Hemorrhoids consist of an external component which is covered with skin and which is highly sensitive. Hemorrhoids also consist of an internal component which is covered with colonic mucosa which is insensitive. Connective tissue holds the hemorrhoids in their normal position in the anal canal. As part of the understanding of anorectal suppuration and fistulas, one needs to be aware of the spaces around the anal canal. For practical purposes, there are four spaces which can become involved with suppuration.
Anorectal suppuration begins as an infected anal gland.
These are located in the intramuscular space. The first disease process that we will consider is that of hemorrhoids . The majority of hemorrhoidal symptoms are related to prolapsing internal hemorrhoids. In this condition, the connective tissue which holds the internal hemorrhoid in place weakens. This allows for progressive protrusion of the internal hemorrhoid into and ultimately out of the anal canal.