A study of clinico-etiological profile and its association in patients of hemorrhoids and varicose veins
DOI:
https://doi.org/10.18203/2349-2902.isj20253013Keywords:
Hemorrhoidal disease, Chronic venous disease, Chronic venous insufficiency, Concomitant pathology, Risk factors, Varicose veinsAbstract
Background: Hemorrhoidal disease (HD) and chronic venous disease (CVD) are prevalent vascular conditions sharing mechanisms such as venous hypertension, pelvic congestion, and connective tissue degeneration. Despite their frequent overlap, concomitant occurrence is often under-recognized. This study aimed to estimate the prevalence of coexisting HD and CVD, identify associated risk factors, and assess clinical correlations to guide integrated management.
Methods: This cross-sectional observational study was conducted at GSVM medical college, Kanpur between June 2023 and December 2024. A total of 140 patients were enrolled (70 HD, 70 CVD). Detailed demographic, clinical, and lifestyle data were collected. HD was assessed by digital rectal examination and graded using Goligher's classification, while CVD was confirmed by duplex ultrasonography and classified using CEAP criteria. Statistical analysis was performed using IBM SPSS version 29, with p<0.05 considered statistically significant.
Results: Of the 140 patients, 60 (42.9%) presented with concomitant HD and CVD, 59 (42.1%) with isolated HD, and 21 (15.0%) with isolated CVD. A statistically significant association was observed between the presence of HD in patients with CVD (54.3%) compared to CVD in patients with HD (31.4%) (p=0.0043). (22.0%). Age>50 years (p=0.035) was significantly associated with the occurrence of concomitant disease.
Conclusions: A substantial prevalence of concurrent HD and CVD was observed, particularly in older individuals with occupational risks. The higher occurrence of HD among CVD patients supports the role of systemic venous insufficiency in anorectal pathology. Routine screening for HD in CVD patients is recommended for comprehensive management.
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References
Godeberge P, Sheikh P, Evgeny Z, Varut L, Abel JM, Pavle K, et al. Hemorrhoidal disease and chronic venous insufficiency: Concomitance or coincidence; results of the CHORUS study. J Gastroenterol Hepatol. 2020;35(4):593-602. DOI: https://doi.org/10.1111/jgh.14857
Sheikh P, Régnier C, Gopal DV. Prospective analysis of the association between hemorrhoidal disease and chronic venous insufficiency. World J Gastroenterol. 2019;25(18):2258-67.
Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. 2012;18(17):2009-17. DOI: https://doi.org/10.3748/wjg.v18.i17.2009
Aigner F, Bodner G, Gruber H, Conrad F, Fritsch H, Margreiter R, et al. The vascular nature of hemorrhoids. J Gastrointest Surg. 2006;10(7):1044-50. DOI: https://doi.org/10.1016/j.gassur.2005.12.004
Chauhan R, et al. Varicose veins of the legs and haemorrhoids: Common pathophysiology and risk factors. Indian J Surg. 2017.
Ekici U, Abdulcabbar K, Murat FF. Association between hemorrhoids and lower extremity chronic venous insufficiency: A prospective observational study. Cureus. 2019;11(4):e4502. DOI: https://doi.org/10.7759/cureus.4502
Sheikh P, Ramesh D, Kushal M, Usha M, Prabakaran J, Sharda P. Clinical presentation of hemorrhoids and its correlation with chronic venous disease in India: A subgroup analysis of the international CHORUS survey. Indian J Surg. 2020;83(2):513-21. DOI: https://doi.org/10.1007/s12262-020-02426-1
Lurie F, Marc P, Mark M, Michael D, Elna M, Harold W, et al. The 2020 update of the CEAP classification system and reporting standards. J Vascular Surg Venous Lymphatic Dis. 2020;8(3):342-52. DOI: https://doi.org/10.1016/j.jvsv.2019.12.075
Burkitt DP. Varicose veins, deep vein thrombosis, and haemorrhoids: Epidemiology and suggested aetiology. Brit Med J. 1972;2(5803):556-61. DOI: https://doi.org/10.1136/bmj.2.5813.556
Misra MC, Parshad R. Randomized clinical trial of micronized flavonoids in the early control of bleeding from acute internal haemorrhoids. Brit J Surg. 2000;87(7):868-72. DOI: https://doi.org/10.1046/j.1365-2168.2000.01448.x
Chauhan R, Kapoor V. association of varicose veins of lower extremities with varicocele and haemorrhoids: A Case Report. Med J Armed Forces India. 1996;52(1):59-60 DOI: https://doi.org/10.1016/S0377-1237(17)30839-0
Peery AF, Robert SS, Galanko JA, Bresalier RS, Figueiredo JC, Ahnen DJ, et al. Risk factors for hemorrhoids on screening colonoscopy. PLoS ONE, 2015;10(9):e0139100. DOI: https://doi.org/10.1371/journal.pone.0139100
Avsar AF, Keskin HL. Haemorrhoids during pregnancy: A review. J Obstet Gynaecol. 2010;30(3):231-7. DOI: https://doi.org/10.3109/01443610903439242
Williams NS, O’Connell PR, McCaskie AW. Bailey and Love’s Short Practice of Surgery (27th edition). CRC Press. 2018;1025-50.
Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery (20th edition). Elsevier Health Sciences. 2017;1812-33.
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