Is cough a predisposing factor for hemorrhoids? A prospective, analytical cross-sectional study

Hemorrhoidal disease has been associated with factors that increase intra-abdominal pressure, yet the clinical relationship between cough and hemorrhoid severity remains poorly defined. This prospective analytical cross-sectional study evaluated whether cough-related variables and smoking history were associated with hemorrhoid grade in 84 adults with internal hemorrhoids. Disease severity was categorized as low-grade (Goligher I-II, n = 42) or high-grade (Goligher III-IV, n = 42). Cough presence, cough duration, cough severity assessed by visual analog scale, and cough-related quality of life measured by the Leicester Cough Questionnaire (LCQ) were analyzed together with smoking exposure. The mean age of the study population was 45.8 ± 11.5 years, and the mean body mass index was 26.8 ± 4.1 kg/m². Cough was present in 22.6% of patients, whereas cough lasting ≥ 4 weeks was uncommon (4.8%). No significant differences were observed between the low-grade and high-grade groups in cough prevalence (23.8% vs 21.4%, p = 0.794), cough lasting ≥ 4 weeks (4.8% vs 4.8%, p > 0.999), cough severity, or Leicester Cough Questionnaire scores. Ever smoking was more frequent in the high-grade group, but the difference was not statistically significant (72.5% vs 58.5%, p = 0.186). In exploratory multivariable logistic regression, neither cough presence nor cough severity was associated with high-grade disease after adjustment for covariates. In this cohort, cough-related variables and smoking history were not significantly associated with hemorrhoid severity. These findings suggest that cough may not be a major determinant of hemorrhoidal severity, particularly in cohorts in which longer-duration cough is uncommon.