It’s a common problem that no one really wants to talk about.
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By age 50, at least half of adults will suffer through a bout of inflamed, itchy veins, or hemorrhoids, that are literally a pain in the butt.
To avoid hemorrhoids and the constipation that causes them, the American Gastroenterological Association released new guidelines Wednesday recommending that people stop scrolling on the toilet and get the recommended daily amount of fiber.
Getting enough fiber is the No. 1 diet consideration for hemorrhoid prevention, said Dr. Trisha Pasricha, a gastroenterologist at Beth Israel Deaconess Medical Center in Boston.
Men should aim to eat about 38 grams of fiber every day, while women should get at least 25 grams, “which is pretty hard to meet for the average American,” Pasricha said.
Only about 5% of men and 9% of women get the recommended daily amount of fiber, according to recent estimates.
With the new dietary guidelines urging a boost in daily protein, especially red meat, high-fiber foods might get left behind.
“The protein isn’t the problem,” Pasricha said. “It’s what you aren’t getting when you’re focusing on the protein.”
Dr. Waqar Qureshi, a gastroenterologist at Baylor College of Medicine in Houston who co-authored the new guidelines, said a diet that prioritizes animal-based proteins over plants can lack fiber and cause constipation, leading to straining in the bathroom that can inflame delicate tissue and cause hemorrhoids.
Meat doesn’t contain any fiber, an essential nutrient that keeps stool soft and feeds gut microorganisms. Processed meats like hot dogs, salami or some deli meats, as well as red meat, also increase a person’s risk for colorectal cancer.
“What you should be eating is more plant-based proteins that also contain vitamins, minerals and fiber,” Qureshi said.
Key sources of fiber, both soluble and insoluble, include seeds, beans, lentils, whole grains and vegetables. Getting a mix of the two types of fiber benefits healthy digestion and protects against constipation.
People should also stay hydrated to avoid constipation.
How your phone may cause hemorrhoids
Sitting on the toilet for extended periods of time increases the chances of developing a hemorrhoid, even if a person isn’t straining, Qureshi said. That’s because when a person’s bottom is unsupported — like when they sit on a toilet seat — blood flow to the anus increases, creating pressure.
“You shouldn’t sit on the toilet for more than five minutes,” Qureshi said, adding that people shouldn’t read or scroll on the toilet to avoid sitting for longer than they need to.
A recent study found that a majority of adults in their 40s and 50s bring their smartphones into the bathroom — and those that do were likelier to have hemorrhoids than people who don’t scroll while seated.
“If you can’t live without your smartphone for five minutes, set a timer so you get up after then,” Qureshi said.
Cohen said that everybody has hemorrhoidal tissue and that it’s usually not a problem. But if a person strains while going to the bathroom or lifting at the gym or has extra pressure in the pelvis from pregnancy or sitting on the toilet for too long, that can cause the delicate hemorrhoidal tissue to become inflamed and turn into “symptomatic hemorrhoids,” the thing most people know simply as hemorrhoids.
Those can occur either internally — that is, inside the rectum — or externally, on the anus, and if inflamed hemorrhoids burst, they can bleed. If a hemorrhoid forms a blood clot, the area can become very painful, especially while sitting, Pasricha said.
In recent years, Cohen and Pasricha said, they are seeing more young patients with hemorrhoids, most likely because of growing awareness of colorectal cancer.
Colorectal cancer has become the leading cause of cancer death for people under 50, and symptoms of rectal bleeding and discomfort may be mistaken for hemorrhoids.
“In the past, it’s been an embarrassing thing that people are reluctant to seek care for. That’s a good thing that people are coming in,” Pasricha said.
Pain relief and treatment
Surgery, while needed in some cases, is no longer the only treatment for chronic hemorrhoids.
For a lot of people, hemorrhoids can be treated at home, using over-the-counter steroidal creams like hydrocortisone, though they shouldn’t be used for more than a week, Pasricha said.
Persistent hemorrhoids may require an in-clinic procedure such as banding, in which a doctor puts a band around a hemorrhoid to cut off blood flow, Qureshi said.
“Office banding is painless, quick, and most gastroenterologists can do them at their office,” he said, adding that the procedure doesn’t require sedation.
The guidelines also recommend infrared coagulation, another in-office procedure that uses infrared light to shrink hemorrhoids.
To avoid straining, and therefore hemorrhoids, people can prop their feet up on stools or even stacks of old magazines to create more of a squatting position than sitting on toilets typically creates, Qureshi said.
Bidets can also cut down on the friction created with wiping with toilet paper, especially if someone has an actively inflamed hemorrhoid.
Sitz baths — a fancy way of saying submerging the bottom in hot water — may help alleviate some discomfort, although there’s not much research showing they treat the condition.
Use hot but not scalding water and sit for only five to 10 minutes, Pasricha said.
In the end, most hemorrhoids do go away on their own after a few days, but it’s always a good idea to confirm with a doctor that what a person has is, indeed, a hemorrhoid, she said.
