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Haemorrhoids

Among Korean women with haemorrhoids, urinary incontinence was more common — and the link peaked between 19 and 39

8,139 women from the national nutrition survey. The age at which the two conditions travelled together most closely was not old age, which is where the pelvic floor usually gets looked at.

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In short

In an analysis of 8,139 adult Korean women from the 2008-2009 Korean National Health and Nutrition Examination Survey, the prevalence of haemorrhoids was 17.5 percent by self-report and 7.9 percent by physician diagnosis, urinary incontinence was significantly more prevalent in the haemorrhoid group under either definition, and multiple logistic regression adjusted for age, body mass index, smoking, heavy drinking, physical activity, education, income, diabetes and hypertension found a significant association between the two conditions that peaked at 19 to 39 years of age.

Key takeaways

  • 8,139 adult Korean women from the 2008-2009 Korean National Health and Nutrition Examination Survey were analysed.
  • Haemorrhoid prevalence was 17.5 percent by self-report and 7.9 percent by physician diagnosis.
  • Urinary incontinence was significantly more prevalent among women with haemorrhoids under both definitions.
  • The association held after adjustment for age, body mass index, smoking, heavy drinking, physical activity, education, income, diabetes and hypertension.
  • The association between the two conditions peaked at 19 to 39 years of age.
  • Both conditions were more prevalent in older women with spouses, and in those with a larger waist circumference and higher body mass index.
  • The authors conclude that women being treated for haemorrhoids should be assessed for other pelvic floor disorders, incontinence among them.

Haemorrhoids and urinary incontinence are treated by different specialists and asked about at different appointments, which is most of the reason nobody had measured them together in Korean women. They share a floor.

Two prevalences, not one

The survey asked women whether they had haemorrhoids and separately recorded whether a doctor had diagnosed them. The answers were 17.5 percent and 7.9 percent. That gap is not an error to be resolved in favour of the smaller number; it is the size of the population who have the condition and have not taken it to a doctor, and it is more than half of all cases. The association with incontinence held under both definitions, which matters — a finding that appeared only among the diagnosed could be an artefact of who seeks care.

The age at which the link was strongest

19 to 39

the age band in which the association between haemorrhoids and urinary incontinence peaked among 8,139 Korean womenLee KY et al., Journal of Women's Health, 2020

The pelvic floor is conventionally a topic for later life, and both conditions do become more common with age — the survey found both more prevalent in older women, in women with spouses, and in those with a larger waist circumference and a higher body mass index. But the association between them was tightest in the youngest adult band. Prevalence and association are different quantities, and conflating them is how a real finding gets lost: more older women have each condition, and yet having one told you most about having the other in women under 40.

What a survey cannot settle

This is cross-sectional: everything was measured at once, so neither condition can be shown to precede the other, and the adjustment set, broad as it is, does not include parity or delivery history. What the design does deliver is a population sample rather than a clinic one — 8,139 women who were not selected for having either complaint, which is why the 17.5 percent can be read as a prevalence at all.

Set beside the screening cohort of 194,620 Korean adults, where parity rather than sex carried the difference between women and men, the two studies point the same way. What makes haemorrhoidal disease look like a women's condition in Korean data is not being a woman. It is what has happened to the pelvic floor.

Sources

  1. 1

    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
  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