European Journal of Cardiovascular Medicine

Hemorrhoids are among the most common anorectal disorders worldwide, affecting millions of individuals and causing significant morbidity and impaired quality of life [1]. They result from symptomatic enlargement and distal displacement of the normal anal cushions, which are characterized by vascular dilatation, connective tissue degeneration, and prolapse of the anal mucosa [1]. The reported global prevalence ranges between 4% and 36%, with peak incidence noted in individuals aged 30–50 years, although older adults are also affected [2].

Several risk factors contribute to the development of hemorrhoids, including chronic constipation, prolonged straining during defecation, sedentary lifestyle, obesity, and a diet deficient in fiber [3]. Clinically, the condition manifests with rectal bleeding, prolapse, pain, itching, mucus discharge, and, in advanced cases, complications such as thrombosis or strangulation [2,4]. Hemorrhoids are graded from I to IV depending on the extent of prolapse, and this classification is essential in guiding the choice of therapeutic intervention [2].

Management options are determined by disease severity. Conservative measures, such as dietary modification, stool softeners, and sitz baths, are typically first-line for early stages. For intermediate grades, office procedures including rubber band ligation, sclerotherapy, and infrared coagulation have demonstrated favorable outcomes [3,5]. Advanced grades often necessitate surgical interventions such as open hemorrhoidectomy or stapled hemorrhoidopexy, which provide definitive relief but are associated with higher postoperative morbidity [2,3].

Given the high disease burden and diversity in management approaches, it is essential to analyze local patient profiles and treatment outcomes. This study was undertaken to evaluate the clinical profile of patients with hemorrhoids and to assess the effectiveness of various management strategies in a tertiary care setting.

Study design and setting:
This was an observational study conducted in the Department of General Surgery, Dr. YSR Government Medical College, Pulivendula, Andhra Pradesh. The study was carried out over a period of five months, from 15 December 2023 to 15 May 2024.

Study population:
A total of 50 patients clinically diagnosed with hemorrhoids and attending the outpatient and inpatient services during the study period were included. Both male and female patients aged above 18 years were eligible.

Inclusion criteria:

• Patients with a clinical diagnosis of hemorrhoids (Grade I–IV).
• Patients willing to provide informed consent.

Exclusion criteria:

• Patients with coexisting anorectal conditions such as fissures, fistula-in-ano, abscess, or malignancy.
• Patients with systemic conditions affecting bleeding or wound healing (e.g., coagulopathy, cirrhosis).
• Pregnant women.

Data collection:
Demographic details including age, sex, and residence were recorded. Clinical data comprised presenting symptoms, duration of illness, and grade of hemorrhoids, determined by proctoscopic examination. Patients were stratified into Grade I–IV based on the extent of prolapse.

Management approaches:
Treatment strategies were individualized according to disease grade and patient preference. Patients received either:

Conservative management (dietary modification, sitz baths, laxatives),

Minimally invasive procedures (rubber band ligation, infrared coagulation), or

Surgical interventions (open hemorrhoidectomy, stapled hemorrhoidopexy).

Outcome assessment:
Primary outcome was symptomatic relief, defined as improvement or resolution of bleeding, pain, and prolapse during follow-up at four weeks post-treatment.

Statistical analysis:
All data were compiled and analyzed using descriptive statistics. Results were expressed as frequencies, percentages, and tabulated for clarity.

A total of 50 patients with clinically diagnosed hemorrhoids were included in the study. The demographic profile is summarized in Table 1. The majority of patients were between 30–50 years of age (56.0%), followed by those above 50 years (28.0%). Males outnumbered females (64.0% vs. 36.0%). Urban residents (60.0%) were more frequently affected compared to rural counterparts (40.0%).

Table 1. Demographic Profile of Patients with Hemorrhoids (n=50)

With respect to clinical presentation, bleeding per rectum was the most common symptom, observed in 80.0% of patients. Prolapse of mass (60.0%) and pain during defecation (56.0%) were also frequent complaints, while itching/irritation (44.0%), constipation (36.0%), and mucus discharge (20.0%) were less common (Table 2, Figure 1).

Table 2. Clinical Presentation of Hemorrhoids

Figure 1. Clinical Presentation of Hemorrhoids

Analysis of the distribution by grade of hemorrhoids showed that Grade II hemorrhoids were the most prevalent (36.0%), followed by Grade III (30.0%), Grade I (20.0%), and Grade IV (14.0%) (Table 3, Figure 2).

Table 3. Distribution of Hemorrhoids by Grade

Figure 2. Distribution of Hemorrhoids by Grade

Regarding management approaches, conservative treatment with dietary modifications, sitz baths, and laxatives was provided to 40.0% of patients, with symptomatic relief achieved in 70.0% of them. Rubber band ligation and infrared coagulation were performed in 24.0% and 12.0% of patients, yielding relief in 83.3% of each group. Surgical interventions, including open hemorrhoidectomy (18.0%) and stapled hemorrhoidopexy (6.0%), demonstrated complete symptomatic resolution in all treated patients (100.0%) (Table 4).

Table 4. Management Approaches and Outcomes

The present observational study examined the clinical profile and treatment outcomes of 50 patients with hemorrhoids in a tertiary care setting. Most patients were middle-aged, with a male predominance, which aligns with global trends reported in epidemiological literature. The high prevalence among this group may reflect greater exposure to modifiable risk factors such as sedentary lifestyle, chronic straining, and dietary influences.

Bleeding per rectum was the most frequent presenting symptom in this study, followed by prolapse and pain. These findings are consistent with earlier reports that describe painless rectal bleeding as the hallmark symptom, although pruritus, constipation, and mucus discharge also contribute to morbidity. Importantly, the predominance of Grade II disease, followed by Grade III, mirrors the trend in many regional studies where patients typically present at intermediate stages rather than at the onset of symptoms. Delayed presentation may be influenced by sociocultural stigma, self-medication, or underestimation of disease severity.

In terms of treatment outcomes, conservative measures yielded symptomatic relief in 70% of patients. While effective in early disease, recurrence and persistence of symptoms often necessitate procedural interventions. Among office-based therapies, rubber band ligation (RBL) was highly effective, with relief achieved in over 80% of patients in our series, which is consistent with existing literature demonstrating RBL as a safe and cost-effective modality for Grades I–II hemorrhoids [6,7]. Infrared coagulation also demonstrated comparable efficacy.

Surgical approaches offered definitive outcomes in our study, with both open hemorrhoidectomy and stapled hemorrhoidopexy achieving 100% symptomatic resolution. This finding concurs with systematic reviews and meta-analyses that confirm the superiority of surgery for advanced disease, though the procedures carry a higher risk of postoperative pain and morbidity [8,10]. However, the debate continues regarding long-term recurrence, particularly following stapled procedures, which some studies have highlighted as a limitation [9,11].

Overall, our findings emphasize that treatment must be tailored to disease grade and patient profile. Conservative and minimally invasive options are sufficient for early to intermediate hemorrhoids, while surgery remains the gold standard for advanced grades. Moreover, patient counseling and early medical consultation are essential to reduce progression and minimize surgical necessity. Educational interventions and structured follow-up could play a critical role in lowering recurrence rates and improving long-term outcomes [12].

This study highlights that hemorrhoids are more prevalent among middle-aged men, with bleeding per rectum as the predominant symptom. Grade II disease was most frequently encountered, followed by Grade III, reflecting delayed presentation at intermediate stages. Conservative measures offered partial relief, while minimally invasive procedures such as rubber band ligation and infrared coagulation provided superior outcomes in early and intermediate grades. Surgical interventions, including open hemorrhoidectomy and stapled hemorrhoidopexy, ensured complete symptomatic resolution, particularly in advanced disease. These findings emphasize the need for individualized, grade-based treatment strategies and underscore the importance of early intervention to reduce morbidity and improve quality of life.

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