Hemorrhoids, characterized by swollen and inflamed veins in the rectum and anus, have traditionally been regarded as a benign disease with symptoms such as pruritus, pain, and bleeding (Lohsiriwat, 2012). However, emerging evidence suggests that the impact of hemorrhoids extends beyond the physical discomfort associated with the condition, resulting in reduced quality of life (QoL) (Lee et al., 2014; Rørvik et al., 2023). The prevalence of hemorrhoids reported in studies conducted in different countries and settings ranges from 11% to 16% (Carter et al., 2013; Lee et al., 2014; Sheikh et al., 2020; Kibret et al., 2021).

In recent years, there has been growing recognition of the intricate relationship between physical health and mental well-being. While the bidirectional link between physical ailments and psychological distress is well established, certain conditions have repeatedly been identified as notable contributors to this complex interplay (Ohrnberger et al., 2017; Feiss and Pangelinan, 2021). While Lee et al. found that depression may increase the risk of hemorrhoids, there is a lack of data describing the impact of hemorrhoids on mental health (Lee et al., 2014).

Hemorrhoids trigger at least two symptoms – chronic pain and pruritus – that have been shown to be associated with subsequent depression in individuals with other diseases (Hadasik et al., 2021; Meda et al., 2022). In a study by Mao et al. evaluating psychological distress in 96 patients with chronic idiopathic anal pain, 93% of patients reported symptoms of psychological distress. However, this study was cross-sectional and not limited to patients with hemorrhoids and depression (Mao et al., 2017).

Furthermore, living with hemorrhoids can present a number of social challenges, with patients’ discomfort often exacerbated by feelings of shame and embarrassment. Due to the intimate nature of the ailment, involving the rectum and anus, those affected tend to desire privacy and are therefore reluctant to discuss symptoms openly, making it difficult for them to seek support or share their experiences with friends, family, or even healthcare professionals (Klein, 2014; Lawrence and McLaren, 2024).

Against this background, the aim of the present study was to evaluate the cumulative incidence of depression diagnosis in patients with hemorrhoids compared to the population without hemorrhoids in Germany using a large outpatient database.