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Hemorrhoids, also called piles, refers to a condition in which the veins around the anus or rectum are swollen and inflamed. Dietary adjustments are known to help relieve hemorrhoids.
Ten million people in the United States have hemorrhoids, leading to a prevalence greater than 4%. Up to a third of these people require medical treatment,.
resulting in 1.5 million prescriptions per year. The peak age for hemorrhoids is 45-65 years. The term hemorrhoid is usually related to symptoms caused by hemorrhoids. Hemorrhoids occur in healthy individuals. It is when they become enlarged, inflamed, or prolapsed, that most people refer to the condition as hemorrhoids. They are rarely a serious risk to health, and result from too much pressure on the hemorrhoidal veins in the rectum. The strain of constipation, diarrhea and pregnancy can cause the veins to swell. Other factors such as obesity and liver disease can also increase pressure and cause hemorrhoids. There are three types of hemorrhoids:
- Internal hemorrhoids: Internal hemorrhoids can not be seen, they are inside the anus. Straining or irritation from passing stool can injure a hemorrhoid’s delicate surface and cause bleeding. Because internal anal membranes lack pain-sensitive nerve endings, these hemorrhoids usually do not cause discomfort
- External hemorrhoids: These hemorrhoids are under the skin around the anus and tend to be painful. Sometimes blood may collect in an external hemorrhoid and form a clot, causing severe pain, swelling and inflammation. When irritated, external hemorrhoids can itch or bleed
- Prolapsed hemorrhoids: These are internal hemorrhoids that are so distended that they are pushed outside the anus
In the absence of complications, treatment usually involves over-the-counter corticosteroid creams that can reduce the pain and swelling of hemorrhoids and bathing in tubs with warm water to ease painful perianal conditions. Another important step in treating hemorrhoids is to relieve anal pressure and straining. This can often be done by controlling constipation with a high-fiber diet.
Foods that are high in fiber have been shown to help in the treatment of constipation and hemorrhoids. The American Academy of Family Physicians recommends the following simple dietary guidelines to prevent or lower hemorrhoids symptoms:
- Eating at least 4.5 cups of fruits and vegetables each day.
- Replacing white bread with whole-grain breads and cereals.
- Eating bran cereal for breakfast.
- Adding 1/4 cup of wheat bran (Miller’s bran) to foods such as cooked cereal or applesauce or meat loaf. (This advice is contrary to other experts and organisations who advise against this practice as it can make constipation worse.)
- Eating cooked beans each week.
In its most recent 2005 public health recommendations for dietary fiber, the National Academy of Sciences established an Adequate Intake (AI) level of 38g of total daily fiber for males 19-50 years of age and 25g for women in this same age range. The following foods are excellent sources of dietary fiber and can be included as part of a hemorrhoid diet:
- cinnamon, ground, 2 tsp (2.5g)
- turnip greens, cooked, 1 cup (5.0g)
- basil, dried, ground, 2 tsp (1.2g)
- coriander seeds, 2 tsp (1.4g)
- oregano, dried, ground, 2 tsp (1.3g)
- raspberries, 1 cup (8.3g)
- thyme, dried, ground, 2 tsp (1.1g)
- mustard greens, boiled, 1 cup (2.8g)
- rosemary, dried, 2 tsp (0.9g)
- romaine lettuce, 2 cups (1.9g)
- cauliflower, boiled, 1 cup (3.4g)
- collard greens, boiled, 1 cup (5.3g)
- broccoli, steamed, 1 cup (4.7g)
- cloves, dried, ground, 2 tsp (1.5g)
- celery, raw, 1 cup (2.0g)
- swiss chard, boiled, 1 cup (3.7g)
- cabbage, shredded, boiled, 1 cup (3.5g)
- spinach, boiled, 1 cup (4.3g)
- chili pepper, dried, 2 tsp (2.6g)
- black pepper, 2 tsp (1.1g)
- fennel, raw, sliced, 1 cup (2.7g)
- green beans, boiled, 1 cup (4.0g)
- eggplant, cooked, 1 cup (2.5g)
- cayenne pepper, dried, 2 tsp (1.0g)
- cranberries, 1/2 cup (2.0g)
- strawberries, 1 cup (3.3g)
- bell peppers, red, raw, 1 cup (1.8g)
- winter squash, baked, 1 cup (5.7g)
- kale, boiled, 1 cup (2.6g)
- split peas, cooked, 1 cup (16.3g)
- summer squash, cooked, 1 cup (2.5g)
- carrots, raw, 1 cup (3.7g)
- lentils, cooked, 1 cup (15.6g)
- brussel sprouts, boiled, 1 cup (4.1g)
- asparagus, boiled, 1 cup (2.9g)
- black beans, cooked, 1 cup (15.0g)
- green peas, boiled, 1 cup (8.8g)
- pinto beans, cooked, 1 cup (14.7g)
- cucumbers, slices, with peel, 1 cup (0.8g)
- lima beans, cooked, 1 cup (13.2g)
- turmeric, powder, 2 tsp (1.0g)
- flaxseeds, 2 tbs (5.4g)
- kiwifruit, 1 each (2.6g)
- wheat, bulgur, cooked, 1 cup (8.2g)
- tomato, ripe, 1 cup (2.0g)
- oranges, 1 each (3.1g)
- kidney beans, cooked, 1 cup (11.3g)
- barley, cooked, 1 cup (13.6g)
- apricots, 1 each (0.8g)
- blueberries, 1 cup (3.9g)
- onions, raw, 1 cup (2.9g)
- chickpeas, 1 cup (12.5g)
- papaya, 1 each (5.5g)
- apples, 1 each (3.7g)
- grapefruit, 1/2 (1.7g)
- beets, boiled, 1 cup (3.4g)
- navy beans, cooked, 1 cup (11.7g)
- rye, whole grain, uncooked, 1/3 cup (8.2g)
- pear, 1 each, (4.0g)
- soybeans, cooked, 1 cup (10.3g)
- yam, cubed, cooked, 1 cup (5.3g)
- sweet potato, baked, with skin, 1 each (3.1 g)
- avocado, slices, 1 cup (7.3g)
- mustard seeds, 2 tsp (1.1g)
- prunes, 1.4 cup (3.0g)
- buckwheat, cooked, 1 cup (4.5g)
- olives, 1 cup (4.3g)
- oats, whole grain, cooked, 1 cup (4.0g)
- plum, 1 each (1.0g)
- miso, 1 oz (1.9g)
- banana, 1 each (2.8g)
- corn, yellow, cooked, 1 cup (4.6g)
- pineapple, 1 cup (1.9g)
- cantaloupe, cubes, 1 cup (1.3g)
- potato, baked, with skin, 1 cup (2.9g)
Eating more high-fiber foods such as fruits, vegetables and grains softens the stool and increases its bulk, which helps to reduce the straining that can cause hemorrhoids or worsen the symptoms of existing hemorrhoids.
Fiber helps to keep stool soft while lowering pressure inside the colon so that bowel contents can move through easily. Eating a high-fiber diet will not only relieve constipation and alleviate hemorrhoid symptoms, it is also beneficial in supporting bowel regularity, maintaining normal cholesterol and blood sugar levels, and keeping excess weight off. Additionally, a high-fiber diet is believed to play a role in the prevention and treatment of the following health conditions:
- Breast cancer
- Cardiovascular disease
- Colon cancer
- High cholesterol
- Irritable bowel syndrome
- Syndrome X
Intake of dietary fiber exceeding 50 grams per day may cause intestinal obstructions. Excessive intake of fiber can also result in body fluid imbalance and dehydration. This is why individuals who start increasing their fiber intake are often advised to also increase their water intake, up to 2 liters (8 cups) of fluid daily.
When people increase the fiber content of their diet, they are usually advised to do so gradually, adding small amounts to start with so as to allow the intestinal tract to adjust. Otherwise, abdominal cramps, gas, bloating, and diarrhea or constipation may result. Excessive intake of dietary fiber has also been linked with reduced absorption of vitamins, minerals, proteins, and calories. However, it is unlikely that healthy adults who consume fiber in amounts within the recommended ranges will experience such problems.
Most medical experts agree that low-fiber diets result in small stools, that increase straining during defecation. This increased pressure causes congestion of the hemorrhoids. Pregnancy can also cause hemorrhoidal problems. A decreased venous return is.
believed to be the mechanism of action. Prolonged sitting on a toilet, for instance while reading, is also thought to cause a venous return problem in the perianal area, resulting in enlarged hemorrhoids. Aging also weakens the anal support structures, which facilitates prolapse. Weakening of support structures can occur as early as the third decade of life. There is agreement among health practitioners that the best way to prevent hemorrhoids is to keep stools soft so that they can pass easily, and to empty bowels as soon as there is an urge. Waiting to pass stool may cause it become dry and harder to pass.
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Monique Laberge, Ph.D.