Materiały źródłowe

• #1 Hemorrhoids: From basic pathophysiology to clinical management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3342598/

  This review discusses the pathophysiology, epidemiology, risk factors, classification, clinical evaluation, and current non-operative and operative treatment of hemorrhoids. […] Although hemorrhoids are recognized as a very common cause of rectal bleeding and anal discomfort, the true epidemiology of this disease is unknown because patients have a tendency to use self-medication rather than to seek proper medical attention. An epidemiologic study by Johanson et al in 1990 showed that 10 million people in the United States complained of hemorrhoids, corresponding to a prevalence rate of 4.4%. In both sexes, peak prevalence occurred between age 45-65 years and the development of hemorrhoids before the age of 20 years was unusual. […] In the United Kingdom, hemorrhoids were reported to affect 13%-36% of the general population. However, this estimation may be higher than actual prevalence because the community-based studies mainly relied on self-reporting and patients may attribute any anorectal symptoms to hemorrhoids.

• #2 Hemorrhoids: From basic pathophysiology to clinical management

  https://www.wjgnet.com/1007-9327/full/v18/i17/2009.htm

  Hemorrhoids are a very common anorectal condition defined as the symptomatic enlargement and distal displacement of the normal anal cushions. They affect millions of people around the world, and represent a major medical and socioeconomic problem. […] Although hemorrhoids are recognized as a very common cause of rectal bleeding and anal discomfort, the true epidemiology of this disease is unknown because patients have a tendency to use self-medication rather than to seek proper medical attention. An epidemiologic study by Johanson et al in 1990 showed that 10 million people in the United States complained of hemorrhoids, corresponding to a prevalence rate of 4.4%. In both sexes, peak prevalence occurred between age 45-65 years and the development of hemorrhoids before the age of 20 years was unusual. Whites and higher socioeconomic status individuals were affected more frequently than blacks and those of lower socioeconomic status. However, this association may reflect differences in health-seeking behavior rather than true prevalence. In the United Kingdom, hemorrhoids were reported to affect 13%-36% of the general population. However, this estimation may be higher than actual prevalence because the community-based studies mainly relied on self-reporting and patients may attribute any anorectal symptoms to hemorrhoids.

• #3 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Epidemiology-of-Hemorrhoids.aspx

  Worldwide, the overall prevalence of hemorrhoids in the general population is estimated to be 4.4%. […] However, experts have noticed that in the United States (US) and United Kingdom (UK), the number of people visiting hospital as a result of hemorrhoids has fallen. […] According to the HD Treatment Center, estimates suggest that around half of Americans develop hemorrhoids by time they are aged 50 and only a small proportion of those people seek therapy. The number of people in the US suffering from hemorrhoids is estimated to be around 10.4 million and 1 million new cases occur each year. Ten to 20% of those new cases require surgery. […] The HD Treatment Center has also found that among people older than 45 years, 25% of people who develop hemorrhoids are female and 15% are men. […] Research has also shown there is a greater likelihood of men seeking treatment for their hemorrhoids than there is for women.

• #4 Hemorrhoids: Background, Anatomy, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/775407-overview

  Worldwide, the prevalence of symptomatic hemorrhoids is estimated at 4.4% in the general population. In the United States, up to one third of the 10 million people with hemorrhoids seek medical treatment, resulting in 1.5 million related prescriptions per year. […] The number of hemorrhoidectomies performed in US hospitals is declining. A peak of 117 hemorrhoidectomies per 100,000 people was reached in 1974; this rate declined to 37 hemorrhoidectomies per 100,000 people in 1987. Outpatient and office treatment of hemorrhoids account for some of this decline. […] Patients presenting with hemorrhoidal disease are more frequently white, from higher socioeconomic status, and from rural areas. There is no known sex predilection, although men are more likely to seek treatment. However, pregnancy causes physiologic changes that predispose women to developing symptomatic hemorrhoids. As the gravid uterus expands, it compresses the inferior vena cava, causing decreased venous return and distal engorgement. […] External hemorrhoids occur more commonly in young and middle-aged adults than in older adults. The prevalence of hemorrhoids increases with age, with a peak in persons aged 45-65 years.

• #5 Hemorrhoids: From basic pathophysiology to clinical management

  https://www.wjgnet.com/1007-9327/full/v18/i17/2009.htm

  Hemorrhoids are a very common anorectal condition defined as the symptomatic enlargement and distal displacement of the normal anal cushions. They affect millions of people around the world, and represent a major medical and socioeconomic problem. […] Although hemorrhoids are recognized as a very common cause of rectal bleeding and anal discomfort, the true epidemiology of this disease is unknown because patients have a tendency to use self-medication rather than to seek proper medical attention. An epidemiologic study by Johanson et al in 1990 showed that 10 million people in the United States complained of hemorrhoids, corresponding to a prevalence rate of 4.4%. In both sexes, peak prevalence occurred between age 45-65 years and the development of hemorrhoids before the age of 20 years was unusual. Whites and higher socioeconomic status individuals were affected more frequently than blacks and those of lower socioeconomic status. However, this association may reflect differences in health-seeking behavior rather than true prevalence. In the United Kingdom, hemorrhoids were reported to affect 13%-36% of the general population. However, this estimation may be higher than actual prevalence because the community-based studies mainly relied on self-reporting and patients may attribute any anorectal symptoms to hemorrhoids.

• #6 Hemorrhoids: Diagnosis and Treatment Options | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0201/p172.html

  Hemorrhoids are common. The exact prevalence is unknown because most patients are asymptomatic and do not seek care from a physician. A study of patients undergoing routine colorectal cancer screening found a 39% prevalence of hemorrhoids, with 55% of those patients reporting no symptoms. Hemorrhoids are more prevalent in persons 45 to 65 years of age. Although the precise cause is not well understood, hemorrhoids are associated with conditions that increase pressure in the hemorrhoidal venous plexus, such as straining during bowel movements secondary to constipation. Other associations include obesity, pregnancy, chronic diarrhea, anal intercourse, cirrhosis with ascites, pelvic floor dysfunction, and a low-fiber diet. […] Hemorrhoids develop when the venous drainage of the anus is altered, causing the venous plexus and connecting tissue to dilate, creating an outgrowth of anal mucosa from the rectal wall. However, the exact pathophysiology is unknown. Hemorrhoids occur above or below the dentate line where the proximal columnar transitions to the distal squamous epithelium.

• #7

  https://journals.lww.com/aoam/fulltext/2019/18010/hemorrhoidal_disease__predilection_sites,_pattern.3.aspx

  An engorgement and prolapse of the anal cushion lead to haemorrhoidal disease. There are different anatomical sites and presentation of this common pathology which affects the quality of life. […] Hemorrhoids are a leading cause of lower gastrointestinal bleeding with a high impact on quality of life. […] A literature search showed paucity of literature on epidemiology of hemorrhoids in Africa, but interventional studies from Nigeria reported a peak incidence in the late and early third and fourth decades respectively with a male predominance. […] In general, it is estimated that 50% of the people older than 50 years have hemorrhoids symptoms at least for a period. […] The most common presentation of hemorrhoids seen was painless rectal bleeding during defecation with or without prolapsing anal tissue in 71% of cases. […] Over half of the population of patients had Grade 1 and 2 hemorrhoids that were diagnosed with the aid of endoscopy. […] The prevalence of hemorrhoids is highest in the middle-aged population mostly males.

• #8 Hemorrhoids epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Hemorrhoids_epidemiology_and_demographics

  In the USA, the prevalence is about 4,400 per 100,000 individuals. […] It is estimated that approximately one half of all Americans have had this condition by the age of 50, and that 50% to 85% of the world’s population will be affected by hemorrhoids at some point in their life. However, only a small number seek medical treatment. […] Annually, only about 500,000 in the U.S. are medically treated for massive hemorrhage, with 10 to 20% requiring surgery. […] Hemorrhoids are most prevalent in people between 45-65 years old. […] Both males and females are affected equally by hemorrhoids.

• #9 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Epidemiology-of-Hemorrhoids.aspx

  Worldwide, the overall prevalence of hemorrhoids in the general population is estimated to be 4.4%. […] However, experts have noticed that in the United States (US) and United Kingdom (UK), the number of people visiting hospital as a result of hemorrhoids has fallen. […] According to the HD Treatment Center, estimates suggest that around half of Americans develop hemorrhoids by time they are aged 50 and only a small proportion of those people seek therapy. The number of people in the US suffering from hemorrhoids is estimated to be around 10.4 million and 1 million new cases occur each year. Ten to 20% of those new cases require surgery. […] The HD Treatment Center has also found that among people older than 45 years, 25% of people who develop hemorrhoids are female and 15% are men. […] Research has also shown there is a greater likelihood of men seeking treatment for their hemorrhoids than there is for women.

• #10 Hemorrhoids epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Hemorrhoids_epidemiology_and_demographics

  In the USA, the prevalence is about 4,400 per 100,000 individuals. […] It is estimated that approximately one half of all Americans have had this condition by the age of 50, and that 50% to 85% of the world’s population will be affected by hemorrhoids at some point in their life. However, only a small number seek medical treatment. […] Annually, only about 500,000 in the U.S. are medically treated for massive hemorrhage, with 10 to 20% requiring surgery. […] Hemorrhoids are most prevalent in people between 45-65 years old. […] Both males and females are affected equally by hemorrhoids.

• #11 Hemorrhoid Disease and the Role of the Gastroenterologist

  https://www.gastroendonews.com/Review-Articles/Article/01-19/Hemorrhoid-Disease-and-the-Role-of-the-Gastroenterologist/53852?sub=14EBB94819BEDF16889AE192D84D5D7F12BAB184E7D2270C73D794B269D&enl=true

  Patients with symptomatic hemorrhoids frequently present to family physicians and gastroenterologists. […] Hemorrhoids account for approximately 3.5 million physician visits and $500 million in health care costs in the United States alone. […] Risk factors for symptomatic hemorrhoids include low consumption of dietary fiber, chronic straining, excessive time on the toilet, constipation, diarrhea, pregnancy, and family history. […] Nearly all patients with symptomatic Grade I internal hemorrhoids respond well to medical therapy. […] The majority of patients presenting with symptomatic hemorrhoids improve with a bowel management program alone. […] Gastroenterologists can offer a successful alternative to invasive surgical excision. […] Multiple randomized controlled trials have compared the above methods, but no single study has assessed all 5 at once. […] Overall, 5% to 10% of patients with hemorrhoids will require surgery; the vast majority of these have Grade III to IV lesions.

• #12 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Epidemiology-of-Hemorrhoids.aspx

  Worldwide, the overall prevalence of hemorrhoids in the general population is estimated to be 4.4%. […] However, experts have noticed that in the United States (US) and United Kingdom (UK), the number of people visiting hospital as a result of hemorrhoids has fallen. […] According to the HD Treatment Center, estimates suggest that around half of Americans develop hemorrhoids by time they are aged 50 and only a small proportion of those people seek therapy. The number of people in the US suffering from hemorrhoids is estimated to be around 10.4 million and 1 million new cases occur each year. Ten to 20% of those new cases require surgery. […] The HD Treatment Center has also found that among people older than 45 years, 25% of people who develop hemorrhoids are female and 15% are men. […] Research has also shown there is a greater likelihood of men seeking treatment for their hemorrhoids than there is for women.

• #13 The epidemiology and Etiology of Hemorrhoids

  https://www.jstage.jst.go.jp/article/jcoloproctology/63/10/63_10_819/_article/-char/en

  There have been few articles regarding the epidemiology of hemorrhoids, therefore the prevalence of hemorrhoids is not well documented. In the USA, an annual nationwide health questionnaire showed a prevalence rate of 4.4%. In both sexes, a peak in prevalence was noted from age 45-65 years. […] There seems to be a fall in the rate of hospital visits in both the USA and the UK. […] Despite the fact that the pathogenesis of hemorrhoids still remains elusive because of the diversity and complexity of their pathophysiology, it is reasonable to assume that both vascular tissue factors and the connective tissue factors contribute to the etiology of hemorrhoids.

• #14 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Epidemiology-of-Hemorrhoids.aspx

  There is a paucity of data on the incidence of hemorrhoids by race, although it has been shown that there is a greater likelihood of Caucasian individuals seeking treatment compared with other races. […] Age is known to influence hemorrhoid risk, with the likelihood of hemorrhoids increasing as a person ages. In most cases, hemorrhoids develop in individuals who are over 30 years old, although they can develop at any age. […] People who live in rural areas and those with a higher socioeconomic background appear to be more likely to be affected by hemorrhoids. […] The number of patients that require surgical removal of hemorrhoids, known as a hemorrhoidectomy, in hospitals in the United States is declining. It reached a peak in 1974 with 117 hemorrhoidectomies per 100,000 people, which dropped to 37 in 1987.

• #15 Hemorrhoids: Background, Anatomy, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/775407-overview

  Worldwide, the prevalence of symptomatic hemorrhoids is estimated at 4.4% in the general population. In the United States, up to one third of the 10 million people with hemorrhoids seek medical treatment, resulting in 1.5 million related prescriptions per year. […] The number of hemorrhoidectomies performed in US hospitals is declining. A peak of 117 hemorrhoidectomies per 100,000 people was reached in 1974; this rate declined to 37 hemorrhoidectomies per 100,000 people in 1987. Outpatient and office treatment of hemorrhoids account for some of this decline. […] Patients presenting with hemorrhoidal disease are more frequently white, from higher socioeconomic status, and from rural areas. There is no known sex predilection, although men are more likely to seek treatment. However, pregnancy causes physiologic changes that predispose women to developing symptomatic hemorrhoids. As the gravid uterus expands, it compresses the inferior vena cava, causing decreased venous return and distal engorgement. […] External hemorrhoids occur more commonly in young and middle-aged adults than in older adults. The prevalence of hemorrhoids increases with age, with a peak in persons aged 45-65 years.

• #16 External Hemorrhoid | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/21477

  Hemorrhoid disease is a common anorectal disorder affecting millions in the United States and the most common cause of rectal bleeding. Hemorrhoids are believed to affect men and women equally. They are rare under 20 years of age, and incidence peaks between the ages of 45 and 65. Estimates of hemorrhoid disease in pregnant women vary but range as high as 35%. […] Hemorrhoids are classified as internal or external based on their location relative to the dentate line. External hemorrhoids occur distal to the dentate line. Internal hemorrhoids occur proximal to the dentate line and are further categorized into 4 different grades. Grade I hemorrhoids prolapse beyond the dentate line upon straining. Grade II hemorrhoids prolapse through the anus upon straining but spontaneously reduce, while grade III hemorrhoids prolapse through the anus upon straining and can only be reduced manually. Grade IV hemorrhoids have prolapsed through the anus and cannot be reduced.

• #17 Hemorrhoids | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/haemorrhoids?embed_domain=external.radpair.com%2527%255B0%255D

  The prevalence of hemorrhoids is ~20% (range 4-40%), and the actual prevalence remains unknown 2. It has an equal distribution between males and females 1. It is most commonly seen between 45 and 65 years of age and is more common in higher socioeconomic groups 1-3. […] Symptomatic pathological hemorrhoids occur secondary to raised intra-abdominal pressure 2.

• #18 External Hemorrhoid – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK500009/

  Hemorrhoid disease is a common anorectal disorder affecting millions in the United States and the most common cause of rectal bleeding. Hemorrhoids are believed to affect men and women equally. They are rare under 20 years of age, and incidence peaks between the ages of 45 and 65. Estimates of hemorrhoid disease in pregnant women vary but range as high as 35%. […] Hemorrhoids are rich in vascular supply and have a tendency to engorge and prolapse. Symptoms can vary from mild itching and bleeding to severe pain. Unfortunately, because of the location, many patients never seek treatment for fear of embarrassment.

• #19 Hemorrhoids: Background, Anatomy, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/775407-overview

  Worldwide, the prevalence of symptomatic hemorrhoids is estimated at 4.4% in the general population. In the United States, up to one third of the 10 million people with hemorrhoids seek medical treatment, resulting in 1.5 million related prescriptions per year. […] The number of hemorrhoidectomies performed in US hospitals is declining. A peak of 117 hemorrhoidectomies per 100,000 people was reached in 1974; this rate declined to 37 hemorrhoidectomies per 100,000 people in 1987. Outpatient and office treatment of hemorrhoids account for some of this decline. […] Patients presenting with hemorrhoidal disease are more frequently white, from higher socioeconomic status, and from rural areas. There is no known sex predilection, although men are more likely to seek treatment. However, pregnancy causes physiologic changes that predispose women to developing symptomatic hemorrhoids. As the gravid uterus expands, it compresses the inferior vena cava, causing decreased venous return and distal engorgement. […] External hemorrhoids occur more commonly in young and middle-aged adults than in older adults. The prevalence of hemorrhoids increases with age, with a peak in persons aged 45-65 years.

• #20 Hemorrhoids: From basic pathophysiology to clinical management

  https://www.wjgnet.com/1007-9327/full/v18/i17/2009.htm

  Hemorrhoids are a very common anorectal condition defined as the symptomatic enlargement and distal displacement of the normal anal cushions. They affect millions of people around the world, and represent a major medical and socioeconomic problem. […] Although hemorrhoids are recognized as a very common cause of rectal bleeding and anal discomfort, the true epidemiology of this disease is unknown because patients have a tendency to use self-medication rather than to seek proper medical attention. An epidemiologic study by Johanson et al in 1990 showed that 10 million people in the United States complained of hemorrhoids, corresponding to a prevalence rate of 4.4%. In both sexes, peak prevalence occurred between age 45-65 years and the development of hemorrhoids before the age of 20 years was unusual. Whites and higher socioeconomic status individuals were affected more frequently than blacks and those of lower socioeconomic status. However, this association may reflect differences in health-seeking behavior rather than true prevalence. In the United Kingdom, hemorrhoids were reported to affect 13%-36% of the general population. However, this estimation may be higher than actual prevalence because the community-based studies mainly relied on self-reporting and patients may attribute any anorectal symptoms to hemorrhoids.

• #21 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Epidemiology-of-Hemorrhoids.aspx

  Worldwide, the overall prevalence of hemorrhoids in the general population is estimated to be 4.4%. […] However, experts have noticed that in the United States (US) and United Kingdom (UK), the number of people visiting hospital as a result of hemorrhoids has fallen. […] According to the HD Treatment Center, estimates suggest that around half of Americans develop hemorrhoids by time they are aged 50 and only a small proportion of those people seek therapy. The number of people in the US suffering from hemorrhoids is estimated to be around 10.4 million and 1 million new cases occur each year. Ten to 20% of those new cases require surgery. […] The HD Treatment Center has also found that among people older than 45 years, 25% of people who develop hemorrhoids are female and 15% are men. […] Research has also shown there is a greater likelihood of men seeking treatment for their hemorrhoids than there is for women.

• #22 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Epidemiology-of-Hemorrhoids.aspx

  Worldwide, the overall prevalence of hemorrhoids in the general population is estimated to be 4.4%. […] However, experts have noticed that in the United States (US) and United Kingdom (UK), the number of people visiting hospital as a result of hemorrhoids has fallen. […] According to the HD Treatment Center, estimates suggest that around half of Americans develop hemorrhoids by time they are aged 50 and only a small proportion of those people seek therapy. The number of people in the US suffering from hemorrhoids is estimated to be around 10.4 million and 1 million new cases occur each year. Ten to 20% of those new cases require surgery. […] The HD Treatment Center has also found that among people older than 45 years, 25% of people who develop hemorrhoids are female and 15% are men. […] Research has also shown there is a greater likelihood of men seeking treatment for their hemorrhoids than there is for women.

• #23 Hemorrhoids: Background, Anatomy, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/775407-overview

  Worldwide, the prevalence of symptomatic hemorrhoids is estimated at 4.4% in the general population. In the United States, up to one third of the 10 million people with hemorrhoids seek medical treatment, resulting in 1.5 million related prescriptions per year. […] The number of hemorrhoidectomies performed in US hospitals is declining. A peak of 117 hemorrhoidectomies per 100,000 people was reached in 1974; this rate declined to 37 hemorrhoidectomies per 100,000 people in 1987. Outpatient and office treatment of hemorrhoids account for some of this decline. […] Patients presenting with hemorrhoidal disease are more frequently white, from higher socioeconomic status, and from rural areas. There is no known sex predilection, although men are more likely to seek treatment. However, pregnancy causes physiologic changes that predispose women to developing symptomatic hemorrhoids. As the gravid uterus expands, it compresses the inferior vena cava, causing decreased venous return and distal engorgement. […] External hemorrhoids occur more commonly in young and middle-aged adults than in older adults. The prevalence of hemorrhoids increases with age, with a peak in persons aged 45-65 years.

• #24 External Hemorrhoid | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/21477

  Hemorrhoid disease is a common anorectal disorder affecting millions in the United States and the most common cause of rectal bleeding. Hemorrhoids are believed to affect men and women equally. They are rare under 20 years of age, and incidence peaks between the ages of 45 and 65. Estimates of hemorrhoid disease in pregnant women vary but range as high as 35%. […] Hemorrhoids are classified as internal or external based on their location relative to the dentate line. External hemorrhoids occur distal to the dentate line. Internal hemorrhoids occur proximal to the dentate line and are further categorized into 4 different grades. Grade I hemorrhoids prolapse beyond the dentate line upon straining. Grade II hemorrhoids prolapse through the anus upon straining but spontaneously reduce, while grade III hemorrhoids prolapse through the anus upon straining and can only be reduced manually. Grade IV hemorrhoids have prolapsed through the anus and cannot be reduced.

• #25 Hemorrhoids: Symptoms, causes, and treatments

  https://www.medicalnewstoday.com/articles/73938

  Hemorrhoids, also known as piles, are swollen veins in the lower part of the anus and rectum. […] Hemorrhoids may occur in up to 35% of pregnant people. […] Hemorrhoids are most common among adults ages 45-65 years. […] Research links being overweight to a higher risk of hemorrhoids. […] Hemorrhoid symptoms often resolve on their own with conservative treatment, although there is a 10-50% chance they will return over 5 years. […] The chance of hemorrhoids returning after surgery is less than 5%.

• #26 Risk factors for hemorrhoidal disease among healthy young and middle-aged Korean adults | Scientific Reports

  https://www.nature.com/articles/s41598-021-03838-z

  Parous women had a significantly higher prevalence of hemorrhoidal disease compared to men and to nulliparous women, likely due to mechanical changes of the pelvic floor because of increased intra-abdominal pressure, pelvic venous congestion, and damage during labor, and to hormonal factors affecting gastrointestinal motility during pregnancy. […] Smoking was also associated with an increased prevalence of hemorrhoidal disease, possibly by promoting systemic inflammation and by its effects on collagen metabolism. […] The association of excess adiposity with hemorrhoidal disease is controversial. […] Among various self-reported gastrointestinal symptoms, fresh blood in stools, constipation, narrow caliber stools, and tenesmus were associated with the presence of hemorrhoidal disease. […] Further epidemiological studies with longitudinal design are needed to better understand how these factors interact in the development of hemorrhoidal disease.

• #27 Hemorrhoids: Background, Anatomy, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/775407-overview

  Worldwide, the prevalence of symptomatic hemorrhoids is estimated at 4.4% in the general population. In the United States, up to one third of the 10 million people with hemorrhoids seek medical treatment, resulting in 1.5 million related prescriptions per year. […] The number of hemorrhoidectomies performed in US hospitals is declining. A peak of 117 hemorrhoidectomies per 100,000 people was reached in 1974; this rate declined to 37 hemorrhoidectomies per 100,000 people in 1987. Outpatient and office treatment of hemorrhoids account for some of this decline. […] Patients presenting with hemorrhoidal disease are more frequently white, from higher socioeconomic status, and from rural areas. There is no known sex predilection, although men are more likely to seek treatment. However, pregnancy causes physiologic changes that predispose women to developing symptomatic hemorrhoids. As the gravid uterus expands, it compresses the inferior vena cava, causing decreased venous return and distal engorgement. […] External hemorrhoids occur more commonly in young and middle-aged adults than in older adults. The prevalence of hemorrhoids increases with age, with a peak in persons aged 45-65 years.

• #28 Hemorrhoids: From basic pathophysiology to clinical management

  https://www.wjgnet.com/1007-9327/full/v18/i17/2009.htm

  Hemorrhoids are a very common anorectal condition defined as the symptomatic enlargement and distal displacement of the normal anal cushions. They affect millions of people around the world, and represent a major medical and socioeconomic problem. […] Although hemorrhoids are recognized as a very common cause of rectal bleeding and anal discomfort, the true epidemiology of this disease is unknown because patients have a tendency to use self-medication rather than to seek proper medical attention. An epidemiologic study by Johanson et al in 1990 showed that 10 million people in the United States complained of hemorrhoids, corresponding to a prevalence rate of 4.4%. In both sexes, peak prevalence occurred between age 45-65 years and the development of hemorrhoids before the age of 20 years was unusual. Whites and higher socioeconomic status individuals were affected more frequently than blacks and those of lower socioeconomic status. However, this association may reflect differences in health-seeking behavior rather than true prevalence. In the United Kingdom, hemorrhoids were reported to affect 13%-36% of the general population. However, this estimation may be higher than actual prevalence because the community-based studies mainly relied on self-reporting and patients may attribute any anorectal symptoms to hemorrhoids.

• #29 Hemorrhoids: From basic pathophysiology to clinical management

  https://www.wjgnet.com/1007-9327/full/v18/i17/2009.htm

  Hemorrhoids are a very common anorectal condition defined as the symptomatic enlargement and distal displacement of the normal anal cushions. They affect millions of people around the world, and represent a major medical and socioeconomic problem. […] Although hemorrhoids are recognized as a very common cause of rectal bleeding and anal discomfort, the true epidemiology of this disease is unknown because patients have a tendency to use self-medication rather than to seek proper medical attention. An epidemiologic study by Johanson et al in 1990 showed that 10 million people in the United States complained of hemorrhoids, corresponding to a prevalence rate of 4.4%. In both sexes, peak prevalence occurred between age 45-65 years and the development of hemorrhoids before the age of 20 years was unusual. Whites and higher socioeconomic status individuals were affected more frequently than blacks and those of lower socioeconomic status. However, this association may reflect differences in health-seeking behavior rather than true prevalence. In the United Kingdom, hemorrhoids were reported to affect 13%-36% of the general population. However, this estimation may be higher than actual prevalence because the community-based studies mainly relied on self-reporting and patients may attribute any anorectal symptoms to hemorrhoids.

• #30 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Epidemiology-of-Hemorrhoids.aspx

  There is a paucity of data on the incidence of hemorrhoids by race, although it has been shown that there is a greater likelihood of Caucasian individuals seeking treatment compared with other races. […] Age is known to influence hemorrhoid risk, with the likelihood of hemorrhoids increasing as a person ages. In most cases, hemorrhoids develop in individuals who are over 30 years old, although they can develop at any age. […] People who live in rural areas and those with a higher socioeconomic background appear to be more likely to be affected by hemorrhoids. […] The number of patients that require surgical removal of hemorrhoids, known as a hemorrhoidectomy, in hospitals in the United States is declining. It reached a peak in 1974 with 117 hemorrhoidectomies per 100,000 people, which dropped to 37 in 1987.

• #31 Hemorrhoid – Wikipedia

  https://en.wikipedia.org/wiki/Hemorrhoid

  Epidemiology […] It is difficult to determine how common hemorrhoids are as many people with the condition do not see a healthcare provider. However, symptomatic hemorrhoids are thought to affect at least 50% of the US population at some time during their lives, and around 5% of the population is affected at any given time. Both sexes experience about the same incidence of the condition, with rates peaking between 45 and 65 years. Some studies have found that they are common in people of higher socioeconomic status, however this may reflect differences in healthcare access rather than true prevalence. […] Long-term outcomes are generally good, though some people may have recurrent symptomatic episodes. Only a small proportion of persons end up needing surgery.

• #32 Hemorrhoids: Diagnosis and Treatment Options | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0201/p172.html

  Hemorrhoids are common. The exact prevalence is unknown because most patients are asymptomatic and do not seek care from a physician. A study of patients undergoing routine colorectal cancer screening found a 39% prevalence of hemorrhoids, with 55% of those patients reporting no symptoms. Hemorrhoids are more prevalent in persons 45 to 65 years of age. Although the precise cause is not well understood, hemorrhoids are associated with conditions that increase pressure in the hemorrhoidal venous plexus, such as straining during bowel movements secondary to constipation. Other associations include obesity, pregnancy, chronic diarrhea, anal intercourse, cirrhosis with ascites, pelvic floor dysfunction, and a low-fiber diet. […] Hemorrhoids develop when the venous drainage of the anus is altered, causing the venous plexus and connecting tissue to dilate, creating an outgrowth of anal mucosa from the rectal wall. However, the exact pathophysiology is unknown. Hemorrhoids occur above or below the dentate line where the proximal columnar transitions to the distal squamous epithelium.

• #33 Hemorrhoids: Diagnosis and Treatment Options | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0201/p172.html

  Hemorrhoids are common. The exact prevalence is unknown because most patients are asymptomatic and do not seek care from a physician. A study of patients undergoing routine colorectal cancer screening found a 39% prevalence of hemorrhoids, with 55% of those patients reporting no symptoms. Hemorrhoids are more prevalent in persons 45 to 65 years of age. Although the precise cause is not well understood, hemorrhoids are associated with conditions that increase pressure in the hemorrhoidal venous plexus, such as straining during bowel movements secondary to constipation. Other associations include obesity, pregnancy, chronic diarrhea, anal intercourse, cirrhosis with ascites, pelvic floor dysfunction, and a low-fiber diet. […] Hemorrhoids develop when the venous drainage of the anus is altered, causing the venous plexus and connecting tissue to dilate, creating an outgrowth of anal mucosa from the rectal wall. However, the exact pathophysiology is unknown. Hemorrhoids occur above or below the dentate line where the proximal columnar transitions to the distal squamous epithelium.

• #34 Hemorrhoid Disease and the Role of the Gastroenterologist

  https://www.gastroendonews.com/Review-Articles/Article/01-19/Hemorrhoid-Disease-and-the-Role-of-the-Gastroenterologist/53852?sub=14EBB94819BEDF16889AE192D84D5D7F12BAB184E7D2270C73D794B269D&enl=true

  Patients with symptomatic hemorrhoids frequently present to family physicians and gastroenterologists. […] Hemorrhoids account for approximately 3.5 million physician visits and $500 million in health care costs in the United States alone. […] Risk factors for symptomatic hemorrhoids include low consumption of dietary fiber, chronic straining, excessive time on the toilet, constipation, diarrhea, pregnancy, and family history. […] Nearly all patients with symptomatic Grade I internal hemorrhoids respond well to medical therapy. […] The majority of patients presenting with symptomatic hemorrhoids improve with a bowel management program alone. […] Gastroenterologists can offer a successful alternative to invasive surgical excision. […] Multiple randomized controlled trials have compared the above methods, but no single study has assessed all 5 at once. […] Overall, 5% to 10% of patients with hemorrhoids will require surgery; the vast majority of these have Grade III to IV lesions.

• #35 Haemorrhoids (Piles) in Men: Causes, Symptoms & Treatment

  https://www.germoloids.co.uk/tips-advice/piles-in-men

  Piles, also known as haemorrhoids, are common among men and can appear as a number of symptoms, including bright red blood when you go to the toilet, lumps around the anus, as well as pain and itchiness. […] The condition can occur in both men and women and its estimated that around 3 out of 4 of us will get piles at least once in our lives. […] Although piles often pass on their own after a few days, if left untreated, its possible that symptoms can worsen, especially if the root cause of the problem isnt addressed. […] A common cause of haemorrhoids in men is straining too much when on the toilet and the reasons for this are two-fold. […] A diet lacking in fibre is also a very common cause of haemorrhoids. […] Since pressure on the blood vessels is a common cause of haemorrhoids, its probably not surprising that carrying excess weight can be another factor that can make developing piles more likely.

• #36 Haemorrhoids (Piles) in Men: Causes, Symptoms & Treatment

  https://www.germoloids.co.uk/tips-advice/piles-in-men

  Piles, also known as haemorrhoids, are common among men and can appear as a number of symptoms, including bright red blood when you go to the toilet, lumps around the anus, as well as pain and itchiness. […] The condition can occur in both men and women and its estimated that around 3 out of 4 of us will get piles at least once in our lives. […] Although piles often pass on their own after a few days, if left untreated, its possible that symptoms can worsen, especially if the root cause of the problem isnt addressed. […] A common cause of haemorrhoids in men is straining too much when on the toilet and the reasons for this are two-fold. […] A diet lacking in fibre is also a very common cause of haemorrhoids. […] Since pressure on the blood vessels is a common cause of haemorrhoids, its probably not surprising that carrying excess weight can be another factor that can make developing piles more likely.

• #37

  https://step2.medbullets.com/gastrointestinal/120195/hemorrhoids

  prevalence peaks between ages of 45-65 years […] equal distribution between the sexes […] age […] diarrhea […] pregnancy […] pelvic tumors […] prolonged sitting […] straining […] chronic constipation

• #38 Risk factors for hemorrhoidal disease among healthy young and middle-aged Korean adults | Scientific Reports

  https://www.nature.com/articles/s41598-021-03838-z

  Hemorrhoidal disease is a highly prevalent anorectal condition causing substantial discomfort, disability, and decreased quality of life. […] The prevalence of hemorrhoidal disease was 16.6%, and it was higher in females than in males (17.2 vs. 16.3%; P0.001). […] In the adjusted analyses, older age, female sex, smoking, overweight, and being hypertensive were independently associated with the presence of hemorrhoidal disease. […] The prevalence of hemorrhoidal disease was higher in older participants, in those with lower education level, in those who were overweight or obese, or former smokers, and in those with diabetes, hypertension, or dyslipidemia. […] The overall prevalence of hemorrhoidal disease in our study was 16.6%. […] The prevalence of hemorrhoidal disease increased progressively with age, with the highest prevalence observed in the oldest age group.

• #39 Prevalence and associated factors of hemorrhoids among adult patients visiting the surgical outpatient department in the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249736

  The estimated worldwide prevalence of hemorrhoids in the general population is to be 4.4%. […] Reports on the magnitude and risk factors of hemorrhoids have paramount importance to the policymakers, clinical practitioners, and the society at large. In spite of sever clinical and social impacts, there is no documented evidence in Ethiopia so far. The present study is aimed to determine the prevalence and associated factors of hemorrhoids among patients visiting the surgical outpatient department (OPD) at the UoGCSH, Northwest Ethiopia. […] The result of this study revealed that among 403 study participants 53 had hemorrhoids with an overall prevalence of 13.1% (95%CI; 10.1, 16.8). […] From the multivariable logistic regression analysis constipation and BMI had a significant association with the occurrence of hemorrhoid. The odds of having hemorrhoid was 4.32 times higher among participants who had constipation as compared to their counterparts (AOR = 4.32, 95%CI; 2.20, 8.48). The patients who had BMI 25 kg/m2 were 2.6 times higher odds of having hemorrhoid as compared to BMI 25 kg/m2 (AOR = 2.6, 95%CI; 1.08, 6.23).

• #40 Hemorrhoids: Nursing Diagnosis & Interventions | Nurse.com

  https://www.nurse.com/clinical-guides/hemorrhoids/?srsltid=AfmBOorS729JyBUJy7TqD5wLwjcmVrWit2P28ZxCqmC5iV4qbl2xJt6J

  Hemorrhoids develop when there are problems with the venous drainage of the anus. […] The prevalence of hemorrhoids is unknown because most individuals are asymptomatic or do not seek medical care. […] Although the exact cause of hemorrhoids is not well understood, hemorrhoids are associated with conditions that increase pressure on the hemorrhoidal venous plexus. […] Associations with hemorrhoids include (Mott et al., 2018): Straining during bowel movements due to constipation, Pregnancy, Anal intercourse, Low fiber diet, Obesity, Chronic diarrhea, Pelvic floor dysfunction, Cirrhosis with ascites.

• #41 Hemorrhoids: Background, Anatomy, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/775407-overview

  Worldwide, the prevalence of symptomatic hemorrhoids is estimated at 4.4% in the general population. In the United States, up to one third of the 10 million people with hemorrhoids seek medical treatment, resulting in 1.5 million related prescriptions per year. […] The number of hemorrhoidectomies performed in US hospitals is declining. A peak of 117 hemorrhoidectomies per 100,000 people was reached in 1974; this rate declined to 37 hemorrhoidectomies per 100,000 people in 1987. Outpatient and office treatment of hemorrhoids account for some of this decline. […] Patients presenting with hemorrhoidal disease are more frequently white, from higher socioeconomic status, and from rural areas. There is no known sex predilection, although men are more likely to seek treatment. However, pregnancy causes physiologic changes that predispose women to developing symptomatic hemorrhoids. As the gravid uterus expands, it compresses the inferior vena cava, causing decreased venous return and distal engorgement. […] External hemorrhoids occur more commonly in young and middle-aged adults than in older adults. The prevalence of hemorrhoids increases with age, with a peak in persons aged 45-65 years.

• #42

  https://step2.medbullets.com/gastrointestinal/120195/hemorrhoids

  prevalence peaks between ages of 45-65 years […] equal distribution between the sexes […] age […] diarrhea […] pregnancy […] pelvic tumors […] prolonged sitting […] straining […] chronic constipation

• #43 Hemorrhoids: Nursing Diagnosis & Interventions | Nurse.com

  https://www.nurse.com/clinical-guides/hemorrhoids/?srsltid=AfmBOorS729JyBUJy7TqD5wLwjcmVrWit2P28ZxCqmC5iV4qbl2xJt6J

  Hemorrhoids develop when there are problems with the venous drainage of the anus. […] The prevalence of hemorrhoids is unknown because most individuals are asymptomatic or do not seek medical care. […] Although the exact cause of hemorrhoids is not well understood, hemorrhoids are associated with conditions that increase pressure on the hemorrhoidal venous plexus. […] Associations with hemorrhoids include (Mott et al., 2018): Straining during bowel movements due to constipation, Pregnancy, Anal intercourse, Low fiber diet, Obesity, Chronic diarrhea, Pelvic floor dysfunction, Cirrhosis with ascites.

• #44 Hemorrhoids: Nursing Diagnosis & Interventions | Nurse.com

  https://www.nurse.com/clinical-guides/hemorrhoids/?srsltid=AfmBOorS729JyBUJy7TqD5wLwjcmVrWit2P28ZxCqmC5iV4qbl2xJt6J

  Hemorrhoids develop when there are problems with the venous drainage of the anus. […] The prevalence of hemorrhoids is unknown because most individuals are asymptomatic or do not seek medical care. […] Although the exact cause of hemorrhoids is not well understood, hemorrhoids are associated with conditions that increase pressure on the hemorrhoidal venous plexus. […] Associations with hemorrhoids include (Mott et al., 2018): Straining during bowel movements due to constipation, Pregnancy, Anal intercourse, Low fiber diet, Obesity, Chronic diarrhea, Pelvic floor dysfunction, Cirrhosis with ascites.

• #45

  https://step2.medbullets.com/gastrointestinal/120195/hemorrhoids

  prevalence peaks between ages of 45-65 years […] equal distribution between the sexes […] age […] diarrhea […] pregnancy […] pelvic tumors […] prolonged sitting […] straining […] chronic constipation

• #46 Metabolic Syndrome Linked to Internal Hemorrhoids in Older Patients

  https://www.gastroendonews.com/PRN/Article/07-21/Metabolic-Syndrome-Linked-to-Internal-Hemorrhoids-in-Older-Patients/63927

  Older people with metabolic syndrome appear to be at a significantly greater risk for developing internal hemorrhoids and diverticular complaints, researchers have found. […] When metabolic syndrome was present, it was significantly associated with both colonic diverticulosis and internal hemorrhoids. […] Overall, 33.1% of patients had metabolic syndrome, 68% had colonic diverticulosis and 30% had internal hemorrhoids. […] Metabolic syndrome was significantly associated with colonic diverticulosis (odds ratio [OR], 1.4) and internal hemorrhoids (OR, 1.5). […] Of note, increasing age and constipation were not significantly associated with either colonic diverticulosis or internal hemorrhoids, which supports emerging data that other factors may contribute to the development of these conditions.

• #47 Large genetic study sheds light on the causes of hemorrhoids | Karolinska Institutet

  https://news.ki.se/large-genetic-study-sheds-light-on-the-causes-of-hemorrhoids

  The studys results indicate that severe hemorrhoidal disease is at least partly attributable to a genetically caused dysfunction of the intestinal muscle and connective tissue. […] The researchers also report genetic similarities between hemorrhoidal disease and other gastrointestinal conditions, as well as some cardiovascular and psychiatric disorders. […] Our PRS results require further validation and to be studied in different ethnic groups, but they could help to identify at-risk individuals who might be monitored and eventually benefit from preventative lifestyle changes, in analogy with other diagnoses and genetic risk factors, says the studys joint corresponding author Mauro D’Amato, visiting professor at the Department of Medicine, Solna, Karolinska Institutet and professor at CIC bioGUNE in Spain.

• #48 Large genetic study sheds light on the causes of hemorrhoids | Karolinska Institutet

  https://news.ki.se/large-genetic-study-sheds-light-on-the-causes-of-hemorrhoids

  The studys results indicate that severe hemorrhoidal disease is at least partly attributable to a genetically caused dysfunction of the intestinal muscle and connective tissue. […] The researchers also report genetic similarities between hemorrhoidal disease and other gastrointestinal conditions, as well as some cardiovascular and psychiatric disorders. […] Our PRS results require further validation and to be studied in different ethnic groups, but they could help to identify at-risk individuals who might be monitored and eventually benefit from preventative lifestyle changes, in analogy with other diagnoses and genetic risk factors, says the studys joint corresponding author Mauro D’Amato, visiting professor at the Department of Medicine, Solna, Karolinska Institutet and professor at CIC bioGUNE in Spain.

• #49 Are hemorrhoids genetic? | Decode your DNA and learn your risks!

  https://nebula.org/blog/are-hemorrhoids-genetic/?srsltid=AfmBOooyoL7RjPjLkAaIZPiAaxruTNYxHWA1naQVKQ_oBXG1zENfHv7o

  Hemorrhoids tend to affect people as they age. According to HD Treatment Center, about half of Americans age 50 and above develop them. Overall, 1.5 million new cases occur each year with about 20% requiring surgery. Most cases go undiagnosed. […] Both men and women can get hemorrhoids and the most common age of reporting them is between 45 and 65 years. Studies suggest that men seek immediate treatment when they occur more than women. Changes caused by pregnancy can also increase the tendency of hemorrhoids in women. […] Experts notice that the condition affects those who are White more than other races and link it to higher socioeconomic status. […] Another factor that can predispose an individual is hereditary. People who have a family history of hemorrhoids should take measures that can decrease their risk of having the issue, such as getting enough fiber, drinking water, exercising, and not straining in the bathroom.

• #50 Hemorrhoid Disease and the Role of the Gastroenterologist

  https://www.gastroendonews.com/Review-Articles/Article/01-19/Hemorrhoid-Disease-and-the-Role-of-the-Gastroenterologist/53852?sub=14EBB94819BEDF16889AE192D84D5D7F12BAB184E7D2270C73D794B269D&enl=true

  Patients with symptomatic hemorrhoids frequently present to family physicians and gastroenterologists. […] Hemorrhoids account for approximately 3.5 million physician visits and $500 million in health care costs in the United States alone. […] Risk factors for symptomatic hemorrhoids include low consumption of dietary fiber, chronic straining, excessive time on the toilet, constipation, diarrhea, pregnancy, and family history. […] Nearly all patients with symptomatic Grade I internal hemorrhoids respond well to medical therapy. […] The majority of patients presenting with symptomatic hemorrhoids improve with a bowel management program alone. […] Gastroenterologists can offer a successful alternative to invasive surgical excision. […] Multiple randomized controlled trials have compared the above methods, but no single study has assessed all 5 at once. […] Overall, 5% to 10% of patients with hemorrhoids will require surgery; the vast majority of these have Grade III to IV lesions.

• #51 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Epidemiology-of-Hemorrhoids.aspx

  Worldwide, the overall prevalence of hemorrhoids in the general population is estimated to be 4.4%. […] However, experts have noticed that in the United States (US) and United Kingdom (UK), the number of people visiting hospital as a result of hemorrhoids has fallen. […] According to the HD Treatment Center, estimates suggest that around half of Americans develop hemorrhoids by time they are aged 50 and only a small proportion of those people seek therapy. The number of people in the US suffering from hemorrhoids is estimated to be around 10.4 million and 1 million new cases occur each year. Ten to 20% of those new cases require surgery. […] The HD Treatment Center has also found that among people older than 45 years, 25% of people who develop hemorrhoids are female and 15% are men. […] Research has also shown there is a greater likelihood of men seeking treatment for their hemorrhoids than there is for women.

• #52 The epidemiology and Etiology of Hemorrhoids

  https://www.jstage.jst.go.jp/article/jcoloproctology/63/10/63_10_819/_article/-char/en

  There have been few articles regarding the epidemiology of hemorrhoids, therefore the prevalence of hemorrhoids is not well documented. In the USA, an annual nationwide health questionnaire showed a prevalence rate of 4.4%. In both sexes, a peak in prevalence was noted from age 45-65 years. […] There seems to be a fall in the rate of hospital visits in both the USA and the UK. […] Despite the fact that the pathogenesis of hemorrhoids still remains elusive because of the diversity and complexity of their pathophysiology, it is reasonable to assume that both vascular tissue factors and the connective tissue factors contribute to the etiology of hemorrhoids.

• #53 Hemorrhoids: Background, Anatomy, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/775407-overview

  Worldwide, the prevalence of symptomatic hemorrhoids is estimated at 4.4% in the general population. In the United States, up to one third of the 10 million people with hemorrhoids seek medical treatment, resulting in 1.5 million related prescriptions per year. […] The number of hemorrhoidectomies performed in US hospitals is declining. A peak of 117 hemorrhoidectomies per 100,000 people was reached in 1974; this rate declined to 37 hemorrhoidectomies per 100,000 people in 1987. Outpatient and office treatment of hemorrhoids account for some of this decline. […] Patients presenting with hemorrhoidal disease are more frequently white, from higher socioeconomic status, and from rural areas. There is no known sex predilection, although men are more likely to seek treatment. However, pregnancy causes physiologic changes that predispose women to developing symptomatic hemorrhoids. As the gravid uterus expands, it compresses the inferior vena cava, causing decreased venous return and distal engorgement. […] External hemorrhoids occur more commonly in young and middle-aged adults than in older adults. The prevalence of hemorrhoids increases with age, with a peak in persons aged 45-65 years.

• #54 Prevalence and associated factors of hemorrhoids among adult patients visiting the surgical outpatient department in the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249736

  Hemorrhoidal disease is a very common benign anorectal disease. It affects millions of people around the world, and represent a major medical and socioeconomic problem. However, studies that determine the magnitude and risk factors are limited. Therefore, the aim this study is to assess the prevalence and associated factors of hemorrhoid among adult patients visiting the surgical outpatient department at the University of Gondar Comprehensive Specialized Hospital (UoGCSH) Northwest Ethiopia. […] The overall prevalence of hemorrhoid was high and its prevalence was higher in male subjects. Constipation and being overweight were found to increase the odds of having hemorrhoids. Screening for early identification and intervention of hemorrhoids, especially for risk groups is better to be practiced by health professionals.

• #55 Prevalence and associated factors of hemorrhoids among adult patients visiting the surgical outpatient department in the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249736

  The estimated worldwide prevalence of hemorrhoids in the general population is to be 4.4%. […] Reports on the magnitude and risk factors of hemorrhoids have paramount importance to the policymakers, clinical practitioners, and the society at large. In spite of sever clinical and social impacts, there is no documented evidence in Ethiopia so far. The present study is aimed to determine the prevalence and associated factors of hemorrhoids among patients visiting the surgical outpatient department (OPD) at the UoGCSH, Northwest Ethiopia. […] The result of this study revealed that among 403 study participants 53 had hemorrhoids with an overall prevalence of 13.1% (95%CI; 10.1, 16.8). […] From the multivariable logistic regression analysis constipation and BMI had a significant association with the occurrence of hemorrhoid. The odds of having hemorrhoid was 4.32 times higher among participants who had constipation as compared to their counterparts (AOR = 4.32, 95%CI; 2.20, 8.48). The patients who had BMI 25 kg/m2 were 2.6 times higher odds of having hemorrhoid as compared to BMI 25 kg/m2 (AOR = 2.6, 95%CI; 1.08, 6.23).

• #56 Risk factors for hemorrhoidal disease among healthy young and middle-aged Korean adults | Scientific Reports

  https://www.nature.com/articles/s41598-021-03838-z

  Hemorrhoidal disease is a highly prevalent anorectal condition causing substantial discomfort, disability, and decreased quality of life. […] The prevalence of hemorrhoidal disease was 16.6%, and it was higher in females than in males (17.2 vs. 16.3%; P0.001). […] In the adjusted analyses, older age, female sex, smoking, overweight, and being hypertensive were independently associated with the presence of hemorrhoidal disease. […] The prevalence of hemorrhoidal disease was higher in older participants, in those with lower education level, in those who were overweight or obese, or former smokers, and in those with diabetes, hypertension, or dyslipidemia. […] The overall prevalence of hemorrhoidal disease in our study was 16.6%. […] The prevalence of hemorrhoidal disease increased progressively with age, with the highest prevalence observed in the oldest age group.

• #57 Epidemiology of Hemorrhoidal Disease | SpringerLink

  https://link.springer.com/10.1007/978-3-319-51989-0_1-1

  Hemorrhoids became symptomatic when enlarged, inflamed, thrombosed, or prolapsed, and the most common symptom is painless rectal bleeding, which is why hemorrhoids are one of the most frequent causes of severe acute lower gastrointestinal bleeding. […] Defining the term hemorrhoids and their epidemiology has always been controversial. […] Unfortunately, at present, even after years of articles, debates, and pathogenetic theories, we do not know the extent of this phenomenon. […] In this chapter, we will discuss the epidemiology of hemorrhoidal disease and compare the most important studies in the literature.

• #58 Epidemiology of Hemorrhoidal Disease | SpringerLink

  https://link.springer.com/10.1007/978-3-319-51989-0_1-1

  Hemorrhoids became symptomatic when enlarged, inflamed, thrombosed, or prolapsed, and the most common symptom is painless rectal bleeding, which is why hemorrhoids are one of the most frequent causes of severe acute lower gastrointestinal bleeding. […] Defining the term hemorrhoids and their epidemiology has always been controversial. […] Unfortunately, at present, even after years of articles, debates, and pathogenetic theories, we do not know the extent of this phenomenon. […] In this chapter, we will discuss the epidemiology of hemorrhoidal disease and compare the most important studies in the literature.

• #59 Epidemiology of Hemorrhoidal Disease | SpringerLink

  https://link.springer.com/10.1007/978-3-319-51989-0_1-1

  Hemorrhoids became symptomatic when enlarged, inflamed, thrombosed, or prolapsed, and the most common symptom is painless rectal bleeding, which is why hemorrhoids are one of the most frequent causes of severe acute lower gastrointestinal bleeding. […] Defining the term hemorrhoids and their epidemiology has always been controversial. […] Unfortunately, at present, even after years of articles, debates, and pathogenetic theories, we do not know the extent of this phenomenon. […] In this chapter, we will discuss the epidemiology of hemorrhoidal disease and compare the most important studies in the literature.

• #60 Hemorrhoids: From basic pathophysiology to clinical management

  https://www.wjgnet.com/1007-9327/full/v18/i17/2009.htm

  Hemorrhoids are a very common anorectal condition defined as the symptomatic enlargement and distal displacement of the normal anal cushions. They affect millions of people around the world, and represent a major medical and socioeconomic problem. […] Although hemorrhoids are recognized as a very common cause of rectal bleeding and anal discomfort, the true epidemiology of this disease is unknown because patients have a tendency to use self-medication rather than to seek proper medical attention. An epidemiologic study by Johanson et al in 1990 showed that 10 million people in the United States complained of hemorrhoids, corresponding to a prevalence rate of 4.4%. In both sexes, peak prevalence occurred between age 45-65 years and the development of hemorrhoids before the age of 20 years was unusual. Whites and higher socioeconomic status individuals were affected more frequently than blacks and those of lower socioeconomic status. However, this association may reflect differences in health-seeking behavior rather than true prevalence. In the United Kingdom, hemorrhoids were reported to affect 13%-36% of the general population. However, this estimation may be higher than actual prevalence because the community-based studies mainly relied on self-reporting and patients may attribute any anorectal symptoms to hemorrhoids.

• #61 Hemorrhoids: From basic pathophysiology to clinical management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3342598/

  This review discusses the pathophysiology, epidemiology, risk factors, classification, clinical evaluation, and current non-operative and operative treatment of hemorrhoids. […] Although hemorrhoids are recognized as a very common cause of rectal bleeding and anal discomfort, the true epidemiology of this disease is unknown because patients have a tendency to use self-medication rather than to seek proper medical attention. An epidemiologic study by Johanson et al in 1990 showed that 10 million people in the United States complained of hemorrhoids, corresponding to a prevalence rate of 4.4%. In both sexes, peak prevalence occurred between age 45-65 years and the development of hemorrhoids before the age of 20 years was unusual. […] In the United Kingdom, hemorrhoids were reported to affect 13%-36% of the general population. However, this estimation may be higher than actual prevalence because the community-based studies mainly relied on self-reporting and patients may attribute any anorectal symptoms to hemorrhoids.

• #62 Hemorrhoids: Background, Anatomy, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/775407-overview

  Worldwide, the prevalence of symptomatic hemorrhoids is estimated at 4.4% in the general population. In the United States, up to one third of the 10 million people with hemorrhoids seek medical treatment, resulting in 1.5 million related prescriptions per year. […] The number of hemorrhoidectomies performed in US hospitals is declining. A peak of 117 hemorrhoidectomies per 100,000 people was reached in 1974; this rate declined to 37 hemorrhoidectomies per 100,000 people in 1987. Outpatient and office treatment of hemorrhoids account for some of this decline. […] Patients presenting with hemorrhoidal disease are more frequently white, from higher socioeconomic status, and from rural areas. There is no known sex predilection, although men are more likely to seek treatment. However, pregnancy causes physiologic changes that predispose women to developing symptomatic hemorrhoids. As the gravid uterus expands, it compresses the inferior vena cava, causing decreased venous return and distal engorgement. […] External hemorrhoids occur more commonly in young and middle-aged adults than in older adults. The prevalence of hemorrhoids increases with age, with a peak in persons aged 45-65 years.

• #63 External Hemorrhoid – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK500009/

  Hemorrhoid disease is a common anorectal disorder affecting millions in the United States and the most common cause of rectal bleeding. Hemorrhoids are believed to affect men and women equally. They are rare under 20 years of age, and incidence peaks between the ages of 45 and 65. Estimates of hemorrhoid disease in pregnant women vary but range as high as 35%. […] Hemorrhoids are rich in vascular supply and have a tendency to engorge and prolapse. Symptoms can vary from mild itching and bleeding to severe pain. Unfortunately, because of the location, many patients never seek treatment for fear of embarrassment.

• #64 Hemorrhoids | Concise Medical Knowledge

  https://www.lecturio.com/concepts/hemorrhoids/

  Hemorrhoids are normal vascular cushions in the anal canal composed of dilated vascular tissue, smooth muscle, and connective tissue. The two main types of hemorrhoids are external, usually with perianal pain, and internal, which are usually painless. […] Worldwide estimated prevalence is 4.4%. […] Prevalence increases with age: peak at 45-65 years old. […] Hemorrhoids affect up to 10 million patients in the United States annually. […] About 40% of patients are asymptomatic. […] No known sex predilection. […] Present more frequently in people of higher socioeconomic backgrounds, those living in rural areas, and the white population.

• #65 Hemorrhoid Disease and the Role of the Gastroenterologist

  https://www.gastroendonews.com/Review-Articles/Article/01-19/Hemorrhoid-Disease-and-the-Role-of-the-Gastroenterologist/53852?sub=14EBB94819BEDF16889AE192D84D5D7F12BAB184E7D2270C73D794B269D&enl=true

  Patients with symptomatic hemorrhoids frequently present to family physicians and gastroenterologists. […] Hemorrhoids account for approximately 3.5 million physician visits and $500 million in health care costs in the United States alone. […] Risk factors for symptomatic hemorrhoids include low consumption of dietary fiber, chronic straining, excessive time on the toilet, constipation, diarrhea, pregnancy, and family history. […] Nearly all patients with symptomatic Grade I internal hemorrhoids respond well to medical therapy. […] The majority of patients presenting with symptomatic hemorrhoids improve with a bowel management program alone. […] Gastroenterologists can offer a successful alternative to invasive surgical excision. […] Multiple randomized controlled trials have compared the above methods, but no single study has assessed all 5 at once. […] Overall, 5% to 10% of patients with hemorrhoids will require surgery; the vast majority of these have Grade III to IV lesions.

• #66 Large genetic study sheds light on the causes of hemorrhoids | Karolinska Institutet

  https://news.ki.se/large-genetic-study-sheds-light-on-the-causes-of-hemorrhoids

  Although hemorrhoids are a common health problem, relatively little is known about the field, possibly because many people find them difficult to talk about. […] Hemorrhoids are a very common problem that has both social and financial consequences. In the U.S., the annual cost of surgery for severe hemorrhoids is estimated at $800 million (approximately 6.7 billion kronor). […] Despite hemorrhoid being very common, the field is relatively under-researched. Science has yet to explain why only certain people develop them, or provide clues as to the molecular pathogenesis of the disease. […] The data, which was sourced from several biobanks in Europe and the U.S. including the UK Biobank and 23andMe, comprised 218,929 patients with hemorrhoidal disease and 725,213 healthy controls, making a total genome set of almost one million individuals.

• #67 Internal Hemorrhoid | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/22760

  It is challenging to determine the actual incidence of hemorrhoidal disease as many patients do not seek medical attention for their symptoms. Estimates are that hemorrhoidal disease is the third most common outpatient gastrointestinal diagnosis in the United States with about 4 million office and emergency department visits every year. About 75% of Americans will experience hemorrhoidal symptoms at some point in their lives. The true prevalence of hemorrhoidal disease is unknown with various studies reporting a prevalence between 4% and 40%. The prevalence is highest in Caucasian patients between the ages of 45 and 65 and patients of high socioeconomic status. However, this observation can be attributed to selection bias as this group has the greatest access to care. […] The prognosis for internal hemorrhoids is good. Most internal hemorrhoids resolve with conservative medical management. The recurrence rate with conservative medical management is 10 to 50% over 5 years. Recurrence rates after surgical hemorrhoidectomy are below 5%.

• #68 Hemorrhoids: Symptoms, causes, and treatments

  https://www.medicalnewstoday.com/articles/73938

  Hemorrhoids, also known as piles, are swollen veins in the lower part of the anus and rectum. […] Hemorrhoids may occur in up to 35% of pregnant people. […] Hemorrhoids are most common among adults ages 45-65 years. […] Research links being overweight to a higher risk of hemorrhoids. […] Hemorrhoid symptoms often resolve on their own with conservative treatment, although there is a 10-50% chance they will return over 5 years. […] The chance of hemorrhoids returning after surgery is less than 5%.

• #69 Internal Hemorrhoid | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/22760

  It is challenging to determine the actual incidence of hemorrhoidal disease as many patients do not seek medical attention for their symptoms. Estimates are that hemorrhoidal disease is the third most common outpatient gastrointestinal diagnosis in the United States with about 4 million office and emergency department visits every year. About 75% of Americans will experience hemorrhoidal symptoms at some point in their lives. The true prevalence of hemorrhoidal disease is unknown with various studies reporting a prevalence between 4% and 40%. The prevalence is highest in Caucasian patients between the ages of 45 and 65 and patients of high socioeconomic status. However, this observation can be attributed to selection bias as this group has the greatest access to care. […] The prognosis for internal hemorrhoids is good. Most internal hemorrhoids resolve with conservative medical management. The recurrence rate with conservative medical management is 10 to 50% over 5 years. Recurrence rates after surgical hemorrhoidectomy are below 5%.

• #70 Risk factors for hemorrhoidal disease among healthy young and middle-aged Korean adults | Scientific Reports

  https://www.nature.com/articles/s41598-021-03838-z

  Hemorrhoidal disease is a highly prevalent anorectal condition causing substantial discomfort, disability, and decreased quality of life. […] The prevalence of hemorrhoidal disease was 16.6%, and it was higher in females than in males (17.2 vs. 16.3%; P0.001). […] In the adjusted analyses, older age, female sex, smoking, overweight, and being hypertensive were independently associated with the presence of hemorrhoidal disease. […] The prevalence of hemorrhoidal disease was higher in older participants, in those with lower education level, in those who were overweight or obese, or former smokers, and in those with diabetes, hypertension, or dyslipidemia. […] The overall prevalence of hemorrhoidal disease in our study was 16.6%. […] The prevalence of hemorrhoidal disease increased progressively with age, with the highest prevalence observed in the oldest age group.

• #71 Epidemiology of Hemorrhoidal Disease | SpringerLink

  https://link.springer.com/10.1007/978-3-319-51989-0_1-1

  Hemorrhoids became symptomatic when enlarged, inflamed, thrombosed, or prolapsed, and the most common symptom is painless rectal bleeding, which is why hemorrhoids are one of the most frequent causes of severe acute lower gastrointestinal bleeding. […] Defining the term hemorrhoids and their epidemiology has always been controversial. […] Unfortunately, at present, even after years of articles, debates, and pathogenetic theories, we do not know the extent of this phenomenon. […] In this chapter, we will discuss the epidemiology of hemorrhoidal disease and compare the most important studies in the literature.

• #72

  https://journals.lww.com/aoam/fulltext/2019/18010/hemorrhoidal_disease__predilection_sites,_pattern.3.aspx

  An engorgement and prolapse of the anal cushion lead to haemorrhoidal disease. There are different anatomical sites and presentation of this common pathology which affects the quality of life. […] Hemorrhoids are a leading cause of lower gastrointestinal bleeding with a high impact on quality of life. […] A literature search showed paucity of literature on epidemiology of hemorrhoids in Africa, but interventional studies from Nigeria reported a peak incidence in the late and early third and fourth decades respectively with a male predominance. […] In general, it is estimated that 50% of the people older than 50 years have hemorrhoids symptoms at least for a period. […] The most common presentation of hemorrhoids seen was painless rectal bleeding during defecation with or without prolapsing anal tissue in 71% of cases. […] Over half of the population of patients had Grade 1 and 2 hemorrhoids that were diagnosed with the aid of endoscopy. […] The prevalence of hemorrhoids is highest in the middle-aged population mostly males.

• #73

  https://journals.lww.com/aoam/fulltext/2019/18010/hemorrhoidal_disease__predilection_sites,_pattern.3.aspx

  An engorgement and prolapse of the anal cushion lead to haemorrhoidal disease. There are different anatomical sites and presentation of this common pathology which affects the quality of life. […] Hemorrhoids are a leading cause of lower gastrointestinal bleeding with a high impact on quality of life. […] A literature search showed paucity of literature on epidemiology of hemorrhoids in Africa, but interventional studies from Nigeria reported a peak incidence in the late and early third and fourth decades respectively with a male predominance. […] In general, it is estimated that 50% of the people older than 50 years have hemorrhoids symptoms at least for a period. […] The most common presentation of hemorrhoids seen was painless rectal bleeding during defecation with or without prolapsing anal tissue in 71% of cases. […] Over half of the population of patients had Grade 1 and 2 hemorrhoids that were diagnosed with the aid of endoscopy. […] The prevalence of hemorrhoids is highest in the middle-aged population mostly males.

• #74 External Hemorrhoid – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK500009/

  Hemorrhoid disease is a common anorectal disorder affecting millions in the United States and the most common cause of rectal bleeding. Hemorrhoids are believed to affect men and women equally. They are rare under 20 years of age, and incidence peaks between the ages of 45 and 65. Estimates of hemorrhoid disease in pregnant women vary but range as high as 35%. […] Hemorrhoids are rich in vascular supply and have a tendency to engorge and prolapse. Symptoms can vary from mild itching and bleeding to severe pain. Unfortunately, because of the location, many patients never seek treatment for fear of embarrassment.

• #75 Hemorrhoids | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0715/p204.html

  The prevalence of hemorrhoids has been estimated at 4.4 percent of U.S. adults, with the highest prevalence in those between 45 and 65 years of age. Factors that increase intra-abdominal pressure (e.g., prolonged straining, constipation, pregnancy, ascites) contribute to dilatation, engorgement, and prolapse of hemorrhoidal vascular tissue. […] Many persons treat the symptoms of hemorrhoids without medical advice. Patients may present to physicians when symptoms worsen. […] Some experts recommend colonoscopy for all patients older than 40 years who have hemorrhoidal symptoms and rectal bleeding.

• #76 Hemorrhoids: Diagnosis and Treatment Options | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0201/p172.html

  Hemorrhoids are common. The exact prevalence is unknown because most patients are asymptomatic and do not seek care from a physician. A study of patients undergoing routine colorectal cancer screening found a 39% prevalence of hemorrhoids, with 55% of those patients reporting no symptoms. Hemorrhoids are more prevalent in persons 45 to 65 years of age. Although the precise cause is not well understood, hemorrhoids are associated with conditions that increase pressure in the hemorrhoidal venous plexus, such as straining during bowel movements secondary to constipation. Other associations include obesity, pregnancy, chronic diarrhea, anal intercourse, cirrhosis with ascites, pelvic floor dysfunction, and a low-fiber diet. […] Hemorrhoids develop when the venous drainage of the anus is altered, causing the venous plexus and connecting tissue to dilate, creating an outgrowth of anal mucosa from the rectal wall. However, the exact pathophysiology is unknown. Hemorrhoids occur above or below the dentate line where the proximal columnar transitions to the distal squamous epithelium.

• #77 Large genetic study sheds light on the causes of hemorrhoids | Karolinska Institutet

  https://news.ki.se/large-genetic-study-sheds-light-on-the-causes-of-hemorrhoids

  The studys results indicate that severe hemorrhoidal disease is at least partly attributable to a genetically caused dysfunction of the intestinal muscle and connective tissue. […] The researchers also report genetic similarities between hemorrhoidal disease and other gastrointestinal conditions, as well as some cardiovascular and psychiatric disorders. […] Our PRS results require further validation and to be studied in different ethnic groups, but they could help to identify at-risk individuals who might be monitored and eventually benefit from preventative lifestyle changes, in analogy with other diagnoses and genetic risk factors, says the studys joint corresponding author Mauro D’Amato, visiting professor at the Department of Medicine, Solna, Karolinska Institutet and professor at CIC bioGUNE in Spain.

• #78 Are hemorrhoids genetic? | Decode your DNA and learn your risks!

  https://nebula.org/blog/are-hemorrhoids-genetic/?srsltid=AfmBOooyoL7RjPjLkAaIZPiAaxruTNYxHWA1naQVKQ_oBXG1zENfHv7o

  Hemorrhoids tend to affect people as they age. According to HD Treatment Center, about half of Americans age 50 and above develop them. Overall, 1.5 million new cases occur each year with about 20% requiring surgery. Most cases go undiagnosed. […] Both men and women can get hemorrhoids and the most common age of reporting them is between 45 and 65 years. Studies suggest that men seek immediate treatment when they occur more than women. Changes caused by pregnancy can also increase the tendency of hemorrhoids in women. […] Experts notice that the condition affects those who are White more than other races and link it to higher socioeconomic status. […] Another factor that can predispose an individual is hereditary. People who have a family history of hemorrhoids should take measures that can decrease their risk of having the issue, such as getting enough fiber, drinking water, exercising, and not straining in the bathroom.

• #79 Hemorrhoids: Background, Anatomy, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/775407-overview

  Worldwide, the prevalence of symptomatic hemorrhoids is estimated at 4.4% in the general population. In the United States, up to one third of the 10 million people with hemorrhoids seek medical treatment, resulting in 1.5 million related prescriptions per year. […] The number of hemorrhoidectomies performed in US hospitals is declining. A peak of 117 hemorrhoidectomies per 100,000 people was reached in 1974; this rate declined to 37 hemorrhoidectomies per 100,000 people in 1987. Outpatient and office treatment of hemorrhoids account for some of this decline. […] Patients presenting with hemorrhoidal disease are more frequently white, from higher socioeconomic status, and from rural areas. There is no known sex predilection, although men are more likely to seek treatment. However, pregnancy causes physiologic changes that predispose women to developing symptomatic hemorrhoids. As the gravid uterus expands, it compresses the inferior vena cava, causing decreased venous return and distal engorgement. […] External hemorrhoids occur more commonly in young and middle-aged adults than in older adults. The prevalence of hemorrhoids increases with age, with a peak in persons aged 45-65 years.

• #80 Haemorrhoids – Classification – Management – TeachMeSurgery

  https://teachmesurgery.com/general/anorectal/haemorrhoids/

  Haemorrhoids are defined as an abnormal swelling or enlargement of the anal vascular cushions. […] The prevalence of haemorrhoids varies, mainly due to wrong attribution of anorectal symptoms, however it is estimated that around 4% of individuals in the USA have symptomatic haemorrhoids to varying degree. They have a prevalence peak at age 45-65yrs. […] The main risk factors for the development of haemorrhoids are excessive straining (from chronic constipation), increasing age, and raised intra-abdominal pressure (such as pregnancy, chronic cough, or ascites). […] Nearly all haemorrhoids can be managed conservatively, especially if uncomplicated. […] Haemorrhoids can be managed either conservatively or with surgical intervention if required.

• #81 Hemorrhoids: Background, Anatomy, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/775407-overview

  Worldwide, the prevalence of symptomatic hemorrhoids is estimated at 4.4% in the general population. In the United States, up to one third of the 10 million people with hemorrhoids seek medical treatment, resulting in 1.5 million related prescriptions per year. […] The number of hemorrhoidectomies performed in US hospitals is declining. A peak of 117 hemorrhoidectomies per 100,000 people was reached in 1974; this rate declined to 37 hemorrhoidectomies per 100,000 people in 1987. Outpatient and office treatment of hemorrhoids account for some of this decline. […] Patients presenting with hemorrhoidal disease are more frequently white, from higher socioeconomic status, and from rural areas. There is no known sex predilection, although men are more likely to seek treatment. However, pregnancy causes physiologic changes that predispose women to developing symptomatic hemorrhoids. As the gravid uterus expands, it compresses the inferior vena cava, causing decreased venous return and distal engorgement. […] External hemorrhoids occur more commonly in young and middle-aged adults than in older adults. The prevalence of hemorrhoids increases with age, with a peak in persons aged 45-65 years.

• #82 External Hemorrhoid | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/21477

  Hemorrhoid disease is a common anorectal disorder affecting millions in the United States and the most common cause of rectal bleeding. Hemorrhoids are believed to affect men and women equally. They are rare under 20 years of age, and incidence peaks between the ages of 45 and 65. Estimates of hemorrhoid disease in pregnant women vary but range as high as 35%. […] Hemorrhoids are classified as internal or external based on their location relative to the dentate line. External hemorrhoids occur distal to the dentate line. Internal hemorrhoids occur proximal to the dentate line and are further categorized into 4 different grades. Grade I hemorrhoids prolapse beyond the dentate line upon straining. Grade II hemorrhoids prolapse through the anus upon straining but spontaneously reduce, while grade III hemorrhoids prolapse through the anus upon straining and can only be reduced manually. Grade IV hemorrhoids have prolapsed through the anus and cannot be reduced.

• #83 Hemorrhoids: Diagnosis and Treatment Options | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0201/p172.html

  Hemorrhoids are common. The exact prevalence is unknown because most patients are asymptomatic and do not seek care from a physician. A study of patients undergoing routine colorectal cancer screening found a 39% prevalence of hemorrhoids, with 55% of those patients reporting no symptoms. Hemorrhoids are more prevalent in persons 45 to 65 years of age. Although the precise cause is not well understood, hemorrhoids are associated with conditions that increase pressure in the hemorrhoidal venous plexus, such as straining during bowel movements secondary to constipation. Other associations include obesity, pregnancy, chronic diarrhea, anal intercourse, cirrhosis with ascites, pelvic floor dysfunction, and a low-fiber diet. […] Hemorrhoids develop when the venous drainage of the anus is altered, causing the venous plexus and connecting tissue to dilate, creating an outgrowth of anal mucosa from the rectal wall. However, the exact pathophysiology is unknown. Hemorrhoids occur above or below the dentate line where the proximal columnar transitions to the distal squamous epithelium.

• #84 Large genetic study sheds light on the causes of hemorrhoids | Karolinska Institutet

  https://news.ki.se/large-genetic-study-sheds-light-on-the-causes-of-hemorrhoids

  The studys results indicate that severe hemorrhoidal disease is at least partly attributable to a genetically caused dysfunction of the intestinal muscle and connective tissue. […] The researchers also report genetic similarities between hemorrhoidal disease and other gastrointestinal conditions, as well as some cardiovascular and psychiatric disorders. […] Our PRS results require further validation and to be studied in different ethnic groups, but they could help to identify at-risk individuals who might be monitored and eventually benefit from preventative lifestyle changes, in analogy with other diagnoses and genetic risk factors, says the studys joint corresponding author Mauro D’Amato, visiting professor at the Department of Medicine, Solna, Karolinska Institutet and professor at CIC bioGUNE in Spain.

• #85 Hemorrhoid Disease and the Role of the Gastroenterologist

  https://www.gastroendonews.com/Review-Articles/Article/01-19/Hemorrhoid-Disease-and-the-Role-of-the-Gastroenterologist/53852?sub=14EBB94819BEDF16889AE192D84D5D7F12BAB184E7D2270C73D794B269D&enl=true

  Patients with symptomatic hemorrhoids frequently present to family physicians and gastroenterologists. […] Hemorrhoids account for approximately 3.5 million physician visits and $500 million in health care costs in the United States alone. […] Risk factors for symptomatic hemorrhoids include low consumption of dietary fiber, chronic straining, excessive time on the toilet, constipation, diarrhea, pregnancy, and family history. […] Nearly all patients with symptomatic Grade I internal hemorrhoids respond well to medical therapy. […] The majority of patients presenting with symptomatic hemorrhoids improve with a bowel management program alone. […] Gastroenterologists can offer a successful alternative to invasive surgical excision. […] Multiple randomized controlled trials have compared the above methods, but no single study has assessed all 5 at once. […] Overall, 5% to 10% of patients with hemorrhoids will require surgery; the vast majority of these have Grade III to IV lesions.

• #86 Large genetic study sheds light on the causes of hemorrhoids | Karolinska Institutet

  https://news.ki.se/large-genetic-study-sheds-light-on-the-causes-of-hemorrhoids

  Although hemorrhoids are a common health problem, relatively little is known about the field, possibly because many people find them difficult to talk about. […] Hemorrhoids are a very common problem that has both social and financial consequences. In the U.S., the annual cost of surgery for severe hemorrhoids is estimated at $800 million (approximately 6.7 billion kronor). […] Despite hemorrhoid being very common, the field is relatively under-researched. Science has yet to explain why only certain people develop them, or provide clues as to the molecular pathogenesis of the disease. […] The data, which was sourced from several biobanks in Europe and the U.S. including the UK Biobank and 23andMe, comprised 218,929 patients with hemorrhoidal disease and 725,213 healthy controls, making a total genome set of almost one million individuals.

• #87 Prevalence and associated factors of hemorrhoids among adult patients visiting the surgical outpatient department in the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249736

  The present study was conducted to determine the prevalence of hemorrhoids in adult patients visiting surgical OPD at the UOG Comprehensive Hospital, Ethiopia, and to define associated risk factors. Constipation and being overweight found to be significantly associated with hemorrhoids. […] This study helps us to know the burden and possible risk factor of the disease and may allow us to easily identify individuals at risk of hemorrhoids and to provide early diagnosis, prevention measures, and appropriate interventions. However, there are some limitations of this study such as it could not establish a cause-effect relationship because of the cross sectional nature of the study design. […] Hemorrhoid is found to be the common health problem among surgical patients and its prevalence was higher in male subjects. Constipation and being overweight were found to increase the odds of having hemorrhoids. Screening for early identification and intervention of hemorrhoids, especially for risk groups is better to be practiced by health professionals.

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