Relationship between hemorrhoids and benign prostatic hyperplasia: A prospective clinical study with correlation and grading analysis in elderly Indian males

BACKGROUND: Hemorrhoids and benign prostatic hyperplasia (BPH) are prevalent conditions in elderly men, often occurring concurrently. Chronic straining from lower urinary tract symptoms (LUTS) due to BPH may contribute to hemorrhoidal disease, yet prospective evidence is limited. OBJECTIVE: To investigate the relationship between BPH-related LUTS and hemorrhoids, and to evaluate the effect of surgical relief of bladder outlet obstruction via Transurethral Resection of the Prostate (TURP) on hemorrhoidal symptoms in elderly Indian males. MATERIALS AND METHODS: In this prospective observational study, 50 men aged ≥60 years scheduled for TURP were enrolled. Hemorrhoid presence and severity were assessed at baseline and at 3, 6, and 12 months postoperatively through blinded proctoscopic evaluation by two independent colorectal specialists. The primary outcome was hemorrhoid resolution post-TURP. Secondary analyses included time-to-resolution via Kaplan–Meier survival curves and predictors of persistence using multivariable logistic regression with model diagnostics. RESULTS: At baseline, 42% (21/50) had hemorrhoids. Median time to resolution was 2.1 months, with 85.7% achieving complete resolution by 12 months. Lower-grade hemorrhoids (Grades I–II) resolved more reliably (92.3%) than advanced grades (III–IV). No significant demographic or clinical predictors for hemorrhoid presence were found. Calibration of regression models and inter-rater reliability (Cohen’s kappa) confirmed robustness. CONCLUSIONS: Findings suggest a causal association between BPH-induced chronic straining and hemorrhoidal disease, with significant improvement following surgical correction of bladder outlet obstruction. Integrated management of LUTS and hemorrhoids is advisable in elderly men. Larger, multicenter studies including patient-reported outcomes are recommended to validate these results.