TITLE:
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
AUTHORS:
Sheikh Firoj Kabir, Debasish Das, Kazi Zana Alam, Mahbub Murshed, Din Mohammad
KEYWORDS:
Hemorrhoidal Complaints, Chronic Venous Disease, Frequency
JOURNAL NAME:
Surgical Science,
Vol.12 No.9,
September
18,
2021
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