Background: Haemorrhoidal disease (HD) is a frequent anal disorder and one of the
most common findings identified at colorectal clinic. This article aims to provide an overview of
the anatomy, physiology and pathophysiology of haemorrhoids and haemorrhoidal disease.
Introduction: Internal haemorrhoids are vascular cushions located in the anal canal, above the
dentate line and covered by columnar epithelium. They contribute to the faecal continence and to
the sensitivity of the anal canal. The enlargement and/or sliding of haemorrhoidal tissue produce
symptoms and complications, the so-called haemorrhoidal disease.
Method: A systematic research was realized, looking at the best evidence in literature , searching
PubMed, Embase, Cochrane library and most renowned text of colorectal surgery from January
1980 to January 2020.
Result: Aetiology and pathophysiology of HD are still controversial, but multifactorial.
Disruption of stromal scaffolding, enlargement of vascular component, elevated anal pressure and
rectal redundancy represent key events in the development and complications of the disease. Local
inflammation may play also a role. Goligher’s classification remains the most widely used. A
careful patient history and examination are paramount to diagnose HD, excluding other anal or
Conclusion: Several aspects of etiopathogenesis and pathophysiology remain controversial.
Further studies are needed to obtain a better understanding of the disease.