HEMORRHOID DISEASE: DIAGNOSIS TREATMENT AND COMPLICATION MANAGEMENT

Hemorrhoidal_Disease_Bahadir_Egekapak

HEMORRHOIDAL DISEASE IN HIV PATIENTS: THE IMPACT OF SEXUAL ACTIVITY ON HEMORRHOIDAL DISEASE

İsmail Hakkı Özerhan

Atılım University, Faculty of Medicine, Department of General Surgery,Ankara, Türkiye

Özerhan İH. Hemorrhoidal Disease in HIv Patients: The Impact of Sexual Activity on Hemorrhoidal Disease. In: Ege B, editor. Hemorrhoidal Disease: Diagnosis, Treatment and Complication Management. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.125-133.

ABSTRACT

Hemorrhoidal disease (HD) is a prevalent anorectal disorder that significantly affects HIv-positive individuals. This chapter explores the complex relationship between HIv infection, sexual behaviors, and the prevalence and severity of HD. HIv-related immunosuppression, antiretroviral therapy (ART), and coexisting comorbidities can all influence the development of HD in this population. Sexual practices, particularly receptive anal intercourse, exacerbate the condition due to friction, trauma, and potential sexually transmitted infections (STIs), which contribute to inflammation and damage to anal tissues. The risk of HD is further compounded by low CD4+ T cell counts and lack of adherence to ART, both of which compromise immune function and wound healing. The role of diet, hydration, and fiber intake also plays a critical part in managing hemorrhoids, as constipation and straining are significant risk factors. The chapter highlights the importance of a comprehensive approach that includes safe sexual practices, proper nutrition, and personalized treatment plans to manage HD in HIv-positive individuals. understanding the interactions between HIv, sexual activity, and HD will enable healthcare providers to offer better prevention strategies and improve the quality of life for those affected by this condition. The management and treatment of HD in HIv-positive patients requires a multifaceted approach, considering the impact of HIv-related immunosuppression, ART, and comorbidities. Initially, conservative management is recommended, focusing on lifestyle modifications such as a fiber-rich diet, increased fluid intake, weight management, and topical treatments. For patients who do not respond to conservative measures, office-based procedures like rubber band ligation and sclerotherapy offer effective, minimally invasive alternatives. In severe or resistant cases, surgical interventions such as hemorrhoidectomy may be necessary. However, surgery in HIv-positive individuals is complicated by immunosuppression, which impairs wound healing and increases the risk of complications, including infection and delayed recovery. Therefore, careful evaluation of the patient’s immune status, CD4 count, and ART regimen is essential before proceeding with surgical treatment. Tissue-selective stapling for prolapsed hemorrhoids has shown promise as a safe option with low complication rates in HIv-infected patients. Despite the generally safe outcome of surgeries, unexpected malignancies, such as squamous cell carcinoma or Kaposi’s sarcoma, may be discovered during hemorrhoidectomy, necessitating thorough histopathological examination of excised tissue. In summary, while HD in HIv-positive patients can be effectively managed through a combination of conservative treatments, office-based procedures, and surgical interventions, personalized care plans must take into account the patient’s immune status and potential risks for complications.

Keywords: Hemorrhoids; HIv; Immunity; Complications; Sexual behavior

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