title: Haemorrhoids, constipation and faecal incontinence: is there any relationship?
abstract: OBJECTIVE
  Little is known about the association of haemorrhoids and anorectal function. Moreover, available data on the impact of constipation on the presence of haemorrhoids are conflicting. The present study aimed to assess any potential relationship between haemorrhoids and anorectal dysfunction.
  
  
  METHODS
  All participants who attended the Austrian nationwide healthcare programme for colorectal cancer screening at four medical institutions were enrolled prospectively between 2008 and 2009. A colonoscopy and detailed anorectal examination were performed on all patients. Haemorrhoids were classified according to an international grading system. Faecal incontinence was defined as the involuntary loss of solid stool, liquid stool or gas, at least once a month. Constipation was recorded by a constipation scoring system.
  
  
  RESULTS
  Of 976 participants, 380 (38.9%) were found to have haemorrhoids. There was an association between healthy individuals, patients with symptomatic and patients with asymptomatic haemorrhoids and incontinence of liquid stool. No association was found regarding incontinence for solid stool and gas. The median constipation score was significantly higher in those patients with haemorrhoids (grade I-IV) compared with patients without haemorrhoids (2.5 points (range, 0-19) and 3 points (range, 0-19); P = 0.0113). 'Painful evacuation effort' and 'assistance for defaecation (stimulant laxatives, digital assistance or enema)' showed a significant correlation with haemorrhoids (P = 0.0394 and P = 0.0143).
  
  
  CONCLUSIONS
  Although the median constipation score was low in both groups, there was a significant association between constipation and haemorrhoids in adult patients.
authors.affiliation: Medical University of Vienna, Department of Surgery, Vienna, Austria. stefan.riss@meduniwien.ac.at
authors.forename: S
authors.initials: S
authors.lastname: Riss
authors.forename: F A
authors.initials: FA
authors.lastname: Weiser
authors.forename: K
authors.initials: K
authors.lastname: Schwameis
authors.forename: M
authors.initials: M
authors.lastname: Mittlböck
authors.forename: A
authors.initials: A
authors.lastname: Stift
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003113:Colonoscopy; D003248:Constipation / Q000150:complications*; D003672:Defecation; D005242:Fecal Incontinence / Q000150:complications*; D005260:Female; D006484:Hemorrhoids / Q000145:classification / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric