The War-Drill Model of Hemorrhoid Pathogenesis – An Integrated Framework Supported by Clinical, Physiological, and Mechanistic Evidence

The War-Drill Model of Hemorrhoid Pathogenesis – An Integrated Framework Supported by Clinical, Physiological, and Mechanistic Evidence | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The War-Drill Model of Hemorrhoid Pathogenesis – An Integrated Framework Supported by Clinical, Physiological, and Mechanistic Evidence Cem Atabiner This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6607959/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Hemorrhoids, conventionally viewed as anorectal venous dilatation due to mechanical factors, often present with clinical heterogeneity and treatment limitations that this definition fails to fully address. This article introduces Nimsai Herbal’s War-Drill Model, a novel paradigm that reframes hemorrhoid pathogenesis as a dynamic physiological response to venous congestion triggered by underlying pathologies (War Mode) or hormonal fluctuations (Drill Mode). The model’s validity is supported by findings from a multicenter randomized controlled trial (RCT), a prospective diagnostic accuracy study of the novel Parola Phenomenon, in vitro mechanistic investigations, and a comprehensive analysis of existing literature. In the RCT involving Grade 2-3 hemorrhoids, Nimsai Herbal demonstrated significantly higher rates of regression (78% vs 22%, p<0.001) and symptom resolution (62% vs 18%, p<0.001) compared to placebo. The Parola Phenomenon exhibited high diagnostic accuracy in differentiating War and Drill Modes (94% sensitivity, 91% specificity). Integrating genetic and microbiota considerations further enhances the model’s explanatory capacity for patient heterogeneity. The War-Drill Model offers an advanced understanding of hemorrhoid pathophysiology and suggests potential for more targeted and etiology-specific therapeutic strategies. Hemorrhoids Full Text Additional Declarations The authors declare potential competing interests as follows: This study was funded by Nimsai Academia. Nimsai Herbal, a commercial product of Nimsai Academia, was evaluated in this research. The authors are employees of Nimsai Academia, and thus declare a potential conflict of interest. The study was monitored by an independent data monitoring committee and third-party statisticians. Ethical approvals were obtained from all participating centers under Protocol ID NA-2024-01. Compliance with CONSORT guidelines was ensured (see Supplementary Figure S3). All participants in this study provided consent for participation and publication of findings (with the condition that their identities would not be disclosed). Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6607959","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":453146227,"identity":"680a142d-6e25-4cb1-a0fb-9706f8b2e0f1","order_by":0,"name":"Cem Atabiner","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAApElEQVRIiWNgGAWjYBACNgbGBwwfGCSATMYGYrUwGzDOIEkLA1ALMw9JDuOTbmZ8bLvDIlq+/XADw4+KbUQ4TOYws3HuGYncDWcSGxh7ztwmQotE/jHp3DagFobEBmbGNqK0JLNJWwK1zO9/SIoWRqCWhhsk2MJs2Aty2I2HDQeJ8ov8jGTGBz/b6oAOS3/44EcFEVpQwAES1Y+CUTAKRsEowAUAEdw2oW2Am5gAAAAASUVORK5CYII=","orcid":"https://orcid.org/0009-0008-2886-2127","institution":"Nimsai Academia","correspondingAuthor":true,"prefix":"","firstName":"Cem","middleName":"","lastName":"Atabiner","suffix":""}],"badges":[],"createdAt":"2025-05-07 04:34:14","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":true,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6607959/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6607959/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82392461,"identity":"e08ebd04-573f-401b-ab80-796e2baf858d","added_by":"auto","created_at":"2025-05-09 18:44:01","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":312685,"visible":true,"origin":"","legend":"","description":"","filename":"TheRealityofHemorrhoidPathogenesis..pdf","url":"https://assets-eu.researchsquare.com/files/rs-6607959/v1_covered_675593f9-7675-483e-ae3a-64126d4266c1.pdf"}],"financialInterests":"\u003cp\u003eThe authors declare potential competing interests as follows: This study was funded by Nimsai Academia. 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