Aetiology of thrombosed external haemorrhoids: a questionnaire study

Abstract

BackgroundIt is important to better understand the aetiology of thrombosed external haemorrhoids (TEH) because recurrence rates are high, prophylaxis is unknown, and optimal therapy is highly debated.FindingsWe conducted a questionnaire study of individuals with and without TEH. Aetiology was studied by comparison of answers to a questionnaire given to individuals with and without TEH concerning demography, history, and published aetiologic hypotheses. Participants were evaluated consecutively at our institution from March 2004 through August 2005.One hundred forty-eight individuals were enrolled, including 72 patients with TEH and 76 individuals without TEH but with alternative diagnoses, such as a screening colonoscopy or colonic polyps. Out of 38 possible aetiologic factors evaluated, 20 showed no significant bivariate correlation to TEH and were no longer traced, and 16 factors showed a significant bivariate relationship to TEH. By multivariate analysis, six independent variables were found to predict TEH correctly in 79.1% of cases: age of 46 years or younger, use of excessive physical effort, and use of dry toilet paper combined with wet cleaning methods after defaecation were associated with a significantly higher risk of developing TEH; use of bathtub, use of the shower, and genital cleaning before sleep at least once a week were associated with a significantly lower risk of developing TEH.ConclusionSix hypotheses on the causes of TEH have a high probability of being correct and should be considered in future studies on aetiology, prophylaxis, and therapy of TEH.

Management and Treatment of External Hemorrhoidal Thrombosis

“…It is linked to an increased intravenous pressure in the hemorrhoidal plexus which leads to rupturing of the endothelial lining initiating thrombosis ( 4 , 5 ). Young age, hard stool, constipation, excessive physical effort and use of dry toilet paper combined with wet cleaning methods after defecation appear to promote EHT development, whereas the use of bathtub or shower before sleep seem to have a protective role ( 4 , 5 ). Pregnancy, commonly considered a risk factor for EHT, has no significant relationship, except for childbirth ( 5 ).…”

“…Young age, hard stool, constipation, excessive physical effort and use of dry toilet paper combined with wet cleaning methods after defecation appear to promote EHT development, whereas the use of bathtub or shower before sleep seem to have a protective role ( 4 , 5 ). Pregnancy, commonly considered a risk factor for EHT, has no significant relationship, except for childbirth ( 5 ). Occasionally, recurrent EHT could be associated with administration of L-asparaginase, in patients with Philadelphia chromosome-positive acute lymphoblastic leukemia ( 6 ).…”

Our Results in the Surgical Treatment of Acute Hemorrhoidal Thrombosis

“…Nowadays hemorrhoids remain one of the frequent proctologic disease. Analysis of patients uptake patterns for ambulatory surgical treatment shows that the vast majority of cases associated with a visit to the clinic on hemorrhoid is acute thrombosis of hemorrhoids which may recur up to 5 times a year [1] . 2/3 of the patients seeking medical aid were the people of working age.…”

“…2/3 of the patients seeking medical aid were the people of working age. During each exacerbation the period of temporary invalidity is from 6 to 35 days [1,4] . Acute thrombosis of hemorrhoidal cushions can also be the primary process from which the disease begins.…”