Hemorrhoids, commonly known as piles, are a prevalent medical condition that affects a significant portion of the population, causing discomfort and distress to those afflicted. Despite their high prevalence, misconceptions and inadequate understanding of hemorrhoids often persist among patients. This knowledge gap can lead to delayed treatment seeking, exacerbation of symptoms and poor quality of life [1,2]. The current study aims to shed light on the level of understanding regarding hemorrhoids among patients attending the outpatient department of Civil Hospital, Manali, located in the picturesque District Kullu, Himachal Pradesh.

Hemorrhoids are vascular structures located in the anal canal and are essential for maintaining fecal continence. When these structures become inflamed or swollen, they give rise to the condition known as hemorrhoids. Symptoms commonly associated with hemorrhoids include rectal bleeding, anal pain, itching and discomfort during bowel movements. The condition can be broadly categorized into two main types: internal and external hemorrhoids, each having distinct clinical characteristics and management strategies [3,4].

Understanding and awareness of hemorrhoids are crucial for various reasons. Firstly, an accurate understanding of the condition enables patients to recognize the symptoms early, facilitating timely medical intervention and reducing the risk of complications. Secondly, misconceptions about hemorrhoids may lead to unnecessary fear and anxiety, potentially hindering individuals from seeking proper medical care. Lastly, an inadequate understanding of the condition can result in the use of incorrect or ineffective home remedies, potentially worsening the condition [5-7].

As the leading healthcare provider in the region, Civil Hospital, Manali, plays a pivotal role in the diagnosis, management and education of patients regarding various medical conditions, including hemorrhoids. Therefore, it is essential to assess the current level of understanding and awareness regarding hemorrhoids among the patients visiting this healthcare facility.

This study endeavor to determine the prevailing knowledge base among patients by assessing their familiarity with hemorrhoids, including their causes, symptoms, risk factors and available treatment options. The findings will serve as a foundation for developing targeted educational interventions and materials to enhance patient awareness, promote early diagnosis and improve the overall management of hemorrhoids in this community.

In this pursuit, we hope to contribute to the broader goal of public health awareness and patient empowerment, ensuring that individuals in Himachal Pradesh, particularly in the scenic district of Kullu, can access appropriate healthcare services and make informed decisions about their health. To the best of our knowledge, this study represents a vital step towards bridging the knowledge gap surrounding hemorrhoids, thereby enhancing the quality of healthcare delivery in this region.

Objectives of the Study

To evaluate the level of understanding regarding hemorrhoids among patients attending the outpatient department of Civil Hospital, Manali, District Kullu, Himachal Pradesh.

• Research Approach: Descriptive

• Research Design: Hospital based cross-sectional survey design

• Setting of the Study: OPD in Civil Hospital, Manali, District Kullu, Himachal Pradesh

• Study Duration: Between July 2023- September 2023

• Study Population: Patients aged above 30 years came to OPD 

• Sample Size: 400 patients, assuming 50% have adequate knowledge regarding hemorrhoids, 5% absolute error, 95% confidence level and 5% non-response rate

• Sampling Technique: Convenience Sampling technique

• Sampling Criteria: First five patients who came to OPD were selected everyday till the completion of sample size after explaining the purpose of the study. Informed consent was taken from them and confidentiality of the selected participants was also maintained 

• Inclusive Criteria: Patients who were willing to participate in the study

• Exclusion Criteria: Patients who were not willing to participate in the study

Description of Tool

• Demographic Data Survey Instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education, family’s monthly income etc.

• Questionnaire: The questionnaire contains 20 structured knowledge related questions having three options (yes, no, don’t know). The participants have to choose right one. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80% (16-20) = very good, 60-79% (12-15) = Good, 41-59% (8-11) = Fair, <40% (<8) = poor

• Validity of Tool: By the experts in this field

• Data collection by under the guidance of supervisors and patients were given 30 minutes’ time to complete that questionnaire and collected at the end of the prescribed time

• Data analysis with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage

The goal of the current study was to assess the awareness about hemorrhoids among patients attending outpatient department of Civil Hospital, Manali, District Kullu, Himachal Pradesh.

A total of 400 respondents including 278 (69.5%) male patients and 122 (40.5%) female patients were participated in the study. Among the total, 139 (34.75%) were from urban area and 261 (65.25%) were from rural area (Table 1).

Table 1: Knowledge Regarding Hemorrhoids among Study Participants

Table 2: Knowledge Score Regarding Hemorrhoids among Study Participants

In the present study 24.75% (99) participants had very good knowledge (16-20 marks) towards hemorrhoids, 42% (168) had good knowledge (12-15 marks), 23% (92) had fair knowledge (8-11 marks) and 10.25% (41) having poor knowledge (<8 marks) (Table 2).

The current study aimed to assess the level of understanding regarding hemorrhoids among patients attending the outpatient department of Civil Hospital in Manali, Himachal Pradesh. The findings reveal valuable insights into the awareness and knowledge of patients about this common medical condition, which can significantly impact their health-seeking behavior and overall quality of life.

The demographic profile of the study participants included 278 (69.5%) male patients and 122 (30.5%) female patients, with a significant representation from both urban (34.75%) and rural areas (65.25%). This diversity in the study population allows for a comprehensive analysis of the level of understanding about hemorrhoids across different demographics.

The results of the study indicate varying levels of knowledge among participants in different aspects related to hemorrhoids. It is encouraging to note that a substantial portion of the participants demonstrated good to very good knowledge, with 66.75% falling in these categories (24.75% with very good knowledge and 42% with good knowledge). This suggests that a significant proportion of patients attending the Civil Hospital in Manali have a reasonable understanding of hemorrhoids, its symptoms and available treatment options.

However, there are areas where knowledge gaps exist. For instance, the causes of hemorrhoids were correctly identified by only 39.75% of participants and 45.25% were aware that lifestyle factors can contribute to the development of hemorrhoids. These findings highlight the need for targeted education and awareness campaigns on the etiology of hemorrhoids and the importance of lifestyle modifications to prevent them.

Furthermore, 47.75% of participants correctly identified specific risk factors associated with hemorrhoids, emphasizing the need to increase awareness about these factors to help individuals better assess their risk and take preventive measures.

While 70.5% of participants recognized the need for seeking medical attention for hemorrhoids, it is crucial to consider the 29.5% who may delay seeking professional help. 

Early intervention can alleviate symptoms, prevent complications and improve the overall prognosis for patients with hemorrhoids. Therefore, further efforts should be directed towards educating patients about when to seek medical care.

The study also demonstrated that 59% of participants were aware of non-surgical treatment options for hemorrhoids, suggesting that many individuals prefer conservative management. This finding highlights the importance of providing comprehensive information on both surgical and non-surgical treatment modalities to patients to facilitate shared decision-making.

Comparing these findings with previous studies conducted in the Indian context, it is evident that awareness and knowledge about hemorrhoids can vary among different populations [4-7]. While some studies show higher levels of awareness in specific regions and age groups, it is essential to recognize that knowledge gaps may still exist. This study contributes to the growing body of literature on this topic and underscores the importance of region-specific interventions to improve understanding and awareness regarding hemorrhoids.

In conclusion, this study provides valuable insights into the level of understanding regarding hemorrhoids among patients attending Civil Hospital, Manali, Himachal Pradesh. While a significant proportion of patients exhibited good knowledge, there are specific areas where gaps exist, including the causes, risk factors and the importance of early medical intervention. These findings support the need for targeted education and awareness initiatives to enhance patient knowledge, facilitate timely diagnosis and improve the overall management of hemorrhoids in this community.

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