Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Availability of Data and Material

All data generated or analyzed during this study are included in this published article.

Abbreviations

ACRSI:

Association of Colon & Rectal Surgeons of India

AGA:

American Gastroenterological Association

ASCRS:

American Society of Colon and Rectal Surgeons

BMI:

Body mass index

CEAP:

Clinical-etiology-anatomy-pathophysiology

CPs:

Consulting physicians

CVD:

Chronic venous disease

GPs:

General practitioners

HRT:

Hormone replacement therapy

MPFF:

Micronized purified flavonoid fraction

VAI:

Venous Association of India

References

  1. Lohsiriwat V (2012) Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol 18:2009–2017

    Article  CAS  Google Scholar 

  2. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ, GRADE Working Group (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924–926

    Article  Google Scholar 

  3. Abramowitz L, Benabderrahmane M, Pospait D, Philip J, Laouénan C (2014) The prevalence of proctological symptoms amongst patients who see general practitioners in France. Eur J Gen Pract 20:301–306

    Article  Google Scholar 

  4. MacKay D (2001) Hemorrhoids and varicose veins: a review of treatment options. Altern Med Rev 6:126–140

    CAS  PubMed  Google Scholar 

  5. Burkitt DP (1972) Varicose veins, deep vein thrombosis, and haemorrhoids: epidemiology and suggested aetiology. Br Med J 2:556–561

    Article  CAS  Google Scholar 

  6. Abramowitz L, Godeberge P, Soudan D (2001) Société Nationale Française de Colo-Proctologie. French recommendations for treatment of hemorrhoidal disease. Gastroenterol Clin Biol 25:674–702

    CAS  PubMed  Google Scholar 

  7. Johanson JF, Sonnenberg A (1994) Constipation is not a risk factor for hemorrhoids: a case-control study of potential etiological agents. Am J Gastroenterol 89:1981–1986

    CAS  PubMed  Google Scholar 

  8. Mounsey AL, Halladay J, Sadiq TS (2011) Hemorrhoids. Am Fam Physician 84:204–210

    PubMed  Google Scholar 

  9. Recek C (2013) Calf pump activity influencing venous hemodynamics in the lower extremity. Int J Angiol 22:023–030

    Article  Google Scholar 

  10. Takase S, Pascarella L, Lerond L, Bergan JJ, Schmid-Schönbein GW (2004) Venous hypertension, inflammation and valve remodeling. Eur J Vasc Endovasc Surg 28:484–493

    Article  CAS  Google Scholar 

  11. Takase S, Pascarella L, Bergan JJ, Schmid-Schönbein GW (2004) Hypertension-induced venous valve remodeling. J Vasc Surg 39:1329–1334

    Article  Google Scholar 

  12. Peery AF, Sandler RS, Galanko JA, Bresalier RS, Figueiredo JC, Ahnen DJ, Barry EL, Baron JA (2015) Risk factors for hemorrhoids on screening colonoscopy. PLoS One 10:e0139100

    Article  Google Scholar 

  13. Holdstock JM, Dos Santos SJ, Harrison CC, Price BA, Whiteley MS (2015) Haemorrhoids are associated with internal iliac vein reflux in up to one-third of women presenting with varicose veins associated with pelvic vein reflux. Phlebology. 30:133–139

    Article  CAS  Google Scholar 

  14. Godeberge P, Sheikh P, Zagriadskiĭ E, Lohsiriwat V, Montaño AJ, Košorok P, De Schepper H (2020) Hemorrhoidal disease and chronic venousinsufficiency: Concomitance or coincidence; results of the CHORUS study (Chronic venous and HemORrhoidal diseases evalUation and Scientific research). J Gastroenterol Hepatol 35(4):577–585

  15. Rivadeneira DE, Steele SR, Ternent C, Chalasani S, Buie WD, Rafferty JL (2011) Standards Practice Task Force of The American Society of Colon and Rectal Surgeons. Practice parameters for the management of hemorrhoids (revised 2010). Dis Colon Rectum 54:1059–1064

    Article  Google Scholar 

  16. Cospite M (1994) Double-blind, placebo-controlled evaluation of clinical activity and safety of Daflon 500 mg in the treatment of acute hemorrhoids. Angiology. 45:566–573

    CAS  PubMed  Google Scholar 

  17. Misra MC, Parshad R (2000) Randomized clinical trial of micronized flavonoids in the early control of bleeding from acute internal haemorrhoids. Br J Surg 87:868–872

    Article  CAS  Google Scholar 

  18. Godeberge P (1994) Daflon 500 mg in the treatment of hemorrhoidal disease: a demonstrated efficacy in comparison with placebo. Angiology. 45:574–578

  19. Madoff RD, Fleshman JW (2004) American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterology. 126:1463–1473

    Article  Google Scholar 

  20. Agarwal N, Singh K, Sheikh P, Mittal K, Mathai V, Kumar A (2017) Executive summary-the Association of Colon & Rectal Surgeons of India (ACRSI) Practice Guidelines for the Management of Haemorrhoids—2016. Indian J Surg 79:58–61

    Article  Google Scholar 

  21. Dekiwadia DB, Jindal R, Varghese R, Bedi HS, Padaria S, Patel MD, Agarwal S, Saravanan S, Rao UV, Pinjala R, Singh G (2016) Executive summary: a consensus statement – part I: recommendations for the management of chronic venous disease (CVD) in India and key role of primary care doctors. J Assoc Physicians India 64:53–56

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge the participation of all the healthcare professionals who participated in the study: Agartala: Dr. Damodar Chatterjee, Dr. Narayan Das; Agra: Dr. M. L. Bansal; Ahmedabad: Dr. Swati Upadhyay; Ambala: Dr. Rajeev Aggarwal; Aurangabad: Dr. Atul Shende; Baroda: Dr. Gautam D. Patel; Bengaluru: Dr. M. R. V. Prasad, Dr. C. S. Ravindra, Dr. N.S. Shankar, Dr. Somshekhar C.S.; Bhopal: Dr. Krishnanand; Bilaspur: Dr. Sanjay Dhandharia; Burdwan: Dr. Subrata Bhattacherjee; Calicut: Dr. Suhaib Rehaman A.; Chennai: Dr. A. Prabhu, Dr. K. P. Parthasarathy, Dr. K. A. Venkatachalam, Dr. R. Balasubramanian, Dr. K. Arthi; Cochin: Dr. Shameer C. Sulaiman; Cuttack: Dr. Manoranjan Behera; Dehradun: Dr. Pradeep Sharda; Delhi: Dr. Akhlakh Hussain, Dr. Umesh Madan, Dr. J. S. Lamba, Dr. R. K. Luthria, Dr. Arun Kumar Patel, Dr. Tarun Dube, Dr. Amardip Kr. Singh, Dr. Vikram Jeet Singh; Dibrugarh: Dr. A. K. Kalita; Goa: Dr. Emidio Gomes; Guwahati: Dr. Devajit Choudhury; Howrah: Dr. Deepak Kapoor; Hyderabad: Dr. Veerender Sahai Saxena, Dr. Ashraf-Ul-Abeddin, Dr. Praveen Kumar, Dr. Mukesh Sharma; Indore: Dr. Rizwan Farooqui, Dr. Vijay Nichani; Jabalpur: Dr. Arjun Saxena; Jaipur: Dr. Rajeev Sharma, Dr. T. S. Singh, Dr. C. P. Singh; Jalandhar: Dr. Vinod Batra; Jodhpur: Dr. Ram Goel; Kanpur: Dr. S. K. Bhatter; Kolhapur: Dr. Ajit Limaye; Kolkata: Dr. Sanjoy Seal, Dr. Manoj Saha, Dr. Syed Nazim Ahmad, Dr. Parimal Bhattacharya, Dr. Achintya Das, Dr. Rahul Bhattacharyya; Lucknow: Dr. Nishant Kanodia, Dr. S. Munshi; Madurai: Dr. Navaneetha Krishnan; Meerut: Dr. Anil Kumar Chauhan; Mumbai: Dr. Prasad B. Patil, Dr. Pravin Shetty, Dr. Dilip Rajpal, Dr. Sambit Patnaik, Dr. Saurabh Sanjanwala, Dr. Pravin Rangari, Dr. Dheeraj Mulchandani, Dr. Sukesh Singh, Dr. Nitin Tawte, Dr. Kishor V. Naik; Muzaffarpur: Dr. Suman Kumar, Dr. R. K. Prasad; Nagpur: Dr. Praveen Gupta, Dr. Prachi Mahajan; Nasik: Dr. Yogesh P. Chaudhari; Patna: Dr. Alok Sahay; Pondicherry: Dr. R. Rajarathinam; Pune: Dr. Ramesh Dumbre, Dr. Pankaj Waykole, Dr. Chetan N. Mhaske; Raipur: Dr. Suvimal Dutta; Rajkot: Dr. M. V. Vekariya; Ranchi: Dr. Deepak Kumar Singh; Siliguri: Dr. Rajashri Guha; Surat: Dr. Piyush Anajwala; Tirunelveli: Dr. K. Parimalam; Trichy: Dr. B. Hariharan; Trivandrum: Dr. V. Sukumaran; Udaipur: Dr. Sunil Goyal; Varanasi: Dr. A. K. Singh; Vijayawada: Dr. P. Gopalakrishna; Vishakhapatanam: Dr. B. Satrughnudu.

Funding

The CHORUS study was supported by Servier who is a manufacturer of MPFF. The sponsor had no role in the study design or data analysis and interpretation, nor in the decision to submit the manuscript for publication. The sponsor assisted with the setup, data collection, and management of the study in each country. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Author information

Authors and Affiliations

  1. Saifee Hospital, Mumbai, Maharashtra, India

    Parvez Sheikh

  2. Medicare Hospital, Thane, Maharashtra, India

    Kushal Mital

  3. Apollo Spectra Hospitals, New Delhi, Delhi, India

    Usha Maheshwari

  4. Maheshwari Clinics, Delhi, India

    Usha Maheshwari

  5. J P Hospital, Coimbatore, Tamilnadu, India

    J. Prabakaran

  6. Sharda Surgical & Urology Centre, Dehradun, Uttarakhand, India

    Pradeep Sharda

  7. Dumbre Clinic, Pune, Maharashtra, India

    Ramesh Dumbre

Authors
  1. Parvez Sheikh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kushal Mital
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Usha Maheshwari
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Prabakaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pradeep Sharda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ramesh Dumbre
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The authors were among the 95 healthcare professionals who participated in the study and recruited patients. They have made substantial contribution to collect the data and/or interpretation of data collected. All authors have reviewed the article and agree with its contents. All the authors have given their consent for the submission and publication of the manuscript. Each author has participated sufficiently towards data collection, the development, and review of the manuscript, to take public responsibility for appropriate portions of the content and agree to be accountable in ensuring that questions related to the accuracy or integrity of any part of the manuscript are appropriately investigated and resolved.

Corresponding author

Correspondence to Parvez Sheikh.

Ethics declarations

Conflict of Interest

Parvez Sheikh has received lecture fees from Servier. Remaining authors do not have any conflict of interest to declare.

Ethics Approval and Consent to Participate

An Independent Ethics Committee (IEC), Lancelot Independent Ethics Committee [111 C, Lancelot, S.V. Road, Borivali (West), Mumbai–400092] approved the conduction of the CHORUS study in India by during EC meeting held on 22nd September 2015.

A written consent has been obtained from all the patients towards their participation in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sheikh, P., Mital, K., Maheshwari, U. et al. Clinical Presentation of Hemorrhoids and its Correlation with Chronic Venous Disease in India: a Subgroup Analysis of the International CHORUS Survey. Indian J Surg 83, 513–521 (2021). https://doi.org/10.1007/s12262-020-02426-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-020-02426-1

Keywords

Search

Navigation