Correlation Between Poor Defecation Habits and Postoperative Hemorrhoid Recurrence

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 ( < 0.001). A higher ODS score correlated with a higher maximum anal squeeze pressure ( = 0.07) and a more severe inability for the anus to relax during simulated evacuation ( = 0.002). The maximum rectum threshold was also found to be the highest in ODS patients ( = 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 ( = 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 ( < 0.001). Multivariate analysis confirmed a higher ODS score ( < 0.001) was an independent predictor of recurrence. Furthermore, patients who occasionally exercised ( = 0.01) and patients who exercised regularly ( = 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.