Hemorrhoidal disease (HD) is the most common anorectal disorder in adults and one of the most frequent outpatient gastrointestinal diagnoses.^[1][2] Reported prevalence ranges from about 4% to nearly 40%. Most of this spread comes from differences in case definition and ascertainment method (self-report, physician examination, or endoscopy), not from true biological differences between populations.^[3][4]

• The largest meta-analysis to date covered 150 studies and about 9 million individuals. It estimated a global pooled point prevalence of approximately 26%.^[3]
• Prevalence rises with age and is modestly higher in women, mainly because of pregnancy and parity.^[3][5]
• In the United States, HD affects approximately 10 million people. It accounts for nearly 4 million office and emergency department visits each year.^[6][2]
• True prevalence is unknown, because many affected individuals are asymptomatic or self-treat and never seek care.^[3][2]

Prevalence estimates must be interpreted according to how hemorrhoids were ascertained. Endoscopic and physician-examination studies consistently report higher rates than symptom-based self-report or claims data.^[3][7]

• In the meta-analysis, general-population studies gave much lower pooled estimates (about 8%) than studies of patients with gastrointestinal complaints (about 29%). This pattern reflects referral and examination bias.^[3]
• About one in three American adults have hemorrhoids on screening colonoscopy, and most of these are incidental findings.^[2]
• Among patients evaluated for hematochezia or by proctoscopy, reported rates reach 64–86%.^[12]
• The widely quoted U.S. figure of about 4.4% (4,400 per 100,000) comes from a single 1990 analysis of self-reported data. It substantially underestimates burden compared with modern endoscopic and pooled data, and should be cited only as historical context.^[11][3][2]
• No contemporary, nationally representative U.S. prevalence study exists.^[2]

• Reported incidence ranges from about 708 to 1,225 per 100,000 person-years, depending on data source.^[7]
• Incidence is difficult to measure directly. Nationwide claims for invasive treatment have been used as an indirect surrogate.^[7]

• Prevalence increases with age:
  • In pooled case-control data, patients with HD were significantly older than controls.^[3]
  • Older age was an independent risk factor in a large Korean screening cohort.^[5]
• Pooled point prevalence is about 25% in adults and about 14% in children. The pediatric estimate is based on only five small datasets.^[3]
• The traditional teaching that HD “peaks” at 45–65 years comes from historical self-report and care-utilization data.^[11] It likely reflects care-seeking and procedural patterns rather than underlying prevalence.^[2][7]
• More than half of adults older than 50 years are commonly estimated to have had HD at some point.^[13]

• Women have a slightly higher pooled point prevalence than men: 27.3% vs. 25.7%.^[3]
• Pooled case-control data showed no significant sex difference. Higher healthcare-seeking among women may partly inflate reported female prevalence.^[3]
• In a large Korean screening cohort:^[5]
  • Overall prevalence was slightly higher in women than men (17.2% vs. 16.3%).
  • The excess was confined to parous women (adjusted OR 1.06 vs. men).
  • Nulliparous women had lower prevalence than men (adjusted OR 0.92).
• The legacy statement that both sexes are “affected equally” is outdated. The modest female excess is driven largely by parity.^[5][3]

• Pooled prevalence in pregnant women is about 31%, the highest of any population subgroup in the meta-analysis.^[3]
• Pregnancy was associated with more than twice the odds of HD (unadjusted OR 2.6).^[3]
• Prevalence is higher in the postpartum period than in early pregnancy.^[3]
• Multiparity and cesarean delivery were not significantly associated with HD in pooled unadjusted analyses, although only two studies informed each estimate.^[3]
• Among parous women, higher body mass index and waist circumference were associated with HD.^[5]

Robust data on racial or ethnic differences in HD prevalence are not available.

• Pooled point prevalence by WHO region:^[3]
  • African region: 28.1% (highest)
  • Region of the Americas: 26.4%
  • European region: 26.0%
  • South-East Asia region: 23.4% (lowest)
• Prevalence was not associated with a country’s Human Development Index. The burden appears broadly similar across socioeconomic contexts.^[3]
• Country-level outliers mostly come from single studies and do not reliably represent national prevalence. Examples include about 53% in Germany and about 2.5% in Malaysia.^[3]

• In the United States:
  • HD is the third most common outpatient gastrointestinal diagnosis, with nearly 4 million office and emergency department visits annually.^[2]
  • It affects approximately 10 million people.^[6]
  • In 29 states covering about two-thirds of the U.S. population, there were 25,292 ambulatory surgery center visits for hemorrhoids in 2013 and 203,552 emergency department visits in 2014.^[2]
• The estimated annual economic burden is about $800 million, in the U.S. employer-insured population aged 18–64 years alone.^[7]
• Only a minority of patients undergo surgery.^[6]
• Death from hemorrhoids is exceedingly rare.^[14]

• Any quoted prevalence should be interpreted together with its ascertainment method and study population. Between-study heterogeneity in the meta-analysis was extreme (I² >99%).^[3]
• Hemorrhoids found on endoscopy are frequently asymptomatic. Symptoms commonly attributed to hemorrhoids are reported equally often by patients with and without them.^[2]
• Because hemorrhoids are so common, finding them does not establish them as the source of rectal bleeding. Colorectal cancer and other colorectal pathology must still be excluded where appropriate.^[1][2]
• Population-level associations with older age, pregnancy, constipation, and low grain-fiber intake are discussed in risk factors.^[3][8]