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Measuring Symptom Severity and Health-Related Quality-of-Life with Hemorrhoid Treatments: Systematic Review

Marquise Soto¹, Vamshek Srinivasan², William Perry³

¹Massachusetts General Hospital, Ann Arbor, Michigan.

Diseases of the Colon and Rectum

|September 23, 2026

Abstract

Background:

Hemorrhoids are common and relief anchors on symptom improvement. Despite several available treatment options, the optimal patient-reported outcome measure for contemporary clinical trials is not established.

Objective:

We aimed to systematically assess patient-reported outcome measures that measure hemorrhoid symptom severity and/or health-related quality of life.

Data Sources:

A systematic review was performed using PubMed and Embase (1980-2025).

Study Selection:

Prospective development/validation studies evaluating patient-reported outcome measures relevant to hemorrhoidal disease.

Main Outcome Measures:

Patient-reported outcome measures were evaluated on key measurement properties of reliability, internal consistency, construct validity, and responsiveness according to COSMIN v2.0 criteria.

Results:

Of the 1,266 total studies reviewed, nine patient-reported outcome measures were identified: seven measure symptom severity and six measure health-related quality-of-life. Three demonstrated reliability, internal consistency, construct validity, and responsiveness. The Patient Reported Outcome Measure-Haemorrhoidal Impact And Satisfaction Score comprehensively measures symptom severity, health-related quality-of-life, and treatment satisfaction. The Hemorrhoidal Disease Symptom Score classifies patients with high or low symptom load, and when used in combination with Short Health Scale-Hemorrhoidal Disease, also measures impact on health-related quality of life.

Limitations:

Preference toward specific measures may differ between clinical trials and clinical practice.

Conclusions:

We identify two viable patient-reported outcome measures for use in future clinical trials that evaluate hemorrhoid interventions.

Keywords:

Clinical trial Hemorrhoids Reliability Responsiveness Validity

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