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Haemorrhoids

Do haemorrhoids have to be operated on?

Korean national data lets the question be answered with a proportion rather than an opinion: of the people who get the diagnosis, about two in five end up having surgery.

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Answer

Most people diagnosed with haemorrhoids are not operated on: in a Korean national cohort of 467,567 people followed from 2002 to 2015, haemorrhoids were diagnosed at 13.9 per 1,000 person-years and operated on at 5.7 per 1,000 person-years — roughly two surgical cases for every five diagnoses — and what predicted each was different, with a high income level associated with being diagnosed and alcohol consumption associated with being operated on.

Key takeaways

  • In a Korean national cohort of 467,567 people, haemorrhoids were diagnosed at 13.9 per 1,000 person-years.
  • Surgery occurred at 5.7 per 1,000 person-years — roughly two operations for every five diagnoses.
  • A high income level was a risk factor for diagnosis but not for surgery.
  • Alcohol consumption was a risk factor for surgery but not for diagnosis.
  • Incidence peaked among people in their forties and was higher in men in both diagnosis and surgery.
  • Incidence was higher in metropolitan areas than elsewhere in both models.
  • The prevalence of haemorrhoidal disease in a separate Korean screening population of 194,620 adults was 16.6 percent, most of it never operated on.

The reason this question is hard to answer in a consultation is that the people asking it are in a clinic, and clinics see the cases that got worse. National data sees everybody who was diagnosed, including the majority who were not operated on.

13.9 vs 5.7

haemorrhoid diagnoses against operations, per 1,000 person-years, among 467,567 Koreans followed from 2002 to 2015Hong J et al., Asian Journal of Surgery, 2022

What separates the two groups

If severity alone decided, the two curves would be the same shape at different heights. They are not. A high income level predicted being diagnosed and did not predict being operated on. Alcohol consumption predicted surgery and not diagnosis.

The most economical reading is that a diagnosis partly measures who goes to a doctor — and income buys that access — while an operation sits closer to how bad the disease actually is, with alcohol acting on the disease rather than on the decision to seek care. The study cannot separate access from severity directly, so that is an interpretation of the pattern rather than a result of it.

The people the numbers describe

Incidence peaked in the forties, not in old age, and was higher in men and in metropolitan areas in both models. A separate Korean study that examined 194,620 healthy adults by colonoscopy at a health check found haemorrhoidal disease in 16.6 percent of them — most of whom had no complaint and were never going to be operated on.

One oddity worth knowing about, because it shows the limits of this kind of data: people who exercised one to four times a week had a higher incidence than people who did not exercise, in both models. Exercise is not a risk factor for haemorrhoids. What that result is measuring is who ends up with a recorded diagnosis, which tracks being the kind of person who goes to a doctor about an uncomfortable but non-urgent problem.

Sources

  1. 1

    Hong J, Kim I, Song J, Ahn BK

    Socio-demographic factors and lifestyle associated with symptomatic hemorrhoids: Big data analysis using the National Health insurance Service-National Health screening cohort (NHIS-HEALS) database in Korea

    Asian Journal of Surgery 2022;45(1):353-359

    doi:10.1016/j.asjsur.2021.06.020 · PMID:34187725

    https://doi.org/10.1016/j.asjsur.2021.06.020
  2. 2

    Hong YS, Jung KU, Rampal S, Zhao D, Guallar E, Ryu S, Chang Y, Kim HO, Kim H, Chun HK, Sohn CI, Shin H, Cho J

    Risk factors for hemorrhoidal disease among healthy young and middle-aged Korean adults

    Scientific Reports 2022;12(1):129

    doi:10.1038/s41598-021-03838-z · PMID:34996957

    https://doi.org/10.1038/s41598-021-03838-z