Clinical Presentation of Hemorrhoids and its Correlation with Chronic Venous Disease in India: a Subgroup Analysis of the International CHORUS Survey

Abstract

To determine the frequency of symptoms (bleeding, pain, rectal swelling, itching, soiling, constipation) in subjects consulting for hemorrhoidal disease and assess the possible concomitance between hemorrhoids and chronic venous disease (CVD). CHORUS is a multinational cross-sectional survey carried out in seven countries. Consecutive patients consulting for hemorrhoidal disease were screened to confirm the presence of chronic venous disease. Data collected exclusively from India is analyzed here. Of the 2511 eligible patients, 63.8% were male and the mean age was 43.3 ± 12.2 years. Overall, 95.7% patients had physician-confirmed hemorrhoidal disease. Bleeding, swelling, prolapse, and fecal incontinence were significantly associated with the presence of hemorrhoidal disease (p < 0.0001). About one third of patients (37.5%) had reported simultaneous occurrence of hemorrhoidal disease and CVD and the occurrence of hemorrhoidal disease was significantly correlated with the presence of CVD (p = 0.004). Moreover, 70.4% patients with CVD had recurrent hemorrhoidal disease (p < 0.0001). Venoactive drug was the most commonly (95.7% cases) prescribed treatment; micronized purified flavonoid fraction was the most widely used (86.2%) venoactive drug. More than one third individuals with hemorrhoidal disease in our study had CVD, which highlights the importance of investigating signs of CVD in patient with hemorrhoids during daily clinical practice which could help better understand the disease and optimize the management.