Hemorrhoids occur when clusters of veins in the rectum and around the anus become inflamed and enlarged. They are considered internal hemorrhoids when they happen inside the rectum and external hemorrhoids when they crop up on the skin around the anus. People who deal with hemorrhoids often experience itchiness, pain, and sometimes bleeding. The condition is fairly common—three out of four people will experience the condition (though not everyone has symptoms). Still, what causes them isn’t abundantly clear, says Elana Maser, MD, assistant professor of gastroenterology at Mount Sinai Hospital in New York City.
When looking for information about hemorrhoids online, you may see “family history” as a risk factor. But that doesn’t necessarily mean the condition is genetic, Dr. Maser says. For something to be considered genetic, it has to be connected to the makeup of your DNA. Currently, there’s only one major study that suggests a genetic correlation with hemorrhoids. A 2020 research paper published in the BMJ journal, Gut, analyzed genetic data from 944,133 people and discovered 102 independent locations within the genome connected to hemorrhoidal disease risks. The researchers concluded that hemorrhoidal disease likely has a genetic component that predisposes certain people to dysfunction in the muscles and tissues that support hemorrhoidal veins.
However, your DNA is only one possible factor, says Christine Lee, MD, a gastroenterologist with the Cleveland Clinic. “We do think there is some genetic component because, genetically, if you have weaker veins or weaker muscle tone, you’re a little more at risk of developing hemorrhoids,” she says. “But there’s a little bit of nurture involved, too.”
Basically, anything that puts a lot of pressure on your rectum can contribute to hemorrhoids, Dr. Lee says. That includes sitting for long periods of time, pregnancy (thanks to the weight of the baby), constipation, diarrhea, and even spending too much time on the toilet.
Whether or not you’ll get hemorrhoids could be somewhat genetic, but it’s also dependent on lifestyle habits—many of which you likely learned from your family. If your parents didn’t eat much fiber, you might not either. If your parents didn’t exercise much, you might’ve learned to skip movement, as well. And if your family (like mine) kept a magazine rack or handheld video game in the bathroom, you might spend time hanging out on the toilet as an adult. Whether you learned these habits from your folks or developed them on your own, doctors can link lifestyle factors like diet, exercise, and toilet time to hemorrhoids.
So what can you do if you have a family history of hemorrhoids—genetic or not? The good news is that you’re not doomed. Your family history might increase your risk, but lifestyle changes can help keep them at bay.
First, make sure you’re eating enough fiber and drinking water every day. You’ll find a lot of fiber in simple foods like beans, lentils, and fruits or vegetables that have skin—even potatoes are a great source of fiber. Gradually increasing your daily fiber intake to 20 to 30 grams a day can reduce symptomatic hemorrhoids (as in bleeding or itching), Dr. Maser says. Overall, fiber helps make stool softer and easier to pass (which reduces constipation), and making sure you're drinking enough water helps the fiber in your diet even more effective, according to the National Institue of Diabetes, and Digestive and Kidney Diseases. Ensuring enough dietary fiber is “our best preventative intervention,” Dr. Maser says.
And, as with many aspects of our health, exercise can help, but it’s important to exercise properly, Dr. Lee says. If you’re lifting weights (or anything else) and you close off your breathing, that actually increases your risk of hemorrhoids. “So you want to make sure you exhale as you’re pushing,” Dr. Lee says. A good trainer will teach you to breathe out as you lift.
Fiber, water, and exercise are helpful because they help keep constipation at bay, but make an effort to get off the toilet as soon as you’re done, too. “When you sit there too long and you’re pushing, there’s a risk of prolapse if your pelvic floor isn’t strong,” Dr. Lee says.
“You’re supposed to do your duty, no joke intended,” says Jeffrey Aronoff, MD, a colorectal surgeon in New York. “You get there, you do your thing, and you get up and go. That’s the most perfect toileting you can have.” So if you think you’re prone to hemorrhoids, leave the reading and phone games for another time.
Of course, you might already have hemorrhoids. What do you do then? In the long term, those lifestyle changes can still be helpful. But that doesn’t soothe your itchy bottom right now. If you currently have swollen, itchy hemorrhoids, over-the-counter hemorrhoidal creams like Preparation H Soothing Relief Anti-Itch Cream ($7) can be helpful (Preparation H even has a new cooling spray for those who are squeamish about touching their butt). If your hemorrhoids are more serious — if they’re bleeding or painful or if you can feel them pushing out, it’s best to see your doctor.
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