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.
Highlights
Anorectal disorders are common [1,2,3,4] no data exist regarding the prevalence, incidence and aetiology of thrombosed external haemorrhoids (TEH) [3,5,6,7,8,9]
Aetiology was studied by comparison of answers to a questionnaire given to individuals with and without TEH concerning demography, history, and published aetiologic hypotheses
Common clinical presentations are as a single external pile or as circular thrombosis of external haemorrhoids
Summary
Anorectal disorders are common [1,2,3,4] no data exist regarding the prevalence, incidence and aetiology of thrombosed external haemorrhoids (TEH) [3,5,6,7,8,9]. Common clinical presentations are as a single external pile (figure 1) or as circular thrombosis of external haemorrhoids (figure 2). A single TEH is characterized by acutely evolving, painful, circumscribed perianal swelling of a dark colour occasionally with bleeding (figure 3), and a perforating clot [2,5,6,10,11] (figure 4). We limited our study to single lesions using Hancock's definition of "an acute localised thrombosis which may affect the external plexus" [2]. Synonyms of this clinical presentation include acute thrombosed external haemorrhoid [10,12], acute haemorrhoidal disease [13], anal (page number not for citation purposes). It 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
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