Figure 2.

A new theory on haemorrhoidal disease pathophysiology. In this flow-chart, a new model of haemorrhoidal disease pathophysiology mechanism is presented. In this case, dysbiosis is the primum movens of the disease, and events that lead to symptoms are the direct effect of the local inflammatory state caused by altered rectal microbiota/mycobiota. vascular congestion, neoangiogenesis and arterial hyperperfusion, oedema, and connective disruption due to inflammation are responsible of swelling and cushion prolapse. Inflammation and a possible direct involvement of bacteria (producing substances able affect intestinal muscular layer) could be involved also in internal sphincter hypertonicity and subsequent increased intra-abdominal pressure. The reported mechanism is established and perpetuated with the assistance of many vicious cycles, and it is continuously auto-reinforced. In other words, haemorrhoidal disease becomes worse over time.