Evaluation of the Impact of Preoperative Bowel Habits on the Success of Hemorrhoid Surgery: A Retrospective Observational Study of Grade III and IV Patients

Introduction: Hemorrhoidal disease is a common anorectal disorder that can significantly impair quality of life. While hemorrhoidectomy remains an effective treatment for advanced cases, individual factors such as gastrointestinal function may influence surgical success. This study aimed to quantify and evaluate the impact of preoperative bowel habits, particularly chronic constipation, on postoperative outcomes following hemorrhoid surgery in patients with advanced (grade III and IV) hemorrhoidal disease. Methods: In this retrospective observational study, we analyzed 120 adult patients with grade III or IV hemorrhoids who underwent open or stapled hemorrhoidectomy between January 2020 and December 2024 at a single tertiary center. Preoperative bowel patterns were assessed using the Rome IV criteria, Bristol Stool Form Scale, and the Constipation Severity Instrument (CSI). Surgical success at six months was defined by the complete triple criteria complete wound healing, absence of significant pain [Visual Analog Scale (VAS) score of 2 or less], and no clinical recurrence of prolapse or bleeding. Postoperative outcomes, including complications, pain, healing duration, and recurrence, were compared between patients with and without preoperative chronic constipation. Results: Chronic constipation was identified in 40.8% of patients. Surgical success was significantly lower in constipated patients (72.4%) compared to non-constipated individuals (91.7%, p=0.011). Constipation was also associated with longer healing times (mean 29.4±6.8 vs. mean 22.1±5.5 days, p<0.001), higher pain scores (VAS median: 4.0 vs. 2.0, p=0.004), and greater recurrence (at 6 months: 16.3% vs. 3.6%, p=0.018). Multivariate analysis confirmed chronic constipation [odds ratio (OR): 2.9] and CSI ≥20 (OR: 3.5) as independent predictors of surgical failure. Conclusion: Preoperative constipation is a significant predictor of poorer 6-month outcomes following hemorrhoidectomy for advanced disease. These findings provide novel, quantifiable evidence supporting the need for systematic preoperative bowel assessment. Assessing and managing bowel habits preoperatively may enhance surgical success and reduce postoperative morbidity.