Risk Factors for Hemorrhoids on Screening Colonoscopy

Anne F Peery, Robert S Sandler, Joseph A Galanko, Robert S Bresalier, Jane C Figueiredo, Dennis J Ahnen, Elizabeth L Barry, John A Baron, Anne F Peery, Robert S Sandler, Joseph A Galanko, Robert S Bresalier, Jane C Figueiredo, Dennis J Ahnen, Elizabeth L Barry, John A Baron

Abstract

Background: Constipation, a low fiber diet, sedentary lifestyle and gravidity are commonly assumed to increase the risk of hemorrhoids. However, evidence regarding these factors is limited. We examined the association between commonly cited risk factors and the prevalence of hemorrhoids.

Methods: We performed a cross sectional study of participants who underwent a colonoscopy in a colorectal adenoma prevention trial and who had a detailed assessment of bowel habits, diet and activity. The presence of hemorrhoids was extracted from the subjects' colonoscopy reports. We used logistic regression to estimate odds ratios and 95% confidence intervals while adjusting for age and sex.

Results: The study included 2,813 participants. Of these, 1,074 had hemorrhoids recorded. Constipation was associated with an increased prevalence of hemorrhoids (OR 1.43, 95% CI 1.11, 1.86). Of the fiber subtypes, high grain fiber intake was associated with a reduced risk (OR for quartile 4 versus quartile 1 = 0.78, 95% CI 0.62, 0.98). We found no association when comparing gravid and nulligravida women (OR 0.93, 95% CI 0.62-1.40). Sedentary behavior was associated with a reduced risk (OR 0.80, 95% CI 0.65-0.98), but not physical activity (OR 0.83, 95% CI 0.66-1.03). Neither being overweight nor obese was associated with the presence of hemorrhoids (OR 0.89, 95% CI 0.72-1.09 and OR 0.86, 95% CI 0.70-1.06).

Conclusions: Constipation is associated with an increased risk of hemorrhoids. Gravidity and physical activity do not appear to be associated. High grain fiber intake and sedentary behavior are associated with a decreased risk of hemorrhoids.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. Ganz RA. The evaluation and treatment of hemorrhoids: a guide for the gastroenterologist. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association. 2013;11(6):593–603. Epub 2013/01/22. 10.1016/j.cgh.2012.12.020 .
    1. Riss S, Weiser FA, Schwameis K, Riss T, Mittlbock M, Steiner G, et al. The prevalence of hemorrhoids in adults. International journal of colorectal disease. 2012;27(2):215–20. Epub 2011/09/21. 10.1007/s00384-011-1316-3 .
    1. Johanson JF, Sonnenberg A. Constipation is not a risk factor for hemorrhoids: a case-control study of potential etiological agents. Am J Gastroenterol. 1994;89(11):1981–6. .
    1. Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part II: lower gastrointestinal diseases. Gastroenterology. 2009;136(3):741–54. Epub 2009/01/27. 10.1053/j.gastro.2009.01.015 .
    1. Block G, Hartman AM, Naughton D. A reduced dietary questionnaire: development and validation. Epidemiology. 1990;1(1):58–64. Epub 1990/01/01. .
    1. Whitehead WE CS, Corazziari E, et al. Report of an international workshop on management of constipation. Gastroenterology International. 1991;4(3):99–113.
    1. Drossman DA. The Functional gastrointestinal disorders: diagnosis, pathophysiology, and treatment: a multinational consenus 1st ed. Boston: Little, Brown; 1994. xxi, 370 p. p.
    1. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381–95. Epub 2003/08/06. 10.1249/01.MSS.0000078924.61453.FB .
    1. Willett W, Stampfer MJ. Total energy intake: implications for epidemiologic analyses. Am J Epidemiol. 1986;124(1):17–27. Epub 1986/07/01. .
    1. Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology. 1990;98(2):380–6. Epub 1990/02/01. .
    1. Delco F, Sonnenberg A. Associations between hemorrhoids and other diagnoses. Diseases of the colon and rectum. 1998;41(12):1534–41; discussion 41–2. Epub 1998/12/22. .
    1. Riss S, Weiser FA, Schwameis K, Mittlbock M, Stift A. Haemorrhoids, constipation and faecal incontinence: is there any relationship? Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland. 2011;13(8):e227–33. Epub 2011/06/22. 10.1111/j.1463-1318.2011.02632.x .
    1. Johannsson HO, Graf W, Pahlman L. Bowel habits in hemorrhoid patients and normal subjects. The American journal of gastroenterology. 2005;100(2):401–6. Epub 2005/01/26. 10.1111/j.1572-0241.2005.40195.x .
    1. Alonso-Coello P, Mills E, Heels-Ansdell D, Lopez-Yarto M, Zhou Q, Johanson JF, et al. Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis. The American journal of gastroenterology. 2006;101(1):181–8. Epub 2006/01/13. 10.1111/j.1572-0241.2005.00359.x .
    1. Avsar AF, Keskin HL. Haemorrhoids during pregnancy. Journal of obstetrics and gynaecology: the journal of the Institute of Obstetrics and Gynaecology. 2010;30(3):231–7. Epub 2010/04/09. 10.3109/01443610903439242 .
    1. Bharucha AE, Pemberton JH, Locke GR 3rd. American Gastroenterological Association technical review on constipation. Gastroenterology. 2013;144(1):218–38. Epub 2012/12/25. 10.1053/j.gastro.2012.10.028
    1. Saad RJ, Rao SS, Koch KL, Kuo B, Parkman HP, McCallum RW, et al. Do stool form and frequency correlate with whole-gut and colonic transit? Results from a multicenter study in constipated individuals and healthy controls. The American journal of gastroenterology. 2010;105(2):403–11. Epub 2009/11/06. 10.1038/ajg.2009.612 .
    1. Waye JD. What constitutes a total colonoscopy? The American journal of gastroenterology. 1999;94(6):1429–30. Epub 1999/06/11. 10.1111/j.1572-0241.1999.1429_a.x .

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