Obesity and Hemorrhoids
by Jamie Seiler, PA-C

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Hemorrhoids are more common in the overweight population for several reasons and can be both painful and irritating. Avoid this health problem by eating a high-fiber diet, drinking plenty of fluids and being as active as possible throughout the day.

What are Hemorrhoids?
Hemorrhoids are common and occur in both men and women; however, they are more common in people who are older, overweight or pregnant, and in those who sit for prolonged periods of time and/or strain during bowel movements.

Hemorrhoids are enlarged or swollen veins in the lower rectum. The most common symptoms of hemorrhoids are rectal bleeding, itching and pain. You may be able to see or feel hemorrhoids around the outside of the anus, or they may be hidden from view inside the rectum. Although hemorrhoids do not usually cause serious health problems, they can be annoying and uncomfortable.

Symptoms of hemorrhoids can include the following:

  • Painless rectal, often bright red, bleeding
  • Anal itching or pain
  • Tissue bulging around the anus
  • Leakage of feces or difficulty cleaning after a bowel movement

Hemorrhoids are more common in the overweight population for several reasons including inadequate fiber intake, decreased level of physical activity and prolonged sitting. The best ways to prevent hemorrhoids are:

  • Follow a diet high in fiber
  • Drink plenty of fluids
  • Be active throughout the day

Fiber
One of the most important steps in preventing and treating hemorrhoids is avoiding constipation (hard or infrequent stools). Hard stools can lead to rectal bleeding and/or a tear in the anus, called an anal fissure. In addition, pushing and straining to move your bowels can worsen existing hemorrhoids and increase the risk of developing new hemorrhoids. Increasing fiber in your diet improves the health of the large intestine and is one of the best ways to soften your stools and prevent constipation. An important type of fiber is called insoluble fiber, which you may know as “roughage.”

Insoluble fibers are found in cereal brans, fruits and vegetables. It’s what gives celery its rigid stalk and gives spinach the strong stems that hold up its leaves. It is that same structure that “bulks up” the contents of your stool.

Insoluble Fibers
Insoluble fibers move through the intestinal tract without being digested. Instead, they hold onto water, helping to soften and add bulk to the stools. This action helps stools move more quickly and easily through the large intestine. Stools that move through the large intestine at an easy and regular pace are unlikely to cause constipation. In addition, soft stools are able to pass more easily through the rectal muscles, since there is no need for increased pressure or straining during that bowel movement. This reduces the pressure in the lower bowel, making it less likely that rectal veins will swell and develop into hemorrhoids.

Soluble Fibers
In addition to insoluble fiber, there is another type of fiber called soluble fiber. Soluble fiber is often found in soft or liquid foods. For example, many low-fat and nonfat foods contain soluble fibers called gum or pectin that add texture and consistency to the food. In the body, soluble fiber binds to fatty substances and promotes their excretion as waste. This quality seems to help lower blood cholesterol levels and regulate the body’s use of sugars.

Other Benefits of Fiber
Foods that are high in fiber are often packed with other essential nutrients including disease-fighting and cancer-preventing antioxidants. In addition, foods with fiber often contain less fat and fewer calories. Because they take longer to chew, fiber-rich foods may help slow you down, so you eat less. With their added bulk, they help you feel full longer, making you less inclined to snack too soon after eating.

Fiber itself can’t be fattening or provide calories – it isn’t digested. So, as long as you keep an eye on your calories, a high-fiber diet can be great for your waistline.

The recommended amount of dietary fiber is 20 to 35 grams per day. Most Americans get less than half of this amount every day. Fortunately, fiber is found naturally in many foods and now is being added to several other foods.

In addition, several fiber supplements are available over-the-counter, including psyllium (Konsyl®; Metamucil®), methylcellulose (Citrucel®), calcium polycarbophil (FiberCon®), and wheat dextrin (Benefiber®).

Keep in mind that although fiber supplements may help relieve constipation, they otherwise probably will not make much difference to your health. Fiber-rich foods supply more fiber and are less costly than many fiber supplements; thus, it is generally recommended that your primary source of fiber comes from food.

If you increase the fiber in your diet, do so gradually. Give the bacteria in your stomach and intestines time to adjust. If you add more fiber to your diet too quickly you may end up with gas, diarrhea, cramps and bloating. Start with a small amount of fiber and increase slowly to avoid these side effects.

Fluids
Remember that fiber acts like a sponge in your large intestine. It holds water and keeps waste moving along, which prevents constipation. For fiber to do its job, you need to consume enough fluids.

The recommended amount is at least eight cups of liquids each day. As you increase your fiber intake, your body will need more water to process the additional roughage and prevent constipation. Increasing your fluid intake also helps to reduce intestinal gas which is a normal and common side effect of eating a high-fiber diet.

The best fluids for a healthy diet are water and low-fat milk. Water is fat-free and calorie-free while low-fat milk is a great source of calcium. Most other beverages are not the best fluid sources for the body and should be avoided or only consumed in very small amounts. Fruit juices, while potentially high in nutritional value, are low in fiber and often high in calories. Alcoholic beverages and caffeinated beverages including coffee, tea and some soft drinks act like diuretics, causing the body to lose water through increased urination. In addition, soft drinks are both low in nutritional value and high in calories.

Physical Activity
Physical activity helps maintain muscle tone throughout the body, including the muscles of the intestinal tract. The American College of Sports Medicine recommends a minimum of 30 minutes of some sort of physical activity on most days of each week.

The time you spend exercising in a day does not need to be all at once; it can be accumulated throughout the day. For example, eight minutes spent climbing up the stairs, 15 minutes spent shoveling the snow, and seven minutes walking the dog all contribute to the day’s total.

On a daily basis, you should strive to be as active as possible and to limit sedentary activities such as sitting, watching TV and playing video or computer games. If you sit for prolonged periods of time, take a few minutes every hour to stretch and work your muscles – stand instead of sit when talking on the telephone, walk to a restroom at the other end of the building or walk up a flight of stairs. Work your way up to engaging in more vigorous activities such as swimming, biking or power walking three to five days per week.

In addition to preventing constipation by keeping the bowels moving regularly, physical activity has several other health benefits including restful sleep, maintenance of optimal body weight, resistance to cold and other infections, strong circulation and lung function, and decreased risk of cancer, cardiovascular disease, type 2 diabetes, depression and anxiety.

Treatment
Treatment for hemorrhoids begins with warm sitz baths, which are available over-the-counter. These products should be used two to three times per day to relieve irritation and itching. Your medical provider can provide you with further treatment options including topical agents and procedures for more severe cases.

Hemorrhoids can be both painful and irritating. Avoid this health problem by eating a high-fiber diet, drinking plenty of fluids and being as active as possible throughout the day.

It’s All about Fiber
High-Fiber Foods:

  • Legumes (beans)
  • Whole-wheat bread
  • Bran
  • Fruits (dried or with the peel)
  • Vegetables
  • Popcorn

Look for these terms on food products as you walk through the supermarket:

Term Means
High Fiber 5 grams or more per-serving
Good Source 2.5 to 4.9 grams per-serving
More or added fiber At least 2.5 grams more per-serving

(Compared to standard serving size of the traditional food)

About the Author:
Jamie Seiler, PA-C, is a physician assistant at the Center for Nutrition and Weight Management at Geisinger Medical Center in Danville, Penn. She completed her master of science in Physician Assistant Studies at Marywood University in Scranton, Pennsylvania and is a member of the American Academy of Physician Assistants (AAPA) and an associate member of the American Society for Metabolic and Bariatric Surgery (ASMBS).

Resources:
American Dietetic Association – www.eatright.org
American College of Sports Medicine – www.acsm.org



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