Correlation Between Poor Defecation Habits and Postoperative Hemorrhoid Recurrence

Qing Li; Roshan Ara Ghoorun; Li Li; Heng Zhang; Dan Zhang; Haihua Qian; Dong-Lin Ren; Dan Su

doi:10.3389/fsurg.2022.930215

Correlation Between Poor Defecation Habits and Postoperative Hemorrhoid Recurrence

Front Surg. 2022 Jun 17:9:930215. doi: 10.3389/fsurg.2022.930215. eCollection 2022.

Authors

Qing Li^{1

2}, Roshan Ara Ghoorun³, Li Li³, Heng Zhang³, Dan Zhang¹, Haihua Qian¹, Dong-Lin Ren³, Dan Su³

Affiliations

¹ Department of Anorectal Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
² Department of Anorectal Surgery, The Affiliated Xing Tai People Hospital of Hebei Medical University, Xingtai, China.
³ Department of Colorectal Surgery, The Sixth Affiliated Hospital (Gastrointestinal & Anal Hospital), Sun Yat-sen University, Guangzhou, China.

Abstract

Background: The relationship between hemorrhoid recurrence and poor defecation habits is poorly understood. This study aimed to analyze the effects of poor defecation habits on postoperative hemorrhoid recurrence.

Materials and method: We performed a retrospective study on 1,162 consecutive patients who underwent a surgical procedure for hemorrhoids at the Sixth Affiliated Hospital of Sun Yat-Sen University from December 2016 to May 2020. All patients were followed for 12 months post-operatively. Patients were monitored for disease recurrence. Patient defecation habits were assessed using an obstructive defecation syndrome (ODS) score.

Results: Patients with a score of 0-4 had a mild defecation disorder, 5-8 a moderate defecation disorder, and 9 or more ODS. Of the 1,162 patients, 1,144 (98.45%) had a mild defecation disorder, 13 (1.12%) had a moderate defecation disorder, and 9 (0.43%) had ODS. Older patients were significantly more likely to have worse defecation habits (P < 0.001). A higher ODS score correlated with a higher maximum anal squeeze pressure (P = 0.07) and a more severe inability for the anus to relax during simulated evacuation (P = 0.002). The maximum rectum threshold was also found to be the highest in ODS patients (P = 0.010). The proportion of Procedure for prolapsing hemorrhoids (PPH) was the highest in the moderate defecation disorder group (53.85), followed by the ODS group (40.00) and the mild defecation disorder group (P = 0.023). Recurrence occurred in 5.51% of patients in the mild defecation disorder group, 38.46% of the moderate defecation disorder group, and 60% of the ODS group (P < 0.001). Multivariate analysis confirmed a higher ODS score (P < 0.001) was an independent predictor of recurrence. Furthermore, patients who occasionally exercised (P = 0.01) and patients who exercised regularly (P = 0.021) were less likely to have a recurrence.

Conclusion: Patients with unresolved defecation disorders are more likely to have their hemorrhoids recur and are unlikely to be satisfied with surgical management.

Keywords: defecation habit; hemorrhoid; obstructive defecation syndrome; recurrence; risk factors.