Experiences of patients with haemorrhoidal disease – a qualitative study

Abstract

Purpose To obtain a better understanding of the patients’ experiences with haemorrhoidal disease’ impact on their daily life and results of treatment by performing a qualitative study. Method Individually interviews were conducted among patients with haemorrhoidal disease between 2016 and 2017. Each interview was recorded using an audio recorder and transcribed verbatim. A semi-structured interview guide was used with pre-specified topics, based on a previous conducted literature review. Transcripts were coded and the analysis consisted highlighting passages in the text and assigning each passage a code representing the predefined themes from the interview guide. This resulted in a three-level theme hierarchy: overarching theme, mid-level sub-theme and issues. Results Fifteen participants underwent individual interviews of whom thirteen were conducted by telephone. The mean age was 60.7 years (35–78); five of them were female (33.3%). Pain and blood loss were the most frequently reported symptoms. Participants indicated that these symptoms were directly associated with emotional burden, daily adjustments and social impact. Before diagnosis with haemorrhoidal disease blood loss resulted in feelings of fear and next in embarrassment during social activities. In daily life participants needed to get up early, used sanitary pads for blood loss and anal ice sticks to reduce pain. Participants were often not completely satisfied with the process and outcome of treatment. Conclusion This first qualitative study provides detailed insight into the patients’ experiences with haemorrhoidal disease, impact on daily life and results of treatment. This information may be used in daily practice to create awareness among clinicians.

Making Use of Patient-Reported Outcome Measures for Haemorrhoidal Disease in Clinical Practice: A Perspective

“…There is indeed great potential in the usage of PROMs, not only to inform a treatment decision, but also to evaluate treatment success and the patient's satisfaction with the treatment ( 23 ). It is known that consensus on treatment success can differ substantially between healthcare professionals and patients, given that the doctor observes the disease, yet the patient experiences the symptoms ( 3 , 24 ).…”

“…Finally, a PROM for HD has recently been introduced as an important outcome measure for two large clinical trials in The Netherlands ( 34 , 35 ). The PROM-Haemorrhoidal Impact and Satisfaction Score (PROM-HISS) is the first PROM for HD developed in dialogue with patients suffering from HD ( 3 ). It was developed in response to the COS and measures the same HD symptoms as the previously mentioned scoring systems of both Nyström and Rørvik: prolapse, blood loss, pain, soiling and itching.…”

“…Patients report several restrictions or adjustments to be made in daily life: “Because of the massive blood loss, I could not function normally any more. I did not dare to go anywhere, not to a party, not to my son's soccer match” ( 3 ). Furthermore, HD may impair a patient's intimate relationship and sexuality: “(…) my sex life, I do think it is difficult, because of the flap coming out of my anus” ( 3 – 5 ).…”

“…I did not dare to go anywhere, not to a party, not to my son's soccer match” ( 3 ). Furthermore, HD may impair a patient's intimate relationship and sexuality: “(…) my sex life, I do think it is difficult, because of the flap coming out of my anus” ( 3 – 5 ).…”

Speaking Shame and Laughing It Off: Using Humorous Narrative to Conquer the Shame of Anorectal Illness

“…They may experience an isolated, inferior, and flawed self-consciousness that they define as shame (Dolezal & Lyons, 2017). The stigma of anorectal illness (AI) prevails in different cultures, including China, and can humiliate patients (Chen et al, 2015; Tol et al, 2019). When a patient enters a medical context in which they interact intimately with health care providers, getting undressed, receiving invasive internal examinations, depending on others, or monitoring excretory functions could challenge dignity (Veit & Spiekermann, 2019).…”