{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T23:32:14Z","timestamp":1776295934513,"version":"3.50.1"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,6,17]],"date-time":"2022-06-17T00:00:00Z","timestamp":1655424000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100015285","name":"Foundation of the Hebei Province 2020 Annual Medical Science Research Project","doi-asserted-by":"publisher","award":["20201578"],"award-info":[{"award-number":["20201578"]}],"id":[{"id":"10.13039\/501100015285","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Method<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients with a score of 0\u20134 had a mild defecation disorder, 5\u20138 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 (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001). A higher ODS score correlated with a higher maximum anal squeeze pressure (<jats:italic>P<\/jats:italic>\u2009=\u20090.07) and a more severe inability for the anus to relax during simulated evacuation (<jats:italic>P<\/jats:italic>\u2009=\u20090.002). The maximum rectum threshold was also found to be the highest in ODS patients (<jats:italic>P<\/jats:italic>\u2009=\u20090.010). 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 (<jats:italic>P<\/jats:italic>\u2009=\u20090.023). 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 (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001). Multivariate analysis confirmed a higher ODS score (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001) was an independent predictor of recurrence. Furthermore, patients who occasionally exercised (<jats:italic>P<\/jats:italic>\u2009=\u20090.01) and patients who exercised regularly (<jats:italic>P<\/jats:italic>\u2009=\u20090.021) were less likely to have a recurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients with unresolved defecation disorders are more likely to have their hemorrhoids recur and are unlikely to be satisfied with surgical management.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2022.930215","type":"journal-article","created":{"date-parts":[[2022,6,17]],"date-time":"2022-06-17T05:45:45Z","timestamp":1655444745000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Correlation Between Poor Defecation Habits and Postoperative Hemorrhoid Recurrence"],"prefix":"10.3389","volume":"9","author":[{"given":"Qing","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roshan Ara","family":"Ghoorun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haihua","family":"Qian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dong-Lin","family":"Ren","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Su","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,6,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"716","DOI":"10.14309\/ajg.0000000000000234","article-title":"Piles of money: \u201cHemorrhoids\u201d are a billion-dollar industry","volume":"114","author":"Cosman","year":"2019","journal-title":"Am J Gastroenterol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.cgh.2018.03.020","article-title":"Rethinking what we know about hemorrhoids","volume":"17","author":"Sandler","year":"2019","journal-title":"Clin Gastroenterol Hepatol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2698","DOI":"10.1001\/jama.2014.281","article-title":"JAMA patient page. Hemorrhoids","volume":"312","author":"Sugerman","year":"2014","journal-title":"JAMA"},{"key":"B4","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1038\/s41395-018-0020-0","article-title":"Office management of hemorrhoids","volume":"113","author":"Qureshi","year":"2018","journal-title":"Am J Gastroenterol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"729166","DOI":"10.3389\/fsurg.2021.729166","article-title":"Lifestyle and risk factors in hemorrhoidal disease","volume":"8","author":"De Marco","year":"2021","journal-title":"Front Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1097\/DCR.0000000000001822","article-title":"Influence of bowel habit and hormonal changes on the development of hemorrhoidal disease during pregnancy and the postdelivery period: a prospective cohort study","volume":"64","author":"Par\u00e9s","year":"2021","journal-title":"Dis Colon Rectum"},{"key":"B7","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1038\/nrgastro.2013.91","article-title":"Conservative and surgical treatment of hemorrhoids","volume":"10","author":"Altomare","year":"2013","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1056\/NEJMcp1204188","article-title":"Clinical practice. Hemorrhoids","volume":"371","author":"Jacobs","year":"2014","journal-title":"N Engl J Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1001\/jamasurg.2020.0788","article-title":"Review of american society of colon and rectal surgeons clinical practice guidelines for the management of hemorrhoids","volume":"155","author":"Muldoon","year":"2020","journal-title":"JAMA Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1111\/j.1572-0241.2005.00359.x","article-title":"Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis","volume":"101","author":"Alonso-Coello","year":"2006","journal-title":"Am J Gastroenterol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"773320","DOI":"10.3389\/fphar.2021.773320","article-title":"Evaluation of the efficacy and safety of a compound of micronized flavonoids in combination with vitamin C and extracts of centella asiatica, vaccinium myrtillus, and vitis vinifera for the reduction of hemorrhoidal symptoms in patients with grade II and III hemorrhoidal disease: a retrospective real-life study","volume":"12","author":"Gravina","year":"2021","journal-title":"Front Pharmacol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1093\/bjs\/znab123","article-title":"Obstructed defaecation syndrome: European consensus guidelines on the surgical management","volume":"108","author":"Picciariello","year":"2021","journal-title":"Br J Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1053","DOI":"10.3748\/wjg.v21.i4.1053","article-title":"Management of obstructed defecation","volume":"21","author":"Podzemny","year":"2015","journal-title":"World J Gastroenterol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0000000000002361","article-title":"Functional constipation in patients with hemorrhoids: a systematic review and meta-analysis","author":"Kalkdijk","year":"2022","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"2041","DOI":"10.1007\/s00384-021-03953-3","article-title":"An update on surgical treatment of hemorrhoidal disease: a systematic review and meta-analysis","volume":"36","author":"Aibuedefe","year":"2021","journal-title":"Int J Colorectal Dis"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1297","DOI":"10.1007\/s10350-007-0308-4","article-title":"Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery","volume":"50","author":"Jayaraman","year":"2007","journal-title":"Dis Colon Rectum"},{"key":"B17","doi-asserted-by":"publisher","first-page":"727059","DOI":"10.3389\/fsurg.2021.727059","article-title":"Evolution of surgical management of hemorrhoidal disease: an historical overview","volume":"8","author":"Pata","year":"2021","journal-title":"Front Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1007\/s00464-020-08248-2","article-title":"Doppler-guided hemorrhoidal dearterialization with laser (HeLP): indications and clinical outcome in the long-term. Results of a multicenter trial","volume":"36","author":"Giamundo","year":"2022","journal-title":"Surg Endosc"},{"key":"B19","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1007\/s10151-022-02591-3","article-title":"Is the Goligher classification a valid tool in clinical practice and research for hemorrhoidal disease?","volume":"26","author":"Dekker","year":"2022","journal-title":"Tech Coloproctol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10151-022-02609-w","article-title":"A multicentre, open-label, single-arm phase II trial of the efficacy and safety of sclerotherapy using 3% polidocanol foam to treat second-degree haemorrhoids (SCLEROFOAM) [published online ahead of print, 2022 Mar 25]","author":"Gallo","year":"2022","journal-title":"Tech Coloproctol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"10","DOI":"10.2174\/1574887115666200312163940","article-title":"Classifications and clinical assessment of haemorrhoids: the proctologist\u2019s corner","volume":"16","author":"Picciariello","year":"2021","journal-title":"Rev Recent Clin Trials"},{"key":"B22","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1097\/DCR.0000000000001261","article-title":"Partial stapled hemorrhoidopexy versus circumferential stapled hemorrhoidopexy for grade III to IV prolapsing hemorrhoids: a randomized, noninferiority trial","volume":"62","author":"Lin","year":"2019","journal-title":"Dis Colon Rectum"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1205","DOI":"10.1007\/DCR.0b013e3181a9120f","article-title":"Stapled transanal rectal resection for obstructed defecation syndrome: one-year results of the European STARR Registry","volume":"52","author":"Jayne","year":"2009","journal-title":"Dis Colon Rectum"},{"key":"B24","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1111\/j.1463-1318.2007.01262.x","article-title":"Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome","volume":"10","author":"Altomare","year":"2008","journal-title":"Colorectal Dis"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1538","DOI":"10.1136\/gutjnl-2020-323868","article-title":"Genome-wide analysis of 944 133 individuals provides insights into the etiology of haemorrhoidal disease","volume":"70","author":"Zheng","year":"2021","journal-title":"Gut"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e155","DOI":"10.1111\/j.1365-2982.2011.01850.x","article-title":"An assessment of enteric nervous system and estroprogestinic receptors in obstructed defecation associated with rectal intussusception","volume":"24","author":"Bassotti","year":"2012","journal-title":"Neurogastroenterol Motil"},{"key":"B27","first-page":"1193","article-title":"Biomechanical and morphological peculiarities of the rectum in patients with obstructed defecation syndrome","volume":"58","author":"Brunenieks","year":"2017","journal-title":"Rom J Morphol Embryol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"75","DOI":"10.2174\/1574887115666200406115150","article-title":"Physiology and pathophysiology of haemorrhoids","volume":"16","author":"Pata","year":"2021","journal-title":"Rev Recent Clin Trials"},{"key":"B29","first-page":"15","volume-title":"The pathophysiology of hemorrhoids[M]\/\/Hemorrhoids","author":"Yang","year":"2014"},{"key":"B30","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1007\/DCR.0b013e3181fd2356","article-title":"Prevalence of pelvic floor disorders in the female population and the impact of age, mode of delivery, and parity","volume":"54","author":"Kepenekci","year":"2011","journal-title":"Dis Colon Rectum"},{"key":"B31","doi-asserted-by":"publisher","first-page":"e348","DOI":"10.1097\/DCR.0000000000001127","article-title":"Conservative treatment of hemorrhoids deserves more attention in guidelines and clinical practice","volume":"61","author":"Garg","year":"2018","journal-title":"Dis Colon Rectum"},{"key":"B32","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1080\/00365521.2019.1568544","article-title":"Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials","volume":"54","author":"Gao","year":"2019","journal-title":"Scand J Gastroenterol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1097\/MCO.0b013e32832e6776","article-title":"The impact of physical exercise on the gastrointestinal tract","volume":"12","author":"de Oliveira","year":"2009","journal-title":"Curr Opin Clin Nutr Metab Care"},{"key":"B34","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1038\/s41575-021-00487-5","article-title":"Understanding the physiology of human defaecation and disorders of continence and evacuation","volume":"18","author":"Heitmann","year":"2021","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/0016-5085(90)90828-o","article-title":"The prevalence of hemorrhoids and chronic constipation. An epidemiologic study","volume":"98","author":"Johanson","year":"1990","journal-title":"Gastroenterology"},{"key":"B36","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1007\/BF02587619","article-title":"Age-related changes, and scar formations of perianal connective tissue","volume":"23","author":"Haas","year":"1980","journal-title":"Dis Colon Rectum"},{"key":"B37","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1007\/BF02555533","article-title":"The pathogenesis of hemorrhoids","volume":"27","author":"Haas","year":"1984","journal-title":"Dis Colon Rectum"},{"key":"B38","doi-asserted-by":"publisher","first-page":"264","DOI":"10.20524\/aog.2019.0355","article-title":"Pathophysiology of internal hemorrhoids","volume":"32","author":"Margetis","year":"2019","journal-title":"Ann Gastroenterol"},{"key":"B39","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1097\/DCR.0000000000001843","article-title":"Rectal prolapse: age-related differences in clinical presentation and what bothers women most","volume":"64","author":"Neshatian","year":"2021","journal-title":"Dis Colon Rectum"},{"key":"B40","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1002\/bjs.1800770430","article-title":"Hypertensive anal cushions as a cause of the high anal canal pressures in patients with haemorrhoids","volume":"77","author":"Sun","year":"1990","journal-title":"Br J Surg"},{"key":"B41","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1136\/gut.18.8.651","article-title":"Internal sphincter and the nature of haemorrhoids","volume":"18","author":"Hancock","year":"1977","journal-title":"Gut"},{"key":"B42","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1007\/s10151-020-02149-1","article-title":"Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease","volume":"24","author":"Gallo","year":"2020","journal-title":"Tech Coloproctol"},{"key":"B43","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1016\/S0140-6736(99)08362-2","article-title":"Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomised controlled trial","volume":"355","author":"Mehigan","year":"2000","journal-title":"Lancet"},{"key":"B44","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hta21700","article-title":"A pragmatic multicentre randomised controlled trial comparing stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease: the eTHoS study","volume":"21","author":"Watson","year":"2017","journal-title":"Health Technol Assess"},{"key":"B45","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1007\/s10151-021-02424-9","article-title":"Comments on a systematic review assessing the outcomes of stapled hemorrhoidopexy versus open hemorrhoidectomy","volume":"25","author":"Naldini","year":"2021","journal-title":"Tech Coloproctol"},{"key":"B46","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1007\/s12664-018-0927-9","article-title":"Fecal evacuation disorders in anal fissure, hemorrhoids, and solitary rectal ulcer syndrome","volume":"38","author":"Jain","year":"2019","journal-title":"Indian J Gastroenterol"},{"key":"B47","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1097\/DCR.0000000000000519","article-title":"Use of biofeedback combined with diet for treatment of obstructed defecation associated with paradoxical puborectalis contraction (Anismus): predictive factors and short-term outcome","volume":"59","author":"Murad-Regadas","year":"2016","journal-title":"Dis Colon Rectum"},{"key":"B48","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1007\/s10620-021-07097-w","article-title":"Deconstructing obstructive defecation syndrome with adaptive biofeedback","volume":"67","author":"Heinrich","year":"2022","journal-title":"Dig Dis Sci"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.930215\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,17]],"date-time":"2022-06-17T05:45:50Z","timestamp":1655444750000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.930215\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,17]]},"references-count":48,"alternative-id":["10.3389\/fsurg.2022.930215"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.930215","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,17]]},"article-number":"930215"}}