Knowledge, attitude, and practice of adults toward hemorrhoids in Aseer region, Southern Saudi Arabia - IJMDC
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Fahad S. Alamri et al, 2021;5(1):152–156. International Journal of Medicine in Developing Countries
https://doi.org/10.24911/IJMDC.51-1605716982
ORIGINAL ARTICLE
Knowledge, attitude, and practice of adults
toward hemorrhoids in Aseer region,
Southern Saudi Arabia
Fahad S. Alamri1, Abdulsalam Ali Alshehri2, Omar Mohammed Alfaifi2,
Basim Hassan Alshehri2*, Faisal Abdullah Alamri2, Abdullah Rafa Alshehri2,
Mohammad Saad Al-amer2
ABSTRACT
Background: Hemorrhoidal disease (piles) is a common anorectal disease. Although the majority of patients
can be successfully treated with conservative medication and local applicants, some patients need to undergo
surgery during their life. Population awareness regarding the disease is essential for avoiding long life-annoying
symptoms and complications. The present study aims to assess the general population awareness and attitude
regarding hemorrhoids and its preventive measures in Aseer region, Saudi Arabia.
Methodology: A descriptive, cross-sectional approach was used, targeting the general population in Aseer
region aged 18 years or older. The data were collected using a pre-structured online questionnaire. The ques-
tionnaire covered participants’ data including age, gender, educational level, work filed, and history of having
hemorrhoid disorder. Awareness regarding hemorrhoid was assessed using 13 items covering all aspects of the
disease. The questionnaire was published online. At the end of 4 months, data were extracted and exported as
an excel file for filtering and errors checking.
Results: A sample of totally 390 individuals completed the questionnaire whose ages ranged from 18 to 65
years, with a mean age of 35.6 ± 10.2 years. 255 (65.4%) participants were male, and 45.6% were university
graduated. As for participants’ awareness regarding hemorrhoids, 56.9% of the participants defined hemor-
rhoid as perianal edema, while 73.8% defined it as perianal pain. Generally, 233 participants had good aware-
ness level regarding hemorrhoids in total.
Conclusions: In conclusion, the majority of the general population in Aseer region was aware of hemorrhoid
and its preventive measures. More effort should be paid to improve population awareness regarding the nature
of the disease and the new diagnostic tools.
Keywords: Hemorrhoid, piles, population, awareness, attitude, complications, knowledge, Aseer, Saudi Arabia.
Introduction
Hemorrhoids, which are also called piles, are a vascular rectum. This can include a rectal exam performed with
deformity in the anal canal [1,2]. Physiologically, they a gloved, lubricated finger, or with a small instrument
are cushions that help with stool control [1]. Abnormally, that will allow your physician to visualize the rectum
when swollen or inflamed, the unqualified term more closely. Rectal bleeding could be a symptom of
“hemorrhoid” is often used to refer to this abnormal state
[3]. The signs and symptoms of hemorrhoids depend on
its type. Internal hemorrhoids often result in painless,
Correspondence to: Basim Hassan Alshehri
bright red rectal bleeding when defecating [4,5]. External
*College of Medicine King Khalid University, Abha City,
hemorrhoids usually present with pain and swelling in Kingdom of Saudi Arabia.
the perianal region [5,6]. Bleeding usually occurs in the Email: formalbasim@gmail.com
form of dark blood. The symptoms frequently get better Full list of author information is available at the end of
after a few days with constant skin tag after the healing of the article.
external hemorrhoid [5]. Hemorrhoids can be diagnosed Received: 18 November 2020 | Accepted: 26 November 2020
following a physical examination of the anus and
© IJMDC. https://www.ijmdc.com 152Knowledge, Attitude, and Practice of adults toward hemorrhoids
other, potentially more severe conditions. One source of between participants’ data and their awareness level were
bleeding could be anal fissures, which are tears in the assessed using the Pearson’s chi-squared test.
lining of the anus, causing pain when passing a bowel
movement. Some types of inflammatory bowel disease Results
can also cause rectal bleeding, as can tumors of the
rectum and colon. In the case of passing blood from A total sample of 390 individuals completed the
the anus, consultation of the physician is mandatory to questionnaire, whose ages ranged from 18 to 65 years
determine if further testing is required [3,7,8]. A few with a mean age of 35.6 ± 10.2 years. 255 (65.4%)
studies assessed the magnitude of hemorrhoids. The participants were male, and 45.6% were university
prevalence recorded by the different studies varied graduated, while only 8.7% were illiterate with a
greatly. A study reviewed the records of patients who primary level of education. Exactly 16.9% of the
attended the colorectal department during a specific time participants worked in the medicine filed, and 61.3%
period, and the authors revealed a prevalence rate of 86% had a positive history for hemorrhoids (Table 1). As for
for symptomatic and asymptomatic hemorrhoids [9]. participants’ awareness regarding hemorrhoids, Table
Johanson and Sonnenberg [10] recorded a prevalence 2 demonstrates that 56.9% of the participants defined
rate of 4.4% in the USA. Recently, it was estimated that hemorrhoid as perianal edema, while 73.8% defined it
50%-85% of people around the world had hemorrhoids as perianal pain. Concerning causes of hemorrhoids,
[11]. 60% of the participants told about defecation stretching,
52.8% selected long duration of setting, and 46.4%
In Saudi Arabia, no studies were found focusing on selected chronic constipation or diarrhea. Considering
hemorrhoids or assessing population awareness regarding complications, 48.5% reported anemia and 31.5%
this medical condition. This was the main motivation reported HTN. Regarding preventive measures, 69.7%
behind this research, to assess the population awareness of the participants selected excessive fluid intake, 69.2%
regarding hemorrhoid as one of the health conditions selected eating fiber-rich food, and 58.5% chose going
which may end with severe complications. to the bathroom in need. Generally, 233 participants
(59.7%) had good awareness levels regarding
Subjects and Methods
hemorrhoids in total (Figure 1). On relating the overall
awareness level with participants characteristics (Table
A descriptive, cross-sectional approach was used
3), good awareness was recorded among 77.1% of
targeting the general population in Aseer region aged
those aged 20-30 years compared to 49.1% of those
18 years or older. The data were collected for 2 months
aged 50-60 years with a recorded statistical significance
using a pre-structured online questionnaire which was
(p = 0.001). Also, 78.1% of the participants with university
developed by the researchers after intensive literature
reviews and expert’s consultation with applying all
suggested modifications. The tool covered participants’
personal data including age, gender, educational level,
work filed, and history of having hemorrhoid disorder. Table 1. Personal data of adults in Aseer region, Southern
Awareness regarding hemorrhoid was assessed using Saudi Arabia.
13 items covering the definition of hemorrhoid, causes, Personal data No %
complications, and preventive measures. Attitude
Age in yearsKnowledge, Attitude, and Practice of adults toward hemorrhoids
Table 2. Awareness of adults regarding hemorrhoids in Aseer level of education had a good awareness level compared
region, Southern Saudi Arabia. to 52.9% of those with a primary level of education
Awareness regarding hemorrhoids No %
(p = 0.001) As for work field, 90.9% of the participants
who worked in the medical field recorded a good
Definition of HRDs are anal injuries 97 24.9% awareness level compared to 53.4% of those who did
HRDs
Dilated intestinal veins 36 9.2% not (p = 0.001). Also, 78.1% of the participants who
had personal experience of hemorrhoid recorded good
Dilated anal and rectal 257 65.9%
veins awareness compared to 58.9% of those who did not
(p = 0.003).
Fecal incontinence 140 35.9%
Itching 220 56.4%
Sweating 30 7.7%
Abdominal pain 71 18.2%
Diarrhea 31 7.9%
Perianal pain 288 73.8%
Urine incontinence 50 12.8%
Perianal erosions 88 22.6%
Bleeding with defeca- 252 64.6%
tion
Painful urination 31 7.9%
Anal pus discharge 137 35.1%
Perianal edema 222 56.9%
Causes of Long standing in bath- 102 26.2%
HRDs room Figure 1. Overall awareness level of adults regarding
Eating too much 82 21.0% hemorrhoids in Aseer region, Southern Saudi Arabia.
vegetables
Table 3. Distribution of adult awareness regarding
Long duration of setting 206 52.8% hemorrhoids by their personal data, Southern Saudi Arabia.
Hot bathing with Jacuzzi 37 9.5%
Personal
Awareness level
Defecation stretching 234 60.0% data
p-value
The Frankish Chair 119 30.5% Poor Good
Tight pants 84 21.5% No % No %
Age inKnowledge, Attitude, and Practice of adults toward hemorrhoids
Table 4. The attitude of adults toward hemorrhoids in Aseer region, Southern Saudi Arabia.
No May be Yes
Attitude toward hemorrhoids
No % No % No %
Visiting doctor is embarrassing 99 25.4% 127 32.6% 164 42.1%
If you or someone in your family is diseased, will you see a doctor immediately? 52 13.3% 104 26.7% 234 60.0%
Do you think that customs and traditions constitute a barrier for society in 53 13.6% 90 23.1% 247 63.3%
delaying or not going to the doctor?
If you or one of your family members were injured, would you resort to folk 231 59.2% 85 21.8% 74 19.0%
medicine?
Finally, the attitude of participants regarding hemorrhoid attitude and needs more explanation about what exactly
medical consultation was assessed (Table 4) and it the patient will do. Hemorrhoid is a self-curable disease
revealed that 42.1% of the participants agreed on that but may cause chronic bleeding ending with anemia
visiting a doctor for hemorrhoids is embarrassing. Also, besides affecting the quality of patients’ life. Therefore,
60% of the participants reported that they would consult improving the population awareness and improving their
physicians immediately if one of their families were attitude regarding diagnostic methods and management
suspected. Only 19% of the participants agreed that they will play a crucial role in limiting this negative behavior
could resort to folk medicine in case of have hemorrhoids. against seeking medical consolation.
Discussion Conclusion
Also known as piles, a hemorrhoid is a swelling in the anal In conclusion, the majority of the general population
canal or around the anus with an enlarged blood vessel in Aseer region was aware regarding hemorrhoid and
inside it. When the tissue in these areas becomes swollen, its preventive measures. The thing that was negatively
possibly due to constipation and straining too much reported was participants’ attitude regarding medical
during a bowel movement, a hemorrhoid can develop. consolation for hemorrhoid and this related to methods
If the hemorrhoid becomes damaged, this can lead to of clinical assessment. More efforts should be paid to
pain and bleeding. Heavy lifting and other strenuous improve population awareness regarding the nature of
activities can also result in hemorrhoids [12]. The studies the disease and the new diagnostic tools, which may
concerned with the assessment of the prevalence of eliminate the feeling of shame. Also, more studies are
epidemiology of hemorroids are scarce, and not all cover needed to assess the population’s awareness regarding
all aspects of hemorrhoids. Also, no studies were found this disease all over the kingdom to map the areas of
assessing population awareness regarding hemorroid, defect for medical education.
especially in Saudi Arabia. The current research, to the
best of the authors’ knowledge, is the first one in Saudi Conflict of interest
Arabia covering this subject. The study revealed that The authors declare that there is no conflict of interest
about 60% of the general population in Aseer region was regarding the publication of this article.
aware regarding hemorrhoid. The highest awareness level Funding
was recorded for hemorrhoid definition, symptoms, and None.
causes. Complications and preventive measures awareness
were moderately good, especially complications. Consent to participate
Awareness was better among young aged participants of Written informed consent was obtained from all the
a high level of education and those with a positive history participants.
of the disease. Regarding participants’ attitude regarding
medical consultation for hemorrhoid, about half of the Ethical approval
participants feel ashamed of consulting physician if they The study was approved from the King Khalid University on
complained of hemorrhoids. Also, more than two-thirds 9/11/2020. Approval no.: EMC#2020-1501.
of the participants reported that traditions and customs are
Author details
the main barriers against this medical consultation. This
Fahad S. Alamri1, Abdulsalam Ali Alshehri2, Omar Mohammed
may be due to the nature of the disease area and method of
Alfaifi2, Basim Hassan Alshehri2, Faisal Abdullah Alamri2,
medical examination for diagnosing hemorrhoid, which
Abdullah Rafa Alshehri2, Mohammad Saad Al-amer2
is against Arab traditions and which considers this area
1. Department of Surgery, College of Medicine, King Khalid
as a shameful area to be assessed. The surprising finding
University, Abha, Kingdom of Saudi Arabia
was that irrespective of feeling ashamed to consult a
2. College of Medicine, King Khalid University, Abha, Kingdom
physician, more than half of the cases refused to deal
of Saudi Arabia
with this disease by folk medicine. This is a questionable
155Knowledge, Attitude, and Practice of adults toward hemorrhoids
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