Non-conventional haemorrhoid symptoms reported by female patients

Objective: This study was undertaken to assess the importance of several non-conventional symptoms, including perianal hygiene, to female patients undergoing haemorrhoidectomy and to correlate these with the presence of associated skin tags. Materials and Methods: A single surgeon retrospective study used a customised questionnaire aimed specifically at female patients undergoing Milligan-Morgan haemorrhoidectomy with excision of significant associated skin tags to assess non-conventional symptoms. Postal surveys were sent to 71 women with 52 replies, three exclusions due to hybrid procedures and 49 patients analysed. Results: Painful prolapse and bleeding were still the most common reasons for undergoing haemorrhoidectomy but perianal hygiene (the ability to keep the area clean after toileting and during the day) was significant in nearly 60% of patients. Itching (40%), concerns about odour (35%), general discomfort (35%) and embarrassment in case their partner saw the haemorrhoids or skin tags was significant in 27%. Conclusion: Haemorrhoidectomy with complete removal of the skin tags resulted in statistically significant improvement in the parameters of odour, pruritis, toileting and less interference with the patients sex life. Surprisingly some aspects of continence were improved. The study shows that non-conventional symptoms are important in female patients and may influence the patients perception of the success of the operation. A simple modification of Golighers’ classification is proposed to reflect the presence of skin tags and to guide assessment of the success of novel treatments for haemorrhoids in women.