Hemorrhoids can cause a lot of pain and discomfort, and while medical therapy definitely plays an essential role in relief and prevention, your eating habits play a role, too. About 1 out of every 20 Americans - roughly 5% - suffers from the pain and discomfort of hemorrhoids. If you’re over 50, that number is about 10 times as high - closer to 50%. At his office in White Plains, New York, proctology specialist Michael H Tarlowe, MD, helps patients manage uncomfortable hemorrhoid symptoms with both conservative and surgical approaches, depending on each patient’s unique needs.
What are Hemorrhoids?
Hemorrhoids (HEM-uh-roids), also called piles, are swollen veins in the anus and lower rectum. Hemorrhoids are like varicose veins. In one sense, everyone has hemorrhoids (or piles), the pillow-like clusters of veins that lie just beneath the mucous membranes lining the lowest part of the rectum and the anus. The condition most of us call hemorrhoids (or piles) develops when those veins become swollen and distended, like varicose veins in the legs.
If they develop inside the rectum, they're called internal hemorrhoids. Internal hemorrhoids lie inside the rectum. You usually can't see or feel them, and they rarely cause discomfort. Painless bleeding. A hemorrhoid to push through the anal opening, called a prolapsed or protruding hemorrhoid.
External hemorrhoids are under the skin around the anus. External hemorrhoids are the most uncomfortable, because the overlying skin becomes irritated and erodes. If a blood clot forms inside an external hemorrhoid, the pain can be sudden and severe. You might feel or see a lump around the anus.
Causes and Risk Factors of Hemorrhoids
Researchers aren’t entirely sure why some people develop hemorrhoids while others don’t. The veins around the anus tend to stretch under pressure and may bulge or swell. Hemorrhoids are usually caused by increased pressure due to pregnancy, being overweight, or straining during bowel movements. Risk factors: As people age, the risk of hemorrhoids increases. That's because the tissues that support the veins in the rectum and anus can weaken and stretch. By midlife, hemorrhoids often become an ongoing complaint. By age 50, about half the population has experienced one or more of the classic symptoms, which include rectal pain, itching, bleeding, and possibly prolapse (hemorrhoids that protrude through the anal canal).
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Traditionally, hemorrhoids are associated with chronic constipation, straining during bowel movements, and prolonged sitting on the toilet - all of which interfere with blood flow to and from the area, causing it to pool and enlarge the vessels. More recent studies show that patients with hemorrhoids tend to have a higher resting anal canal tone - that is, the smooth muscle of the anal canal tends to be tighter than average (even when not straining). Constipation adds to these troubles, because straining during a bowel movement increases pressure in the anal canal and pushes the hemorrhoids against the sphincter muscle.
How Diet Influences Hemorrhoids
Chronic constipation and frequent straining during bowel movements are two very common triggers for hemorrhoid pain. For these reasons, Dr. Tarlowe often recommends dietary changes to help promote regular bowel activity and easy-to-pass stools.
The Role of Fiber
Incorporating more fiber into your diet is one of the most important changes you can make to reduce hemorrhoid symptoms. Fiber is a nutrient that’s essential for healthy digestion. It’s naturally found in fruit, vegetables, and whole-grain foods, but many Americans don’t get enough fiber in their daily diets. Eating a lot of food that’s low in fiber (like red meat, dairy products, and baked goods with white flour) increases your risk of constipation. Eating foods that are high in fiber can make stools softer and easier to pass and can help treat and prevent hemorrhoids. You can get extra fiber through many over-the-counter fiber supplements. Reading food labels is the best way to figure out how much fiber is contained in the packaged foods you buy. The Dietary Guidelines for Americans, 2020-2025 recommends a dietary fiber intake of 14 grams per 1,000 calories consumed. The amount of fiber in a food is listed on the food’s nutrition facts label.
To get the most from the fiber you’re eating, you’ll also want to be sure to drink plenty of clear fluids - especially water. Drinking water and other liquids, such as fruit juices and clear soups, can help the fiber in your diet work better. Drink 6 to 8 glasses of water and other liquids each day to help keep stools soft. Women should have about 11.5 cups of fluids each day, and men should have about 15.5 cups, according to the Mayo Clinic. Drinking plenty of water will also help keep your stools soft as you increase your fiber intake.
Foods to Embrace
"Eat more fiber." "Stay hydrated."That's the advice everyone gets about hemorrhoids -- and it's good. But what does it mean in real life, when you're at the grocery store or deciding what to put on your plate?
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- Legumes: You'll get a lot of bang for your bite with the legume family. Just 1/2 cup of beans -- such as kidney, navy, lima, or black beans -- will cover about a third of your daily goal. It will have between 7 and 10 grams of fiber (both soluble and insoluble), depending on which variety you choose. Instead of using just meat in chili and soups, add or substitute beans. You can also use beans and nuts in salads. Try Indian and Middle Eastern recipes, which often call for beans, lentils, and peas.
- Nuts: About 20 almonds or pecans have around 3 grams of fiber. A 1/2 cup of edamame does, too, and it only has about half the calories.
- Whole Grains: Swap white breads, pastas, and crackers for versions made with whole-grain flours, buckwheat, stone-ground cornmeal, or rye to boost the amount of insoluble fiber you'll get. Cooked oats and barley will give you soluble fiber, too. Instead of a plain white bagel for breakfast, have a packet of instant oatmeal -- with twice the fiber for less than half the calories. Reach for no-butter popcorn when you get the munchies. Sprinkle oat bran or wheat germ on salads and soups.
- Fruits and Vegetables: You can't go wrong with plant foods. Keep the skins on when they're thin, like on apples, pears, plums, and potatoes. That's where the insoluble fiber is, as well as compounds called flavonoids that can help control hemorrhoid bleeding. Brightly colored produce -- berries, grapes, tomatoes, and kale and other dark, leafy greens -- are generally rich in flavonoids. And the fresher, the better. Try to keep them whole and not damage the skins or leaves until you're ready to eat them. Avoid cooking to the point that their color fades. A serving of fruit is often good for at least 10% of your daily fiber, usually 3 to 4 grams. A cup of leafy greens, broccoli, Brussels sprouts, winter squash, or green peas will get you 4 to 5 grams of fiber. Some veggies and fruits have fiber plus a lot of water. Cucumbers, celery, mild bell peppers, and watermelon are mostly water -- more than 90%. Make a habit of adding another fruit or vegetable to any meal, like berries or bananas in your cereal, apple chunks on your salad, spinach in your omelet, or grated zucchini in your spaghetti sauce. Snack on dried fruits like figs, apricots, and dates.
Foods to Limit or Avoid
Cutting back on unhealthy fare, including foods high in fats and sugars, can also improve your gut health and support normal bowel activity. Processed Foods: Highly processed foods like fast food, packaged snacks, sugary treats, and processed meats often lack fiber and essential nutrients. Alcohol: Excessive alcohol consumption can lead to dehydration, which can harden stools and make bowel movements difficult and painful. Caffeine: Caffeine-containing beverages like coffee, tea, energy drinks, and sodas can act as diuretics, leading to dehydration and contributing to constipation. Dairy Products: Some individuals find that high-fat dairy products like whole milk, cheese, and ice cream can worsen symptoms. Spice is not your friend when you have hemorrhoids for a number of reasons: it can aggravate your digestion, resulting in diarrhea or constipation, and some compounds may cause anal itching as they’re expelled, intensifying the discomfort of your hemorrhoids. Avoid spicy food and hot sauces.
Soluble vs. Insoluble Fiber
Soluble fiber dissolves in water to form a gel-like goo. (Picture what happens to oats when you mix them with water.) You want this stuff. It makes your stool soft, well-formed, and easy to pass. No constipation, little irritation. Sounds like the Holy Grail of poop, right? Insoluble fiber is what your grandmother would call "roughage." It doesn't dissolve. (If you drop a chunk of celery in water, it just sits there.) It helps to keep things moving through -- and out of -- your system and to balance the chemistry in your intestines. Many "high-fiber" foods have both kinds. You should aim for 25-30 grams or more of fiber every day from what you eat, about twice what most Americans get. In general, you'll want about a third of that to be soluble (more when you have diarrhea). Too much fiber too fast can cause gas and bloating, so add a little bit to your diet at a time if you're not used to it. You'll also need to drink more fluids to help your body use that fiber: 8-10 large glasses (at least a half-gallon) of water every day.
Additional Lifestyle Modifications
Combine these dietary changes with a little more physical activity for even more benefits. Stay active to help prevent constipation and reduce pressure on veins. Exercise: Aim to get 20 to 30 minutes of aerobic exercise every day. Exercise can prevent hemorrhoids because it keeps waste moving through your body. When you’re sedentary, your bowels slow down, and you’re more likely to experience constipation. Both aerobic exercise and strength training promote your overall health. Weightlifting and other activities that cause excessive strain put extra pressure on the veins in your rectum.
When you sit on the toilet for a bowel movement, the muscles in your pelvic area naturally relax to help you pass stool. Avoid sitting on the toilet for any longer than you need to. There’s no way to ensure you’ll be free of hemorrhoids, but there’s much you can do to reduce your risk. Don’t sit on the toilet too long: While it may be tempting to spend more than a few minutes in the bathroom with a book or smartphone, it’s important not to stay seated for too long. Sitting on the toilet increases pressure in the rectal region, which can lead to hemorrhoids - especially if you strain. Aim to be out of the bathroom in two minutes or less. If you need more time, leave the bathroom and return to try again later. Go when you get the urge: Go to the bathroom as soon as you get the urge to make a bowel movement. If you wait too long, the stool could become dry, hard and more difficult to pass, leading to constipation and straining. Along with putting off bathroom breaks, irregular bowel movements, chronic constipation, or chronic diarrhea all affect bowel health.
Home Remedies for Hemorrhoids
Dramatic relief for most hemorrhoid symptoms can be found with simple, home remedies for hemorrhoids.
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- Get more fiber: Add more fiber to your diet from food, a fiber supplement (such as Metamucil, Citrucel, or Fiber Con), or both. Along with adequate fluid, fiber softens stools and makes them easier to pass, reducing pressure on hemorrhoids. High-fiber foods include broccoli, beans, wheat and oat bran, whole-grain foods, and fresh fruit. Fiber supplements help decrease hemorrhoidal bleeding, inflammation, and enlargement. They may also reduce irritation from small bits of stool that are trapped around the blood vessels. Some people find that boosting fiber causes bloating or gas. Start slowly, and gradually increase your intake to 25-30 grams of fiber per day.
- Take time: When you feel the urge to defecate, go to the bathroom immediately; don't wait until a more convenient time. Stool can back up, leading to increased pressure and straining. Also, schedule a set time each day, such as after a meal, to sit on the toilet for a few minutes.
- Sitz bath: A sitz bath is a warm water bath for the buttocks and hips (the name comes from the German "sitzen," meaning "to sit"). It can relieve itching, irritation, and spasms of the sphincter muscle. Pharmacies sell small plastic tubs that fit over a toilet seat, or you can sit in a regular bathtub with a few inches of warm water. Most experts recommend a 20-minute sitz bath after each bowel movement and two or three times a day in addition. Take care to gently pat the anal area dry afterward; do not rub or wipe hard.
- Seek topical relief: Over-the-counter hemorrhoid creams containing a local anesthetic can temporarily soothe pain. Witch hazel wipes (Tucks) are soothing and have no harmful effects. A small ice pack placed against the anal area for a few minutes can also help reduce pain and swelling.
- Treat the clot: When an external hemorrhoid forms a blood clot, the pain can be excruciating. If pain is tolerable and the clot has been present for longer than two days, apply home treatments for the symptoms while waiting for it to go away on its own.
Medical Treatments for Hemorrhoids
Sometimes hemorrhoids can't be managed with conservative treatments alone, either because symptoms persist or because an internal hemorrhoid has prolapsed. Fortunately, a number of minimally invasive hemorrhoid treatments are available that are less painful than traditional hemorrhoid removal (hemorrhoidectomy) and allow a quicker recovery.
- Band it: The most commonly used hemorrhoid treatment in the United States is rubber band ligation, in which a small elastic band is placed around the base of a hemorrhoid. The band causes the hemorrhoid to shrink and the surrounding tissue to scar as it heals, holding the hemorrhoid in place. It takes two to four procedures, done six to eight weeks apart, to completely eliminate the hemorrhoid. Complications, which are rare, include mild pain or tightness (usually relieved with a sitz bath), bleeding, and infection. Other office procedures include laser or infrared coagulation, sclerotherapy, and cryosurgery. They all work on the same principle as rubber band ligation but are not quite as effective in preventing recurrence.
- Hemorrhoidectomy: You may need surgery if you have large protruding hemorrhoids, persistently symptomatic external hemorrhoids, or internal hemorrhoids that return despite rubber band ligation. In a traditional hemorrhoidectomy, a narrow incision is made around both external and internal hemorrhoid tissue and the offending blood vessels are removed. This procedure cures 95% of cases and has a low complication rate - plus a well-deserved reputation for being painful. The procedure requires general anesthesia, but patients can go home the same day. Patients can usually return to work after 7-10 days.
- Staples: An alternative to traditional hemorrhoidectomy is called stapled hemorrhoidopexy. This procedure treats bleeding or prolapsed internal hemorrhoids. The surgeon uses a stapling device to anchor the hemorrhoids in their normal position.
Complications of Hemorrhoids
Don't assume rectal bleeding is due to hemorrhoids, especially if you have changes in bowel habits or if your stools change in color or consistency. Anemia. Rarely, ongoing blood loss from hemorrhoids may cause anemia. Strangulated hemorrhoid. When the blood supply to an internal hemorrhoid is cut off, the hemorrhoid is called strangulated. Blood clot. Sometimes a clot can form in a hemorrhoid. This is called a thrombosed hemorrhoid.
Prevention of Hemorrhoids
The best way to prevent hemorrhoids is to keep your stools soft so they pass easily. Eat high-fiber foods. Eat more fruits, vegetables and whole grains. Doing so softens the stool and increases its bulk. This will help you avoid the straining that can cause hemorrhoids. Drink plenty of fluids. Drink 6 to 8 glasses of water and other liquids each day to help keep stools soft. Consider fiber supplements. Most people don't get enough fiber in their diets. If you use fiber supplements, be sure to drink at least eight glasses of water or other fluids every day. Don't strain. Exercise. Stay active to help prevent constipation and reduce pressure on veins. Avoid long periods of sitting.
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