Bowel habits in hemorrhoid patients and normal subjects

Bleeding, pain, soiling, and prolapse are the classic symptoms in hemorrhoid disease, but the patients sometimes report a variety of other symptoms. Little is known about functional bowel symptoms in patients with hemorrhoids and few studies have previously addressed this subject. The aim of this study was to compare patients with hemorrhoids with a control population regarding functional bowel symptoms and anorectal complaints.

One hundred consecutive patients who participated in a randomized study on hemorrhoidectomy completed a validated questionnaire on bowel and anorectal functional symptoms. Two hundred age- and gender-matched population based control subjects, and 100 gender-matched consecutive patients undergoing an orthopedic procedure served as two control groups, and completed the same questionnaire.

Bowel frequency was the same in all three groups, but only 37% of the patients described their bowel movements as normal, compared to 55 and 67% of the controls (p < 0.001). Up to 37% of the patients reported bloating, compared to 18 and 26% in the control groups. Abdominal pain associated with bowel evacuation was experienced by 34% of the patients but in 3 and 5% of the controls (p < 0.001). Excessive straining, feeling of incomplete evacuation, and repeated toilet visits were significantly more usual in the patients. Reduced feeling of well being and disturbed social life caused by bowel symptoms was often reported by patients but rarely in the control groups.

Beside hemorrhoidal symptoms, many patients with Grade 3-4 hemorrhoids have concomitant functional bowel symptoms, possibly associated with the irritable bowel syndrome. This knowledge might be important while selecting therapy for patients with hemorrhoids.