Prevalence and determinants of hemorrhoids and anal fissures among patients undergoing colonoscopy: A cross-sectional study in northern Iran

Background: Hemorrhoids and anal fissures are common anorectal disorders with multifactorial etiologies. This study aimed to assess the prevalence and associated factors of these conditions in patients referred for colonoscopy. Methods: In this cross-sectional study, 536 individuals aged 35–70 years undergoing colonoscopy at Razi Hospital in Rasht, Iran, were enrolled. Patients with a history of inflammatory bowel disease, malignancy, or colectomy, and pregnant women were excluded. Colonoscopic findings were assessed by a gastroenterologist and confirmed histologically. Demographic, lifestyle, and anthropometric data were collected, including age, sex, education, habitat, BMI, WHR, physical activity, smoking, and alcohol use. Logistic regression was used to identify factors associated with hemorrhoids and fissures. Results: Hemorrhoids were diagnosed in 55.8% and fissures in 17.9% of participants. Higher education levels (university: OR=0.39, 95% CI: 0.17–0.89) and rural residence (OR=0.68, 95% CI: 0.46–1.00) were inversely associated with hemorrhoids. Anal fissures were significantly associated with younger age (OR=0.98, 95% CI: 0.96–1.00), higher education (diploma: OR=0.44, university: OR=0.31), and low WHR (OR=0.29, 95% CI: 0.14–0.62). Other factors such as sex, BMI, smoking, and physical activity showed no significant associations. Conclusion: Education level, age, and WHR were independently associated with anorectal conditions. These findings suggest the importance of socioeconomic and metabolic factors in the prevention and management of hemorrhoids and fissures and warrant further prospective studies.