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Haemorrhoids

I developed haemorrhoids after giving birth. Is that usual?

Usual enough that childbirth, not sex, is what makes haemorrhoids look like a women's condition in Korean data. Women who have not given birth are at slightly lower risk than men.

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Answer

Haemorrhoids after childbirth are usual, and Korean data shows childbirth is the reason the condition appears more often in women at all: among 194,620 healthy Korean adults examined by colonoscopy at a health check, the prevalence of haemorrhoidal disease was 16.6 percent overall and higher in women than men (17.2 against 16.3 percent, P < 0.001), but compared with men the prevalence was higher in women who had given birth (adjusted odds ratio 1.06, 95% CI 1.02 to 1.10) and lower in women who had not (adjusted OR 0.92, 95% CI 0.86 to 0.98).

Key takeaways

  • Among 194,620 healthy Korean adults screened by colonoscopy, 16.6 percent had haemorrhoidal disease.
  • Prevalence was higher in women than men, at 17.2 against 16.3 percent (P < 0.001).
  • Compared with men, women who had given birth had a higher prevalence (adjusted OR 1.06, 95% CI 1.02 to 1.10).
  • Women who had not given birth had a lower prevalence than men (adjusted OR 0.92, 95% CI 0.86 to 0.98).
  • Body mass index and waist circumference were positively associated with prevalence specifically in women who had given birth.
  • Older age, smoking, being overweight and being hypertensive were also independently associated with the condition.
  • Among Korean women, haemorrhoids were also significantly associated with urinary incontinence, and that association peaked between 19 and 39 years of age.

The received wisdom is that haemorrhoids are more common in women. That is true of the population and misleading about the cause, and the Korean screening data separates the two cleanly.

The sex difference is a parity difference

Women did have the higher prevalence — 17.2 against 16.3 percent. But splitting women by whether they had given birth reverses the picture for one of the two groups. Against men as the reference, women who had given birth carried a higher prevalence and women who had not carried a lower one.

1.06 vs 0.92

adjusted odds of haemorrhoidal disease against men as the reference — women who had given birth, and women who had notHong YS et al., Scientific Reports, 2022

So what is more common after childbirth is not haemorrhoids in women generally. It is haemorrhoids in women who have been pregnant and delivered — which is a mechanical story about months of raised intra-abdominal and venous pressure followed by the second stage of labour, not a story about being female.

The question worth raising at the same visit

A separate analysis of 8,139 Korean women found haemorrhoids significantly associated with urinary incontinence after adjustment for age, weight, smoking, drinking, activity, education, income, diabetes and hypertension — and the association was strongest between 19 and 39 years of age, which is precisely the age band in which nobody is asked about it.

The two conditions share a pelvic floor and are treated in different clinics, which is most of the reason they are rarely discussed together. If you have developed one after childbirth, the other is worth mentioning rather than waiting to be asked.

Both studies are cross-sectional — everything was measured at once — so neither can say that childbirth caused the haemorrhoids rather than preceding them. What the screening design does deliver is a population sample: these are people who came for a check-up, not patients who came to complain, which is why 16.6 percent can be read as a prevalence at all.

Sources

  1. 1

    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
  2. 2

    Lee KY, Lee JI, Park YY, Kim YS, Lee DH, Chae HS, Lee TK, Sohn TS, Jeong SC, Lee YB, Han K

    Hemorrhoids Are Associated with Urinary Incontinence

    Journal of Women's Health 2020;29(11):1464-1468

    doi:10.1089/jwh.2019.8168 · PMID:32762610

    https://doi.org/10.1089/jwh.2019.8168