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INTRODUCTION:
Based on clinical experience hemmorhoidal disease (HD) is considered to have a significant impact on patient quality of life (QOL). However there have been only two published studies that have measured QOL in patients with HD and both were unable to detect a significant impact of HD on QOL using generic QOL instruments. We hypothesized that HD and its related symptoms have a negative impact on patient QOL and that this could be detected if the appropriate QOL instrument was used.
METHODS:
All patients seen in the academic practice of two colorectal surgeons were administered the EORTC-C30 questionnaire between January 2009 and October 2011. The EORTC-C30 is a disease specific questionnaire that was designed to measure QOL in cancer patients but has also been used extensively to measure QOL of patients with benign colorectal diseases. Four hundred and ninety-four surveys were returned (response rate 78%). One hundred and twenty four patients were evaluated for complaints related to HD and represented the study cohort while 61 patients who were asymptomatic as measured by the symptom scales were used as the control group (majority of these patients had presented for screening colonoscopies). The minimally important difference (MID) which is defined as the smallest difference in scores of a QOL instrument that is considered clinically significant, was estimated by calculating the Cohen’s D effect size of the mean differences.
RESULTS:
Gender, age and marital status were similar between the 2 groups. Mean difference in functional scales between patients with HD and asymptomatic patients was 16 points and corresponded to a mean Cohen’s D of 0.42 (moderate effect size) and was considered the MID.
Patients with HD had significantly worse QOL on all measured functional scales compared to asymptomatic patients (Table). Common presenting complaints for HD included rectal bleeding (67%), pain (38%), change in bowel habits (21%) and discharge (10%). Among the patients with HD there were no clinically significant differences in overall QOL of patients with and without symptoms of rectal bleeding (70 vs. 70), rectal pain (65 vs. 73) and rectal discharge (59 vs. 71). However patients with change in bowel habits had clinically significant worse overall QOL compared to patients not reporting this symptom (57 vs. 73).
CONCLUSION:
HD and its related symptoms have a negative impact on patient QOL that is measurable with the use of the appropriate QOL instruments. Monitoring resolution of symptoms during treatment of hemmorhoidal disease is essential to offset their impact on QOL.

Comparison of QOL of Patients with HD versus Asymptomatic Patients

	Patients with HD	Asymptomatic Patients
Global Health Status/ QOL	67.9 (22.2)	87.0 (15.9)
Physical Functioning	87.2 (17.4)	99.0 (4.2)
Role Functioning	80.3 (28.4)	99.4 (4.3)
Emotional Functioning	75.5 (23.2)	93.5 (11.3)
Cognitive Functioning	84.4 (20.6)	96.8 (9.5)
Social Functioning	78.8 (30.0)	94.1 (20.7)