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Aetiology of thrombosed external haemorrhoids: a questionnaire study

Ole Gebbensleben1, York Hilger2 and Henning Rohde3*

Author Affiliations

1 Park-Klinik Berlin-Weissensee, Innere Abteilung, Schönstrasse 80, 13086 Berlin, Germany

2 Institut für Biostatistik, Bertoldstr. 1 - 3, 79098 Freiburg, Germany

3 Praxis für Endoskopie und Proktologie, Viktoria-Luise-Platz 12, 10777 Berlin, Germany

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BMC Research Notes 2009, 2:216  doi:10.1186/1756-0500-2-216

Published: 23 October 2009



It is important to better understand the aetiology of thrombosed external haemorrhoids (TEH) because recurrence rates are high, prophylaxis is unknown, and optimal therapy is highly debated.


We conducted a questionnaire study of individuals with and without TEH. Aetiology was studied by comparison of answers to a questionnaire given to individuals with and without TEH concerning demography, history, and published aetiologic hypotheses. Participants were evaluated consecutively at our institution from March 2004 through August 2005.

One hundred forty-eight individuals were enrolled, including 72 patients with TEH and 76 individuals without TEH but with alternative diagnoses, such as a screening colonoscopy or colonic polyps. Out of 38 possible aetiologic factors evaluated, 20 showed no significant bivariate correlation to TEH and were no longer traced, and 16 factors showed a significant bivariate relationship to TEH. By multivariate analysis, six independent variables were found to predict TEH correctly in 79.1% of cases: age of 46 years or younger, use of excessive physical effort, and use of dry toilet paper combined with wet cleaning methods after defaecation were associated with a significantly higher risk of developing TEH; use of bathtub, use of the shower, and genital cleaning before sleep at least once a week were associated with a significantly lower risk of developing TEH.


Six hypotheses on the causes of TEH have a high probability of being correct and should be considered in future studies on aetiology, prophylaxis, and therapy of TEH.