Risk Factors Contributing to the Presence of Internal Hemorrhoids in the Elderly - A Retrospective Study

Introduction: Internal hemorrhoids are the fourth most common gastrointestinal diagnosis on the outpatient basis. Approximately 4% of the population self-report internal hemorrhoids with a peak incidence from age 45-65 years. whites and people with higher socioeconomic status have an increased prevalence. Previous studies have revealed that risk factors for IH are obesity, constipation, and lifestyle choices. We aim to look into these risk factors as well as metabolic syndrome and its components. Methods: We conducted a retrospective chart review to identify patients over the age of 75 who underwent a colonoscopy between 2012 and 2019 within our health network. We divided our sample into a younger age group (75-84 years old) and an older age group (≥85) We collected data on patient demographics, comorbidities, and colonoscopy findings. All statistical analyses were conducted in IBM SPSS Version 26 to analyze our data. Results: A total of 1080 patients were included in our sample. Median age was 78. Most of the patients were white (93.7%) and female (56.8%) with a history of hypertension (81.8%) and didn’t have internal hemorrhoids (66.3%). A significant proportion of patients had ASA ≥3 (40.8%) and (impaired fasting glucose) IFG (35.7%). A higher proportion of patients with internal hemorrhoids had obesity, dementia, IFG, low HDL, hypothyroidism, and iron deficiency anemia (IDA) while ASA level of 3 or more, history of hypertension and cigarette smoking was more prevalent in patients without internal hemorrhoids. Importantly, history of constipation was only found in a minority of patients (35.2%) with internal hemorrhoids and had similar prevalence in those without hemorrhoids. Conclusion: Our limited study reports higher co-morbidity burden in patients with internal hemmorhoids than those without it. However, prevalence of constipation in patients with internal hemorrhoids was much lower than seen in previous studies. Obesity was seen in a higher proportion of these patients and prior literature also reports significant association. IDA was seen more commonly in patients with IH, possibly due to increase risk of bleeding in these patients. Further studies with larger population sizes should be performed to evaluate these relationships.Table 1.: Comparisons of Demographic and Clinical Variables for Internal Hemorrhoids (N = 1,080)