Hemorrhoids - How to Prevent & Treat Without Surgery

Did you know that we are all born with hemorrhoids? Yup! Even babies have hemorrhoids! That’s because hemorrhoids are simply veins surrounding the exterior and interior of the anus. They are part of the normal female and male anatomy and actually serve a beneficial purpose – they cushion and protect the anal sphincter muscles from trauma during bowel movements and help seal the anus closed to minimize leakage of gas and stool.


If they’re “normal” - Why do they bleed and hurt?


Just like varicose veins in one’s legs, hemorrhoidal veins are normal veins, that, when swollen, can lead to symptoms. The cumulative pressure on the hemorrhoids caused by simple daily bowel movements over many years or worse, constipation, diarrhea, pregnancy, obesity, and other lifestyle factors can lead to swelling of these veins. Swollen hemorrhoids can cause irritation, bleeding, itching, and pain.


How can I prevent symptoms?


Follow these 5 diet and lifestyle habits to help minimize hemorrhoid symptoms:


Eat an abundance of fruits, vegetables, legumes, grains and nuts


A healthy diet should include a wide variety of fruits, vegetables, nuts, legumes, and grains. These foods are rich in dietary fiber, they fuel the gut microbiome, and help resolve most cases of constipation or diarrhea. Consuming a diet rich in fiber is always better than taking a supplement because of all the nutritional benefits of a plant and grain rich diet on the gut microbiome. If you would prefer to take a supplement, psyllium husk, either in powder or capsule form is best (choose the kind without added colors and flavors). Either way, fiber helps with stool consistency allowing your hemorrhoids to get a break from the constant trauma of difficult bowel movements.


Drink at least 8 glasses of water daily


Drinking plenty of water is important, especially in those who suffer from constipation. Remember, dietary fiber absorbs water to expand and help with stool bulk. This helps to soften hard stool, allowing for less straining during evacuation, and minimizing the amount of time on the toilet to reduce pressure on your hemorrhoids.


Limit toilet time to less than 5 minutes


Spending WAY too much time sitting on the toilet bowl has to be one of the biggest problems leading to the hemorrhoid epidemic in the United States! I once visited a friend, and found a basket full of children’s books next to their toilet! I couldn’t help but to quote some hemorrhoid statistics that day! This is such a bad habit! If you are guilty, please stop NOW! If you are reading while on the toilet, you are spending too much time there. Not only does the constant pushing and straining lead to hemorrhoids swelling, but even if you are just sitting there without straining, the toilet bowl acts like a vacuum leading to further swelling of your hemorrhoids. Please do yourself a favor and leave your phone out of the rest room and see how much faster your toilet time becomes. How much is too much? A good rule of thumb is 5 minutes; if there’s no action, leave and come back.



Place a step under your feet to help evacuation during # 2


Placing a step stool under your feet while you’re on the toilet can change the anatomy and orientation of the rectum during the bowel movement. This allows the rectal angle to straighten allowing for an easier and more thorough evacuation. It does not have to be a fancy $40 gizmo either; any old step stool will do. Try it out and see how much less straining it takes to complete a bowel movement.


Go when you feel the urge to go


Finally, allowing the urge for # 2 to guide your toilet time rather than trying to force a certain schedule can really help minimize your toilet time and the resulting trauma to your hemorrhoids. While some people may have a medical diagnosis requiring a timed evacuation daily, for most people, trying to force a bowel movement by sitting on the bowl for 30 minutes every morning can really affect the hemorrhoids over time. Your rectum has a pretty sophisticated intrinsic nervous system that will let you know when it’s time, and if you wait for this signal, you can really save time and hassle dealing with the health of your bum over time.



I already have hemorrhoids. Is it too late to reverse the damage?


In most cases of minor symptomatic hemorrhoids, diet and lifestyle modification can reverse symptoms. Over the counter creams combine topical steroids, astringents and vasoconstrictors (medications that temporarily shrink blood vessels) and can help with temporary relief during a flare.


I was told to “just live with" my symptoms. I don't want surgery. What can I do?


The truth is that most people don’t have to just live with their bothersome hemorrhoids. Patients seeing me for a consultation are usually quite surprised to hear about the several non-invasive treatments to deal with symptomatic hemorrhoids. Office treatments are quick and painless and a good option for most mild to moderate hemorrhoids.


While being seen early in the process is best, most office-based treatments can help even severe cases. Hemorrhoid injection or “sclerotherapy” is one of the least invasive, painless treatments performed in the office. This consists of an internal, painless shot (that’s because we have no pain fibers inside the anus) to obliterate the hemorrhoid using an alcohol called phenol and olive oil! Yes, a dirty martini can cure your hemorrhoid problems! Other options are infrared coagulation to heat-treat the hemorrhoids or rubber band ligation, both of which can also be done in the office. With all these non-invasive treatment options, only about 5% of patients being seen for hemorrhoids actually resort to surgery in my hands. You’ll be surprised how simple and fast a consultation and treatment can be!


Karen Zaghiyan, MD

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