Change These 5 Pooping Habits To Prevent Hemorrhoids, Says An MD
You likely won't have given hemorrhoids a second thought, until you're suddenly Googling them in the middle of the workday because you can't sit down without a sharp pain coming from down there.
Whether or not this experience is relatable, you might be surprised to learn that you already have hemorrhoids regardless. Everyone does. They're a normal part of your anatomy, with problems emerging only when they get painful, itchy, or start bleeding.
Trischa Pasricha, M.D., MPH, a leading gastroenterologist, professor at Harvard Medical School, and author of the new book, You've Been Pooping All Wrong, is kind of a hemorrhoids expert, and she says the what really makes them painful might surprise you.
Keep reading for a closer look at what hemorrhoids are, plus five tips on how to prevent them. (For a broader look at what your bathroom habits reveal, see her breakdown of the signs of a healthy poop.)
The two types of hemorrhoids
"Hemorrhoids are just internal cushions of veins, and they usually sit just inside our anal sphincters," Pasricha explains. The sphincter is a muscular ring that surrounds the anus, the external opening where waste exits the body.
In a normal state, hemorrhoids are simply a part of this anatomy, no different from any other tissue in your body. The trouble starts when the connective tissue surrounding the veins weakens over time. When that happens, the veins can engorge, and that's when symptoms appear.
There are two kinds of painful hemorrhoids, and they behave quite differently.
- Internal hemorrhoids sit inside the sphincter. You typically won't notice them unless they bleed. You will see bright red blood in the toilet bowl, which can be alarming, but is often the first indication of a hemorrhoid.
- External hemorrhoids sit just outside the sphincter and are more uncomfortable. Not only do they bleed, but they can be itchy and sore. You might notice the feeling of a lump in your anus with an external hemorrhoid.
There's also a third scenario in which internal hemorrhoids prolapse, meaning they push outward through the sphincter. In this situation, the hemorrhoids need to be manually pushed back in.
One important note: while blood in the stool is often caused by hemorrhoids, it is never something to dismiss on your own. "Make sure you've had a doctor just take a look at that hemorrhoid once before you start to dismiss blood the rest of your life as hemorrhoids," Pasricha says. This is particularly important given the rise in early-onset colorectal cancer.
Don't blame your hemorrhoids on constipation
For a long time, the conventional thinking was that constipation causes hemorrhoids. But the science around hemorrhoids has become more nuanced, and Pasricha says straining is actually a bigger risk factor than constipation itself.
"When you're sitting there straining, you're generating this pressure that, weakens the connective tissue and then fills that tissue with blood," she explains. Doing that repeatedly over months and years creates the conditions for hemorrhoids to become a real problem.
The mechanism that actually damages tissue is the pressure generated during straining, not simply having infrequent bowel movements. Studies have shown that higher fiber intake is associated with fewer hemorrhoids, because fiber makes stools easier to pass and reduces the need to strain.
Yes, your phone might be causing hemorrhoids
Inspired by a reader question she received while writing her health column for The Washington Post, Pasricha conducted a study on smartphone use in the bathroom as part of her work with the Beth Israel Institute For Gut-Brain Research.
The study looked at adults 45 and older who were coming in for screening colonoscopies. Two-thirds of them reported bringing their smartphones into the bathroom, and those who did were 46% more likely to have hemorrhoids, which researchers confirmed endoscopically during the procedure.
Interestingly, smartphone users didn't report straining more than non-smartphone users. Fiber intake and exercise levels were also controlled for. What set them apart was time. Smartphone users were more than five times as likely to spend more than five minutes on the toilet per visit.
Her hypothesis is that the issue isn't the phone itself, it's the prolonged sitting. Modern toilets offer no pelvic floor support, so every minute you spend sitting on one, your tissue is under passive pressure. Do that once in a while and it's probably fine. Do it every day, multiple times a day, for years, and that cumulative pressure adds up.
"The smartphones distract us and hijack our brains the way they do in any other sphere," Pasricha says. If you are bringing your phone into the bathroom, she recommends setting "a two TikTok limit." The bathroom is definitely not the place to sit down and watch a full episode of TV.
5 tips to prevent & relieve hemorrhoids
Hemorrhoids are undoubtedly bothersome, but the good news is they can be dealt with simple, low-cost fixes at home. Here are five of Pasricha's top tips for people who struggle with hemorrhoids.
- Raise your knees above your waist: Modern toilets are designed so you sit the same way you'd sit in a chair, which actually puts a slight kink in the colon. Elevating your feet on a stool straightens that angle, relaxes the muscle, and makes elimination significantly easier. Pasricha says studies have tested this switch1, and even people without hemorrhoids are impressed by the difference it makes in the pooping experience.
- Stick to the five-minute rule: Set a limit on how long you spend on the toilet. If nothing is happening after a few minutes, get up and try again later. Sitting and waiting, especially while scrolling, compounds the passive pressure on hemorrhoidal tissue. Gut health experts have a few evidence-backed tricks worth knowing.
- Increase your fiber intake: Most Americans fall well short of recommended fiber goals. Pasricha recommends spreading fiber throughout the day, starting with a high-fiber breakfast, and supplementing with psyllium husk, which she notes has been well-studied for its effects on stool consistency, cholesterol, and the gut microbiome2. Loading up on fiber-rich foods is one of the most impactful changes you can make for your digestive health overall.
- Consider a bidet: "I became a bidet believer a long time ago," Pasricha says, "and I recommend bidets in my practice to literally almost everyone." The tissue around the anal sphincter is more delicate than most people realize. Repeated wiping, especially with dry toilet paper, can cause micro-abrasions and irritation. A bidet eliminates that friction entirely. For those worried about cost, Pasricha says a $30 nozzle from a hardware stores will do just fine.
- Limit straining: If you're not ready to go, don't force it. Straining is the primary mechanical driver of hemorrhoid development, and no amount of fiber or footstools will fully offset the damage from chronic straining.
The takeaway
Most hemorrhoid symptoms are the cumulative result of years of small, fixable behaviors. The habits that protect you aren't complicated or expensive. An inconspicuously placed footstool, some extra fiber added to your meals, and a two-TikTok limit on bathroom screen time can make a world of difference. Start with one change, and your future self will thank you.