Abstract
Despite frequent occurrence of hemorrhoidal disease, its etiology remains controversial. Recent evidence suggests that diarrhea may represent a pathogenic risk factor. The present study examined prevalence of diarrheal disorders in elderly patients with hemorrhoidal disease to provide further insight into its pathogenic mechanisms. METHODS: Using 8.8 million Medicare patients hospitalized in the United States during 1987, the frequency distribution of all three-digit International Classification of Diseases codes was compared in patients with and without hemorrhoidal disease. A more frequent occurrence of a specific disorder in patients with hemorrhoidal disease compared with the general Medicare population suggests that this disorder may be pathophysiologically related or share common etiologic risk factors with hemorrhoidal disease. RESULTS: Strong associations were observed between hemorrhoidal disease and a number of diarrheal disorders, including ulcerative colitis, noninfectious gastroenteritis, and functional diarrhea. Hemorrhoidal disease was likewise closely associated with benign and malignant anorectal neoplasms. CONCLUSIONS: Results of this study must be interpreted with caution because epidemiologic studies cannot establish cause and effect relationships. Nevertheless, these data would seem to further support the pathogenic influence of diarrhea in development of hemorrhoidal disease.
Similar content being viewed by others
References
Johanson JF. Hemorrhoids. In: Everhart JE, ed. Digestive diseases in the United States: epidemiology and impact. U. S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Disease. Washington, DC: U. S. Government Printing Office, 1994; NIH Publication No. 94-1447, pp. 271–298.
Hyams L, Philpot J. An epidemiological investigation of hemorrhoids. Am J Proctol 1970;21:177–93.
Brown JD. The secret of Kanazawa: side streets of the world. 1989;(September):20–32.
Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation: an epidemiologic study. Gastroenterology 1990;98:380–6.
Smith LE. Hemorrhoids; a review of current techniques and management. Gastroenterol Clin North Am 1987;16:79–91.
Johanson JF, Sonnenberg A. Constipation is not a risk factor for hemorrhoids: a case-control study of potential etiologic agents. Am J Gastroenterol 1994;89:1981–6.
Kahn HA. An introduction to epidemiologic methods. New York: Oxford University Press, 1983:46–8.
Arabi Y, Alexander-Williams J, Keighley MR. Anal pressures in hemorrhoids and anal fissure. Am J Surg 1977;134:608–10.
Hiltunen KM, Matikainen M. Anal manometric findings in symptomatic hemorrhoids. Dis Colon Rectum 1985;28:807–9.
El-Gendi MA-F, Abdel-Baky N. Anorectal pressure in patients with symptomatic hemorrhoids. Dis Colon Rectum 1986;29:388–91.
Read NW, Bartolo DC, Read MG, Hall J, Haynes WG, Johnson AG. Differences in anorectal manometry between patients with hemorrhoids and patients with descending perineum syndrome: implications for management. Br J Surg 1983;70:656–9.
Gass OC, Adams J. Hemorrhoids: etiology and pathology. AmJ Surg 1950;29:40–3.
Goldberg SM, Buls JG. Perianal disease and rectal prolapse. In: Moody FG, Carey LC, Jones RS, Kelly KA, Nahrwold DL, Skinner DB, eds. Surgical treatment of digestive disease. Chicago: Year Book Medical Publishers, 1986:715–9.
Jacobs DM, Bubrick MP, Onstad GR, Hitchcock CR. The relationship of hemorrhoids to portal hypertension. Dis Colon Rectum 1980;23:567–9.
Hosking SW, Johnson AG, Smart HL, Triger DR. Anorectal varices, hemorrhoids, and portal hypertension. Lancet 1989;1:349–52.
Buckwalter JA, Jurayj MN. Relationship of chronic anorectal disease to carcinoma. Arch Surg 1957;75:352–61.
Holly EA, Whittemore AS, Aston DA, Ahn DK, Nickoloff BJ, Kristiansen JJ. Anal cancer incidence: genital warts, anal fissure or fistula, hemorrhoids, and smoking. J Natl Cancer Inst 1989;81:1726–31.
Frisch M, Olsen JH, Bautz A, Melbye M. Benign anal lesions and the risk of anal cancer. N Engl J Med 1994;331:300–2.
Lin AY, Gridley G, Tucker M. Benign anal lesions and anal cancer. N Engl J Med 1995;332:190–1.
Nelson RL, Abcarian H. Do hemorrhoids cause cancer? Semin Colon Rectal Surg 1995;6:178–81.
References
Hennekens CH, Buring JE. Epidemiology in medicine. Boston: Little Brown, 1987:272–85.
Buckwalter JA, Jurayj MN. Relationship of chronic anorectal disease to carcinoma. Arch Surg 1957;75:352–61.
Holly EA, Whittemore AS, Aston DA, Ahn DK, Nickoloff BJ, Kristiansen JJ. Anal cancer incidence: genital warts, anal fissure or fistula, hemorrhoids, and smoking. J Natl Cancer Inst 1989;81:1726–31.
Frisch M, Olsen JH, Bautz A, Melbye M. Benign anal lesions and the risk of anal cancer. N Engl J Med 1994;331:300–2.
Nelson RL, Abcarian H. Do hemorrhoids cause cancer? Semin Colon Rectal Surg 1995;6:178–181.
Lin AY, Gridley G, Tucker M. Benign anal lesions and anal cancer. N Engl J Med 1995;332:190–1.
Johanson JF, Sonnenberg A. Constipation is not a risk factor for hemorrhoids: a case-control study of potential etiologic agents. Am J Gastroenterol 1994;89:1981–6.
Author information
Authors and Affiliations
About this article
Cite this article
Johanson, J.F. Association of hemorrhoidal disease with diarrheal disorders. Dis Colon Rectum 40, 215–221 (1997). https://doi.org/10.1007/BF02054991
Issue Date:
DOI: https://doi.org/10.1007/BF02054991