Chronic Khat Chewing Induced High-Grade Hemorrhoidal Disease and Post-Operative Bleeding in Yemen

Waheeb Radman Al-Kubati1,2 1Surgical Department, 21st September University, Sana’a, Yemen; 2Physiology Department, Sana’a University, Sana’a, YemenCorrespondence: Waheeb Radman Al-Kubati, Surgical Department, 21st September University, Physiology department, Sana’a University, Sana’a, Yemen, Email [email protected]: Khat contains alkaloids, tannins, and flavonoids with physiological and pathological effects. In Yemen, anorectal diseases, including hemorrhoids, are prevalent, and hemorrhoidectomy is frequently performed.Purpose: This study evaluates the relationship between chronic khat chewing and high-grade hemorrhoidal disease, as well as post-operative complications such as bleeding and pain.Patients and Methods: This prospective cross-sectional study included 1,896 patients aged 16– 85 years, meeting the inclusion criteria were included and followed for three months.Patients Were Divided Into Two Groups: Chronic khat chewers (n=1,492) and non-khat chewers (n=404) Data included khat habits, clinical assessments, digital rectal exams, anoproctoscopy, intraoperative findings, and post-operative outcomes.Results: Chronic khat chewing was strongly associated with thrombosed grade IV hemorrhoidal disease. Among khat chewers, 90% had hemorrhoids, with 75% requiring hemorrhoidectomy or hemorrhoidopexy, compared to 25% in non-chewers, where half underwent hemorrhoidopexy. The odds ratio (OR) for hemorrhoids in khat chewers was 27.04. Gender-specific analysis showed a six-fold higher OR for hemorrhoids in khat-chewing females versus non-chewing females. Post-operative complications, including bleeding and severe pain, were significantly higher in male khat chewers (p < 0.05), while no significant differences were observed in females.Conclusion: Chronic khat chewing is strongly associated with high-grade hemorrhoidal disease and increased post-operative complications. Mechanisms include chronic constipation, increased anal sphincter tone, and prolonged sitting. These findings highlight the need for public health strategies to reduce khat use and tailored clinical approaches to improve outcomes. Future research should focus on establishing causality, identifying confounders, dose-response relationships, and exploring gender-specific management strategies that target both mechanical and pharmacological factors to optimize surgical care and long-term outcomes.Plain Language Summary: The study investigates how chronic khat chewing affects high-grade hemorrhoidal disease development and post-operative complications such as bleeding and pain in Yemeni patients. The researchers studied 1,896 patients (1,492 khat chewers, 404 non-chewers) aged 16– 85 and evaluated for khat use, symptoms, surgeries, and post-operative outcomes. The study revealed that severe hemorrhoids affected 90% of khat chewers vs 25% of non-chewers. Hemorrhoidectomy was needed in 75% of chewers vs 50% of non-chewers, with significantly higher post-surgical pain and bleeding, particularly in males. Khat use is widespread in Yemen and contributes to chronic constipation, increased anal sphincter tone, and prolonged sitting, heightening the risk of hemorrhoids and surgical complications. These effects make chronic khat use a key risk factor for severe hemorrhoidal disease and post-surgical issues.Public health efforts should raise awareness of khat-related risks, while surgeons must consider khat habits in hemorrhoidal disease management. Tailored treatment approaches, including dietary adjustments and bowel regulation, can help reduce complications and improve patient outcomes. Addressing this issue requires both reducing khat consumption and enhancing clinical care strategies.Keywords: khat, hemorrhoids, hemorrhoidectomy, post-operative bleeding