title: Haemorrhoids are associated with internal iliac vein reflux in up to one-third of women presenting with varicose veins associated with pelvic vein reflux.
abstract: OBJECTIVE
  To determine the prevalence of haemorrhoids in women with pelvic vein reflux, identify which pelvic veins are associated with haemorrhoids and assess if extent of pelvic vein reflux influences the prevalence of haemorrhoids.
  
  
  METHODS
  Females presenting with leg varicose veins undergo duplex ultrasonography to assess all sources of venous reflux. Those with significant reflux arising from the pelvis are offered transvaginal duplex ultrasound (TVS) to evaluate reflux in the ovarian veins and internal Iliac veins and associated pelvic varices in the adnexa, vulvar/labial veins and haemorrhoids. Patterns and severity of reflux were evaluated.
  
  
  RESULTS
  Between January 2010 and December 2012, 419 female patients with leg or vulvar varicose vein patterns arising from the pelvis underwent TVS. Haemorrhoids were identified on TVS via direct tributaries from the internal Iliac veins in 152/419 patients (36.3%) and absent in 267/419 (63.7%). The prevalence of the condition increased with the number of pelvic trunks involved.
  
  
  CONCLUSIONS
  There is a strong association between haemorrhoids and internal Iliac vein reflux. Untreated reflux may be a cause of subsequent symptomatic haemorrhoids. Treatment with methods proven to work in conditions caused by pelvic vein incompetence, such as pelvic vein embolisation and foam sclerotherapy, could be considered.
authors.affiliation: The Whiteley Clinic, Stirling House, Stirling Road, Guildford, Surrey, UK.
authors.forename: J M
authors.initials: JM
authors.lastname: Holdstock
authors.affiliation: The Whiteley Clinic, Stirling House, Stirling Road, Guildford, Surrey, UK Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Dos Santos
authors.affiliation: The Whiteley Clinic, Stirling House, Stirling Road, Guildford, Surrey, UK.
authors.forename: C C
authors.initials: CC
authors.lastname: Harrison
authors.affiliation: The Whiteley Clinic, Stirling House, Stirling Road, Guildford, Surrey, UK.
authors.forename: B A
authors.initials: BA
authors.lastname: Price
authors.affiliation: The Whiteley Clinic, Stirling House, Stirling Road, Guildford, Surrey, UK Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK mark@thewhiteleyclinic.co.uk.
authors.forename: M S
authors.initials: MS
authors.lastname: Whiteley
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006484:Hemorrhoids / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography; D014648:Varicose Veins / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology
keywords: Haemorrhoids; duplex ultrasound; pelvic vein reflux; varicose veins