that hemorrhoidectomy (which eliminates hemorrhoids) can be improving ED since this hemorrhoidectomy addressed theoretically as causes of ED against logical sequence. However, to our knowledge, no previous studies have looked at the status of the EF of men posthemorrhoidectomy. ...
... We found that IIEF item scores were not evaluated by other studies such as the one reported by Keller and Lin, [8] who used ICD coding to diagnose ED so that we cannot compare the IIEF item scores in our study by other studies. However, in the surgical group in our study, the average total IIEF score was significantly higher in the hemorrhoidectomy group than controls group, for all items apart of frequency of desire. ...
Article
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Introduction: Erectile dysfunction (ED) is a highly prevalent condition among men all over the world and commonly associated with undiagnosed medical diseases as chronic pelvic pain and hemorrhoid. Objective: The purpose of this study was to study the impact of surgical hemorrhoidectomy on sexual function in men with erectile dysfunction (ED). Materials and Methods: In a prospective manner, we studied the effect of surgical hemorrhoidectomy on erectile function (EF) in male patients with ED. Hemorrhoidectomy was carried out in 82 patients with clinical hemorrhoid associated with ED (Group 1) and compared with 81 patients without operative intervention (Group 2; control). The primary efficacy variable was the mean change in the International Index of Erectile Function (IIEF) questionnaire. Results: In Group 1, the IIEF questionnaire increased significantly after hemorrhoidectomy, from 15.56 to 27.37 (P < 0.001), indicating improvement of EF. Thirty-six patients (41.1%) showed improvement of EF compared to 5.3% in the control group (P < 0.001). In Group I, but not in Group II, IIEF values increased significantly when compared with preoperative values (P < 0.001). Conclusion: We concluded that surgical hemorrhoidectomy is clearly related to improvement of EF in male hemorrhoid patients with ED.
... Although some cases, particularly in younger men, may reflect psychological problems, in many cases, ED is caused by organic diseases, in particular, cardiovascular disease, diabetes mellitus, hyperlipidemia, and hypertension [4]; therefore, ED can act as a marker for medical conditions requiring treatment, representing a sign of a generalized vascular disease, as could also be suggested by the association with hemorrhoids [5][6][7]. ...
... Erection is a complex neuro-endocrine phenomenon, vascularly characterized by the dilatation of the afferent arteries to the corpora cavernosa (CC), with increased arterial flow rate, reduction or cessation of venous outflow and dilation of the sinusoidal spaces of the CC [2,3]. Penis erection is produced by an integration of physiological processes involving the central nervous systems, peripheral nervous, hormonal, and vascular systems that result in a relaxation of the tone of the fibrous smooth muscle cells of the arterial walls and of cavernous sinusoids, with a consequent increase in blood flow that fills and relaxes the gaps in the cavernous body, causing it to be mechanically closed and thus blocked in the venous outflow by means of veno-occlusive mechanism [6,7]. The albuginea, left to stretch at first, exhausts the maximum elasticity and becomes inextensible. ...
Article
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Erectile dysfunction caused by venous leakage is a vascular disease in which blood fails to accumulate in the corpora cavernosa due to the abrupt drainage of blood from the penis secondary to an abnormal venous network that affects 1 to 2% of men under 25 years old and about 10 to 20% over 60 years old, who do not raise a sufficient erection for penetrative sex. The study of the venous leak and its characterization in young patients with erectile dysfunction represent a diagnostic challenge, and imaging remains the best way to diagnose this condition. In the article, it is described the methods of execution and the diagnostic role of the cavernous MRI in the study of vasogenic erectile dysfunction from the venous leak, proposing it as a good alternative to the cavernous CT, considering the satisfactory results in terms of diagnostic interpretation, the absence of ionizing radiation, the higher soft tissue resolution of the imaging method and the lower administration of contrast agent.
... La maladie hémorroïdaire est un état pathologique caractérisé par une dilatation de la veine recto-anale plexus qui provoque l'inflammation, la douleur et les saignements dans les tissus environnants [1,2]. Elle est de plus en plus remarquée, une récurrence surtout chez les adultes [3] avec une augmentation du risque de dysfonction érectile [4]. On estime que plus de 50 % des personnes de plus de 50 ans présentent au moins un épisode d'hémorroïdes symptomatiques au cours de leur vie [5]. ...
Article
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La maladie hémorroïdaire est un état pathologique caractérisé par une dilatation de la veine recto-anale plexus. Une enquête ethnobotanique a révélé l’utilisation des écorces de tronc de Parkia biglobosa (Jacq.) sous forme de pommade ou décoction en lavement anal pour son traitement. L’objectif de cette étude était de caractériser l’extrait afin de formuler des suppositoires. Un screening phytochimique et une caractérisation physico-chimique suivi évaluation de l'activité antioxydante et antiinflammatoire de l’extrait ont été réalisés. Une formulation des suppositoires a été définie à partir d’une stratégie utilisant deux masses à suppositoire (Witerpsol H15 et Suppocire ASX2). Les suppositoires obtenus ont fait l’objet de contrôle qualité et d’évaluation de l’efficacité. L’extrait était de couleur marron avec une texture fine. Son taux d’humidité était à 4,67 et le pH de 7,17. Les suppositoires avaient une forme allongée, une texture et un aspect uniforme avec un temps moyen de ramollissement de 8,36min et un point de fusion moyen de 37,3°C. L’étude phytochimique a permis de mettre en évidence des flavonoïdes. L’évaluation de l’activité antioxydante a donné une concentration inhibitrice (IC50) de 9,35 µg/ml Par ABTS, un pourcentage d’inhibition de 54,34% par LPO et l’activité Antiinflammatoire par l’inhibition de la LOX avec une IC50 de 19,01 µg/ml. Les études réalisées offrent une alternative d’utilisation de l’extrait sous forme de suppositoires pour le traitement de l’inflammation de la maladie hémorroïdaire.
... Due to the fact that the related veins are also connected via the deep pelvic vein system, these pictures might reveal the unexplained relation between erectile dysfunction and hemorrhoids [48], as well as possible erectile dysfunction after hemorrhoid sclerotherapy [49]. ...
Chapter
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Erectile dysfunction (ED) is a big issue in various populations with up to 30% of young men suffering from this condition. Unfortunately, treatment schemes are currently mainly focused on elderly patients with chronic disorders. In younger patients, ED is more a vascular problem, which affects the storage capacity of the penis. The impact of penile blood supply on erectile function was recognized some 500 years ago. At the turn of the twentieth century, the first results of penile venous ligation were published. Simple isolated ligation of the deep dorsal vein in humans for ED due to venous leak is currently not recommended, due to some reported low long-term success rates. This was, as shown in several literature reports, obviously due to insufficient technical possibilities. Technical development in imaging and vascular and endovascular treatment have dramatically evolved our understanding of this underlying condition in the past 20 years and turned this disease into a long-term treatable condition. The current state-of-the-art work-up of the underlying condition , using the newest imaging technologies with color Doppler ultrasound and CT scan with additional three-dimensional reconstruction, is to show the surgeon exactly the points to focus on. Additionally, a so-called corporo-venous insufficiency can be recognized as a mainly combined condition, affecting peripheral and more proximal drainage pathways at the same time.
... It might also explain the fact, that neither simple ligation of penile veins, nor ligation of crural veins could sustainly solve the problem of venous leak disease. Furthermore, these pictures might reveal the up to now unexplained relation between erectile dysfunction and hemorrhoids [49] and possible erectile dysfunction after hemorrhoid sclerotherapy [50], due to the fact that the related veins are connected via the deep pelvic vein system. These results also demonstrate the urgent need to re-explore the veinous drainage system with new higher sophisticated techniques. ...
Article
Full-text available
Erectile dysfunction is an increasing issue, especially in young man. Whereas the current treatment strategies are mostly focused on older men, young patients are seeking more for a longer lasting or definitive solution, rather than a life-long medical treatment. Possibly, this is a reason why currently 70% of men with erectile dysfunction are not under treatment.This aspect becomes also a socioeconomic relevance, as this generation of patients can also be called the backbone of most societies. As a logical consequence the treatment strategies in different stages of life should be reviewed. Whereas various chronic disorders have been reported to be associated with elevated rates of ED including depression, diabetes, cardiovascular and neurological diseases in older men, the young generation is more suffering from vascular problems which affects the storage capacity of the penis. The aim of this work is to review the efficiency of newly developed minimal invasive treatment strategies for this blood storage problem, causing erectile dysfunction which is mostly described as caverno-venous leakage. The systematic review of the literature reveals a significant number of recent studies dealing with new minimal invasive methods to provide a potential solution of caverno-venous leakage. Even long-term results reported demonstrate considerable improvement of erectile dysfunction caused by this condition. Furthermore, 3D-Computed tomography cavernosography (CT-cavernosography) is a new technology, which can provide highresolution images of venous drainage from any angle and shows to be very helpful for both the diagnosis of corporal veno-occlusive dysfunction and the anatomical study of the human penile venous system. The application of this technology may also lead to better strategies in venous leak treatment. In summary, over 30 published studies could be found in the literature with constantly good results after caverno-venous leak treatment. Altogether, 13 comparable studies including 538 patients could be found, in which a mean short-term success rate of almost 80% and a mean long term success rate of 74% was achieved. None of the studies described major complications. These encouraging results should lead to reconsider or current strategy in treatment of erectile dysfunction in young men.
... It might also explain the fact, that neither simple ligation of penile veins, nor ligation of crural veins could sustainly solve the problem of venous leak disease. Furthermore, these pictures might reveal the up to now unexplained relation between erectile dysfunction and hemorrhoids [49] and possible erectile dysfunction aft er hemorrhoid sclerotherapy [50], due to the fact that the related veins are connected via the deep pelvic vein system. Th ese results also demonstrate the urgent need to re-explore the veinous drainage system with new higher sophisticated techniques. ...
Article
Full-text available
Introduction: The aim of this work was to verify the value of CT-C vernosography for penile venous leak diagnosis. Furthermore, we evaluated the effectiveness of pelvic vein embolisation with aethoxysclerol in aero-block technique for the treatment of impotence due to venous leakage in men using sildenafil for intercourse. The aim of this procedure was to reduce or eliminate the use of sildenafil. Material and methods: A total of 49 patients with veno-occlusive dysfunction, severe enough for the need of PDE5 inhibitors for vaginal penetration, underwent pelvic venoablation with aethoxysklerol. The mean patient age was 53.5 years. Venous leaks were identified by Color Doppler Ultrasound and CT Cavernosography after intra-cavernousal prostadil injection. Under local anesthesia a 5F-Angioport was inserted antegrade into the deep dorsal penile vein. Aethoxysklerol 3% as sclerosing agent was injected after air-block under valsalva manoeuver. Success was defined as the ability to achieve vaginal insertion without the aid of any drugs, vasoactive injections, penile prosthesis, or vacuum device. Additionally, a pre- and post-therapeutical IIEF-5 score was performed. Results: At a 12 month follow-up 40 out of 49 patients (81.63%) reported to have erections sufficient for vaginal insertion without the use of any drug or additional device. 4 (8.16%) patients did not report any betterment. Mean IIEF-Score and IIEF-Score-Differences after Intervention see Figure 1 & 2. No serious complications occurred. Conclusion: Our new pelvic venoablation technique using pre-operative Ct-cavernosography and aethoxysklerol in air-block technique was effective and minimally invasive. All patients were able to perform sexual intercourse without the previously used dosage of their PDE5 inhibitor. This new method may help in patients with contra-indications against PDE5 inhibitors, in patients who cannot afford the frequent usage of expansive oral medication or those who do not fully response to PDE5-inhibitors.
... The most common and defi nable conditions include fecal incontinence, urinary incontinence, and pelvic organ prolapse. The interdependence and interplay of all these symptoms are clinically relevant as they are just like different spokes in the wheel of pelvic fl oor dysfunction (Aschkenazi and Goldberg 2009 ;Keller and Lin 2012 ). ...
Chapter
The pelvic floor is a tunnel or dome-shaped muscular sheath made up of striated muscle and is positioned to enclose and support the genitourinary and anorectal compartments. The pelvic floor forms the inferior boundary of the abdominopelvic cavity extending from the pubic symphysis anteriorly to the coccyx posteriorly and between the two pelvic side walls. There are four layers: the endopelvic fascia, the muscular diaphragm or levator plate, the perineal membrane or urogenital diaphragm, and the superficial transversus perinei. The pelvic floor has a dynamic mechanization of complex voluntary and involuntary muscles, supporting ligaments, fascial encasings, and complex neural wiring. Pelvic floor dynamics is crucial in maintaining continence and evacuation of the bladder/bowel, supporting the pelvic organs, maintaining the dynamics of the birth canal, and optimized sexual function. The functional dynamics of the pelvic floor results in myriad clinical presentations. It is necessary to understand the possible symptom complexes in relation to different compartments of the pelvic floor. The three compartments, i.e., anterior, middle, and posterior, relate to symptomatology arising from the urinary, genital, and defecatory system complexes, respectively. These three compartments act like “the spokes of a wheel,” i.e., the pelvic floor (Agarwal et al. 2012). The colorectal surgeon deals mostly with the defecatory aspect of the pelvic floor. Constipation is an index symptom of anorectal dysfunction which in itself is an index parameter of pelvic floor dysfunction (Agarwal et al. 2013). Pelvic floor dysfunction refers to a wide range of disorders which occur due to weakness or tightness of muscles of the pelvic floor. Apart from constipation, pelvic floor dysfunctions include fecal incontinence, urinary incontinence, overactive bladder, pelvic discomfort/pain syndromes, sexual dysfunction, and pelvic organ prolapse (rectocele, cystocele, urethrocele, and rectal prolapse). The most common and definable conditions include fecal incontinence, urinary incontinence, and pelvic organ prolapse. The interdependence and interplay of all these symptoms are clinically relevant as they are just like different spokes in the wheel of pelvic floor dysfunction (Aschkenazi and Goldberg 2009; Keller and Lin 2012).
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The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized, pleasurable sexual activity. Little is known about how diseases of the colon, rectum, and anus and their treatments affect RAI. Engaging in RAI with gastrointestinal disease can be difficult due to the unpredictability of symptoms and treatment-related toxic effects. Patients might experience sphincter hypertonicity, gastrointestinal symptom-specific anxiety, altered pelvic blood flow from structural disorders, decreased sensation from cancer-directed therapies or body image issues from stoma creation. These can result in problematic RAI - encompassing anodyspareunia (painful RAI), arousal dysfunction, orgasm dysfunction and decreased sexual desire. Therapeutic strategies for problematic RAI in patients living with gastrointestinal diseases and/or treatment-related dysfunction include pelvic floor muscle strengthening and stretching, psychological interventions, and restorative devices. Providing health-care professionals with a framework to discuss pleasurable RAI and diagnose problematic RAI can help improve patient outcomes. Normalizing RAI, affirming pleasure from RAI and acknowledging that the gastrointestinal system is involved in sexual pleasure, sexual function and sexual health will help transform the scientific paradigm of sexual health to one that is more just and equitable.
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Sclerotherapy for haemorrhoids has been practised in the United Kingdom for almost a century.1 Urological complications due to a misplaced injection are rare and seem to occur in men only after injection of haemorrhoids at right anterior sites.2 I report on three patients who developed urinary symptoms and impotence after such an injection. Case 1 –A 67 year old man underwent proctoscopic injection of grade I haemorrhoids with 3 ml of 5% phenol in arachis oil into each of the primary haemorrhoidal sites. He immediately felt rectal pain; four hours later he developed dysuria, frequency, and frank haematuria. His urinary symptoms settled after a two week course of ciprofloxacin and diclofenac. He was unable to achieve either spontaneous or waking erections after …
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Impotence has been reported as a rare but important complication of sclerotherapy for haemorrhoids. The relationship between the anterior wall of the rectum and the periprostatic parasympathetic nerves responsible for penile erection was studied to investigate a potential anatomical explanation for this therapeutic complication. A tissue block containing the anal canal, rectum and prostate was removed from each of six male cadaveric subjects. The dimensions of the components of the rectal wall and the distance between the rectal lumen and parasympathetic nerves in the periprostatic plexus were measured in horizontal transverse histological sections of the tissue blocks at the level of the lower prostate gland (i.e. the correct level for sclerosant injection). The correct site of sclerosant in the submucosa was on average 0.6 mm (SD 0.3 mm) deep to the rectal mucosal surface and only 0.7 mm (SD 0.5 mm) in thickness. The nearest parasympathetic ganglion cells were a mean of only 8.1 mm (SD 2.0 mm) deep to the rectal lumen. The close proximity of the rectum to the periprostatic parasympathetic nerves defines an anatomical basis for impotence following sclerotherapy. This emphasises the need for all practitioners to be particularly careful when injecting in this area and for strict supervision of trainees.
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There is a strong association between hypertension and erectile dysfunction. Studies of the treatment of hypertension have shown that some pharmacological agents are capable of inducing regression of the vascular structure during treatment. We determined whether penile vascular structure is as susceptible as other vascular beds to regression during antihypertensive drug treatment. Adult spontaneously hypertensive rats were treated for 1 or 2 weeks with 30 mg./kg. enalapril daily, or for 2 weeks with 45 mg./kg. hydralazine daily. Structurally based vascular resistance was determined in isolated penile and skeletal muscle vascular beds perfused with Tyrode-dextran. A cumulative alpha1-adrenoceptor concentration constrictor response curve to 1 to 100 microg./ml. methoxamine was constructed and the maximum constrictor response (vasopressin, methoxamine and angiotensin II) indicating the tissue yield point (that is the average medial bulk of vascular smooth muscle) was determined. The hearts were excised and the ventricles were separated and weighed. Enalapril treatment progressively regressed cardiac and vascular structure during the 1 and 2-week treatment periods with a mean tissue yield point plus or minus standard deviation of -5.91% +/- 5.1% (p <0.05) and -12.1% +/- 6.0% (p <0.05), and a mean left ventricle mass of -11.8% +/- 2.2% (p <0.05) and -13.6% +/- 3.2% (p <0.05), respectively. Hydralazine treatment for 2 weeks was less effective on vascular regression with a mean yield of -7.3% +/- 2.9% (p <0.05) and it did not alter left ventricle hypertrophy compared with controls (3.7% +/- 5.0%). The data suggest that renin-angiotensin system inhibition may at least partially normalize penile vascular structure. The impact of these changes on erectile function must be determined.
Article
The association between erectile dysfunction (ED) and peripheral vascular disease (PVD) among men was examined in the Integrated Healthcare Information Services National Managed Care Benchmark Database (IHCIS). The IHCIS is a fully de-identified, Health Insurance Portability and Accountability Act compliant database and includes complete medical histories for more than 17 million managed-care lives; data from more than 30 US health plans, covering seven census regions; and patient demographics, including morbidity, age and gender. A total of 12 825 ED patients and an equal number of male patients without ED were included in the retrospective cohort study. Logistic regression analyses were performed to assess the adjusted risk of PVD that accounted for age at ED diagnosis, smoking, obesity and medications including angiotensin converting enzyme (ACE) inhibitors, beta blockers and statins. The cohort of men with ED were observed to have a 75% increase in risk for PVD (odds ratio (OR) = 1.75, 95% confidence interval (CI) = 1.06, 2.90) after adjusting for age at ED diagnosis, smoking, obesity and use of ACE inhibitors, beta blockers and statins. Some evidence of a possible trend towards increased risk was detected by age group. After controlling for the aforementioned covariates and compared to men aged 30-39 years, it was noted that patients aged 40-44 years were 2.1 times more likely to develop PVD (OR = 2.07, 95% CI = 0.89, 4.81), 45-49-year-old men were also more than twice as likely to have PVD (OR = 2.32, 95% CI = 1.03, 5.22), and 50-55-year-old patients had a three-fold increased risk of developing PVD (OR = 3.00, 95% CI = 1.40, 6.43). The results of this study indicate that ED may serve as a marker for PVD. The risk becomes more pronounced with increasing age, indicating the need for cardiologists and internists to monitor ED patients who may not necessarily present with cardiovascular symptoms.
Antihypertensive drugs induce structural remodeling of the penile vasculature
  • Hale