Frequency of Hemorrhoidal Complaints in a Real-Life Population and Possible Concomitance between Hemorrhoidal Disease and Chronic Venous Disease: Going Further in Our Understanding of Hemorrhoidal Disease

Abstract

Introduction: Hemorrhoids, more commonly known as piles, are swollen veins, similar to varicose veins in the lower rectum. Hemorrhoids can develop both inside and outside the rectum, and oftentimes, the cause of hemorrhoids remains unknown. This is an extremely common ailment faced by three out of four adults in their lifetime. Hemorrhoids can cause various kinds of complications, but the most common and serious ones are perianal thrombosis and incarcerated prolapsed internal hemorrhoids with subsequent thrombosis. They are accompanied by severe pain in the perianal region, and possible bleeding. Data on the coexistence of hemorrhoids with other conditions are sparse. Some data are consistent with a common pathophysiological link between straining at stool, constipation, and obstetrical events such as pregnancy and delivery. These events are also involved in the development of Chronic Vein Disease (CVD) or Chronic Vein Insufficiency (CVI). CVI is a condition that occurs when the venous walls or valves in the leg veins stop working properly, causing difficulty in blood returning to the heart from the legs. The present study was conducted with an aim to determine the frequency of complaints in hemorrhoidal patients and to assess the possible concomitance between hemorrhoidal disease and chronic venous disease. Methods: This was a multicenter, cross-sectional, observational study that enrolled patients spontaneously consulting for hemorrhoids in 17 different hospitals of different regions of Bangladesh from 1st June 2018 to 31st July 2018. Patients’ demographic and lifestyle characteristics were recorded, information on hemorrhoidal grade and signs of chronic venous disease was collected. Types of prescribed treatments were also recorded by the physicians. Results: A total of 499 patients were enrolled and analyzed. Reported frequencies of hemorrhoidal symptoms were: bleeding (80.8%), pain (66.3%), swelling (51.7%), prolapse (28.9%), itching (37.7%), soiling (12%), fecal incontinence (13.4%). 13.8% of the hemorrhoidal patients presented concomitant chronic venous disease. The Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification was used to classify the clinical signs and symptoms of the patients as C0—no visible or palpable signs of venous disease (6.2%), C1—telangiectasias or reticular veins (4.4%), C2—varicose veins (1.4%), C3—edema (2.6%), C4a—pigmentation or eczema (2%), C4b—lipodermatosclerosis or Atrophie Blanche (0.2%), C5 & C6—venous ulcer (0.6%). Commonly prescribed treatments were dietary fiber (89.8%), veno-active drugs (74.7%), topical treatments (63.7%), painkillers (11.2%), and surgical procedures (30.3%). Conclusion: The study provides small-scale data on patient profiles, risk factors, and commonly prescribed treatments in hemorrhoidal patients. The concomitance of chronic venous disease in 13.8% of the hemorrhoidal patients highlights the importance of examining for Chronic Venous Disease (CVD) with a hemorrhoidal diagnosis. Further clinical studies and large-scale data are needed to confirm the co-morbidity of these two diseases and a common targeted treatment should be developed thereby. Since even early symptoms greatly affect the lives of hemorrhoidal patients, a conservative treatment appears to be the cornerstone treatment in disease management.