The Evaluation and Treatment of Hemorrhoids

A Guide for the Gastroenterologist

Robert A. Ganz


Clin Gastroenterol Hepatol. 2013;11(6):593-603. 

In This Article


The exact prevalence of symptomatic hemorrhoids is very difficult to establish, because many sufferers do not seek care for their problems or rely on over-the-counter remedies, whereas others attribute other anorectal symptoms as being a result of hemorrhoids.[7–9] As noted in a recent American Gastroenterological Association review, the epidemiology of hemorrhoidal disease has been studied via different tools, each of which has methodologic limitations. Surveys that rely on patient self-reporting are nonspecific, and physician-reported diagnoses or hospital discharge data are not always confirmed. Thus, epidemiologic data can vary widely. Estimates of the prevalence of symptomatic hemorrhoid disease in the United States range from 10 million people, a 4.4% prevalence rate,[10] to a National Center for Health Statistics report of up to 23 million people or 12.8% of U.S. adults.[11] Others have reported up to a 30%–40% prevalence rate in the United States.[12,13] A recent prospective study of screening colonoscopy patients revealed the presence of hemorrhoids in 38.9%, with 44.7% of those patients suffering from hemorrhoidal symptoms.[14] In 2004, the National Institutes of Health noted that the diagnosis of hemorrhoids was associated with 3.2 million ambulatory care visits, 306,000 hospitalizations, and 2 million prescriptions in the United States.[15]

Although it has been stated that 50% of the population will experience symptomatic hemorrhoid disease at some point in their lives,[16] the peak incidence of symptomatic disease seems to be between the ages of 45–65 years. Development of hemorrhoids before the age of 20 is unusual, and the risk is higher for whites than for blacks.[10,17,18] Pregnancy is associated with an increased risk for hemorrhoids, and there is a slightly increased prevalence in women compared with men.[9,19] Neither chronic constipation nor portal hypertension has convincingly been linked to hemorrhoids.[20,21] Hemorrhoids are commonly seen in patients with spinal cord injury.[10,22,23]