Sex-specific Associations Between Hemorrhoids and Glycemic Abnormalities: A Population-based Study

Background: Diabetes-related gastrointestinal dysfunction may predispose to anorectal disorders, yet sex-specific associations between glycemic abnormalities and hemorrhoids remain unexplored. Aim: To investigate associations between glycemic dysregulation (prediabetes, diabetes, metabolic syndrome [MetS]) and hemorrhoids using reciprocal regression analyses and identify potential sex-specific patterns. Methods: This cross-sectional study analyzed 4620 participants from a Taiwanese health examination database (2010–2017). Hemorrhoids were diagnosed via colonoscopy (39.6%) or clinical assessment, including medical history and digital rectal examination when indicated. Prediabetes and diabetes were defined per American Diabetes Association criteria; MetS per modified National Cholesterol Education Program Adult Treatment Panel III criteria with Asian-specific cutoffs. Multivariable logistic regression assessed associations, adjusting for metabolic and lifestyle factors, with false discovery rate correction for multiple comparisons. Results: Among 4620 participants (16.5% hemorrhoid prevalence), those with hemorrhoids were older and had higher prediabetes prevalence. In fully adjusted models, diabetes showed an association with hemorrhoids (odds ratio [OR] = 2.00, 95% confidence interval [CI]: 1.08–3.70, P = 0.027). Gender-stratified analyses showed stronger point estimates in males (prediabetes: OR = 1.89; diabetes mellitus [DM]: OR = 2.27) compared to females (prediabetes: OR = 0.92; DM: OR = 1.11), although formal interaction testing did not reach statistical significance (sex × DM, P = 0.218), possibly due to limited statistical power in the female subgroup. Conclusion: This study provides preliminary evidence for male-specific associations between glycemic dysregulation and hemorrhoids (OR: 1.89–2.27), although findings did not withstand multiple comparison correction. While these hypothesis-generating results warrant validation in independent cohorts with a comprehensive assessment of bowel habits and menopausal status, they highlight the importance of considering biological sex in metabolic-anorectal disease research.