Hemorrhoids are rarely brought up during dinner conversations. Or, well, any social conversations, really … unless the company you’re with is past a certain age; a good benchmark would be the mid-60s. While hemorrhoids are admittedly awkward to discuss, the shame, stigma, and mystery surrounding the condition do us all a disservice. After all, research shows it affects nearly 40% of adults (1). That’s two out of five people!
So, to shed some light on this little talked-about topic, here's everything you wanted to know about hemorrhoids (from what it is to whether it's really as painful as people say it is to bottom-saving prevention tips) but found difficult to find out.
Surprise: everybody has hemorrhoids
OK, so the term “hemorrhoids” is a bit of a misnomer. That’s because hemorrhoids are clusters of vascular tissue (i.e., tissues that consist of blood vessels and lymphatic systems), smooth muscle, and connective tissue arranged in three columns along the anal canal, in the lower rectus and anus — and everyone has them (2, 3).
And here’s probably the biggest shocker of all. Hemorrhoids are useful. Uh-huh, that's right: scientists believe they contribute to sensation. In other words, they help you sense what's in the rectum, helping you tell the difference between gas, diarrhea, or a regular bowel movement. Most of the time that is (there are some whom haven’t enthusiastically let one rip, only to realize it wasn’t, in fact, gas.)
So … what's up with the widespread fear around hemorrhoids? Well, it appears that we've confused it with "hemorrhoidal disease", a condition where the hemorrhoids become engorged and inflamed (like varicose veins in the legs). There are two types of hemorrhoidal disease (4, 5, 6, 7):
- Internal hemorrhoids: Occur in the lower rectum. Typically painless, even when they produce bleeding during bowel movements. That said, internal hemorrhoids may protrude outside the body, collecting small amounts of mucus and tiny stool particles that could lead to an intense itching sensation.
- External hemorrhoids: Develop under the skin around the anus. Unlike internal hemorrhoids, external ones tend to cause sudden and severe pain — especially when a blood clot forms within. They’re also associated with uncomfortable itching and burning sensations.
Risk factors for hemorrhoidal disease
But what would cause your hemorrhoids to swell (seemingly) out of the blue? According to research, possible causes and risk factors include (8):
- Chronic constipation; straining during bowel movements
- Excessive time spent on the toilet (e.g., reading, scrolling social media)
- The natural aging process
- Having a family history of hemorrhoids
- Having obesity
- Pregnancy (the enlarging uterus can interfere with blood flow around the hemorrhoids)
- Being over the age of 50
Tips on preventing hemorrhoidal disease
Here’s a fact to take comfort in. Hemorrhoidal disease is rarely life-threatening. Still, just because you're unlikely to die from the condition doesn't mean it's fun to have. All that itching, burning, and, depending on the type of hemorrhoidal disease you have, severe pain can make enjoying life (forgive the pun) a pain in the butt.
Thankfully, there are five things you can do to minimize the chances of your hemorrhoids becoming engorged and causing you misery.
#1: Eat a fiber-rich diet
One of the most important things you could do to prevent hemorrhoidal disease is to avoid excessive straining on the toilet bowl. And the key to preventing that? Answer: by encouraging your body to experience regular, comfortable bowel movements … which is where dietary fiber comes into play (9, 10, 11). Now, you don’t have to be selective about the type of dietary fiber you consume; that’s because both insoluble and soluble fiber have been shown beneficial in constipation relief (12):
- Insoluble fiber: As its name suggests, insoluble fiber doesn’t dissolve in fluids. Instead, it passes through your digestive tract relatively intact, drawing water and sticking to other materials to form stool. This process leads to softer, bulkier, and more regular stools. Sources include wheat bran, vegetables, and whole grains.
- Soluble fiber: Soluble fiber dissolves in fluids to form a gel-like substance that helps your stool pass smoothly through the digestive tract. Sources include nuts, beans, seeds, oat bran, lentils, peas, and some fruits and vegetables.
Wondering exactly how much dietary fiber to aim for? Most nutritionists recommend a daily intake of 18 to 38 grams of fiber for adults; the World Health Organization (WHO) recommends an average daily intake of 25 grams (13). For reference, a medium banana contains roughly 3.1 grams of fiber (14).
#2: Take care of your gut health
To avoid constipation and, in turn, hemorrhoidal disease, beyond simply eating enough dietary fiber, you’ll also need to take care of those tiny bacteria, fungi, and viruses in your gut (collectively known as your “gut microbiome”). That's because several studies suggest that dysbiosis of gut microbiota — defined as an "imbalance in the gut microbial community — may contribute to constipation (15).
Find a list of things you could do to encourage the growth of “good” gut microbes and discourage constipation/straining below:
- Eat a variety of foods: Researchers and health experts agree that a diverse gut microbiome is a healthy one (16, 17, 18, 19). Building your diet around different food types (while focusing on fresh, whole foods) could lead to a more diverse microbiome (20, 21).
- Support your gut lining health: Your gut lining works hard at controlling what enters your bloodstream from the gut 24/7, all days of the week. However, if it's compromised, toxins, bacteria, and partially digested food could sneak past, a phenomenon known as leaky gut syndrome — causing inflammation and gut dysbiosis (and hello, constipation) (22). But how can you “un-compromise” your gut lining? Well, Dr. Danielle’s Gut Assist was specifically formulated to help with this.
- Supplement with probiotic supplements: What better way is there to “top up” your body’s tank of “good” gut bacteria than probiotic supplements (like Dr. Danielle’s Probiotics)? And just so you know, evidence shows they’re wildly effective at alleviating constipation symptoms (23). According to a 2022 randomized controlled trial published in Medicine (Baltimore), for instance, participants experienced an improvement in the weekly frequency of bowel movement and quality of stools after ingesting a probiotic mix daily for 30 days (24).
#3: Avoid sitting on the toilet bowl for too long
Let's be honest. We've all been there. It's a particularly stressful day, and you just need to get away from everything and everyone for a little bit — so you bring your phone or book (or your preferred form of entertainment) into the toilet … and sit. But here's a piece of advice for your hemorrhoids' sake: don't do that. Even if you aren't actively straining, the shape of the toilet bowl puts extra pressure on your rectum and anus (25). Meaning? The longer you sit, the more likely your hemorrhoids will swell.
So, the next time you need some alone time, don't go into the toilet. Instead, head out for a walk if possible. In addition to helping your body release mood-lifting endorphins, all that movement could also help keep your bowel movements regular and strain-free (26, 27, 28). Find out how in the next section.
#4: Get regular movement in
Plenty of research shows that regular physical activity can help resolve constipation symptoms (29, 30). By speeding up your breathing and heart rate, physical activity helps stimulate the natural contractions of muscles in your digestive tract (i.e., peristalsis), decreasing the time it takes for food to move through the large intestine. And this, in turn, limits the amount of water your body absorbs from the stool. As you may already know, hard, dry stools are way harder to pass.
Making a conscious effort to move more could also lower your risk of developing hemorrhoidal disease by increasing your energy expenditure. This could make it easier for you to maintain a healthy weight (as mentioned earlier, obesity is a risk factor for hemorrhoidal disease) (31, 32, 33, 34). If "physical activity" sounds like a lot of work, rest assured that it doesn't have to be. Anything that gets you moving, like household chores or a brisk walk around the neighborhood, counts.
#5: Stay well-hydrated
Imagine that you're dehydrated. Where do you think your body will try to get water from? That's right: your stools (35). And, at this point, you should have a clear idea of how the rest of the story goes (yep … hard, dry stools and loads of hemorrhoids-swelling straining). So, the takeaway here is to stay well-hydrated.
While your fluid requirements can vary according to factors such as your body weight, climate, and physical activity levels, a good guideline to adhere to is 15.5 cups of fluids daily for men and 11.5 cups for women (36). Good news: you don't have to meet your fluid requirements with 100% water. Other liquids, including milk, soy beverages, coffee, and tea, will also help you hit your needs.
Suspect something’s not quite right down there?
Prevention is great. But here's the thing. What if you're already dealing with uncomfortable symptoms that have your mind desperately sounding the hemorrhoidal disease alarm bells?
Don’t panic. The most important thing you can do right now is to visit your primary healthcare provider. They’ll have the necessary knowledge and expertise to diagnose your condition and propose an appropriate treatment plan (if you indeed have hemorrhoidal disease).