Evolution of Discourse in the Reddit Hemorrhoid Community: Topic and Sentiment Analysis.

Background: Online health communities are crucial resources for individuals managing socially stigmatized and physically burdensome conditions, such as hemorrhoids. These anonymous forums provide critical avenues for emotional validation and information exchange that may be underrepresented or difficult to access in traditional clinical settings. Despite their growing importance as data sources for understanding patient experiences, large-scale longitudinal analyses of the thematic and emotional evolution within such communities remain scarce. Objective: This study aimed to conduct a longitudinal computational analysis of the r/hemorrhoids Reddit community (2013-2022) to characterize its thematic concerns, examine its emotional landscape, and explore how emotional expression relates to community engagement. Methods: We collected 9954 Reddit posts, which were refined through preprocessing into a final dataset of 3746 high-quality posts. Our methodology involved a multistage computational approach: (1) topic modeling was performed on the mature phase of the community (2019-2022) using BERTopic to identify stable thematic clusters; (2) fine-grained emotion classification used a DistilRoBERTa-based transformer model (j-hartmann/emotion-english-distilroberta-base) to categorize posts into 7 discrete emotional states (neutral, fear, sadness, joy, anger, surprise, and disgust); and (3) longitudinal analyses examined temporal trends in topic prevalence during the mature phase (2019-2022) and emotional distributions across the full study period (2013-2022), while also assessing associations between emotional categories and engagement metrics (post score and comment count). Results: The analysis revealed a polarized emotional distribution dominated by neutral (n=1247, 33.29%) and high levels of negative affect (fear and disgust). Thematic modeling identified four higher-order thematic domains encompassing 19 semantically coherent topics: (1) symptom recognition and diagnosis; (2) conservative treatment and self-management; (3) medical and surgical interventions; and (4) quality of life, risk factors, and psychosocial impact. Posts expressing fear and sadness received the highest mean comment counts (7.06, SD 7.60, and 7.03, SD 6.36, respectively), exceeding those expressing neutral or positive emotions. Conclusions: The findings suggest that the Reddit hemorrhoid community serves as an important platform for information exchange and emotional expression among individuals with a stigmatized condition. Posts expressing fear and sadness were associated with higher levels of community engagement, highlighting the potential value of online health communities in supporting patient communication and informing future digital health interventions.