Diet and Colon Health

Diverticular Disease, Hemorrhoids and Constipation

Diet plays an important role in your overall health. Your diet can affect some common gastrointestinal conditions, including diverticular disease, hemorrhoids and constipation.

What is diverticulosis?

Diverticulosis is a condition in which the wall of the colon (large intestine) bulges outward, producing small pouch-like structures. These are most frequently located in the left side of the colon, but can occur throughout the entire colon. Diverticulosis is very common as we get older, affecting about  half of all people older than 60 years and is seen more commonly in developed countries. Both men and women are equally affected. Most patients do not have symptoms, and the diverticulosis is often discovered incidentally on sigmoidoscopy, colonoscopy or imaging.

What is diverticular disease?

Diverticular disease is defined as symptomatic diverticulosis and may take the form of any of the following:

Diverticulitis: Some people with diverticulosis can develop a condition called diverticulitis, which is when one of the pouches becomes inflamed and/or infected. This occurs in less than 5% of people with diverticulosis. The most common symptom of diverticulitis is abdominal pain. The pain can be mild to severe. There may also be nausea, vomiting, fever, chills or a change in bowel habits. You should contact your health care provider if you experience any of these symptoms. Mild episodes can be managed  at home with a clear liquid diet and oral antibiotics. However, antibiotics may not be needed in all cases. Severe cases may require hospitalization and or surgical management.

Diverticular bleeding: A small minority of people with diverticulosis can develop major bleeding from one of the pouches. This is known as diverticular bleeding and can be a life-threatening emergency.

Symptomatic uncomplicated diverticular disease (SUDD): This is the presence of abdominal symptoms (e.g. pain or change in bowel habits) without any overt inflammation of the pouches.

How does diet and lifestyle affect diverticular disease?

Diet and lifestyle habits may play a role in the management of diverticular disease. Research shows that the following may help reduce symptoms of diverticular disease and decrease the risk of developing complications like diverticulitis or diverticular bleeding:

  • Increasing fiber in the diet
  • Mediterranean diet (e.g., plant-based foods like whole grains, vegetables, legumes and fruits)
  • Weight reduction
  • Exercise or physical activity
  • Avoiding non-steroidal anti-inflammatory drugs (except low dose aspirin which is fine to take)
  • Avoiding opiates

Contrary to popular belief, certain foods such as seeds, corn and nuts need not be avoided with diverticulosis. The following may increase the risk of developing symptoms of diverticular disease and complications like diverticulitis or diverticular bleeding:

  • Obesity
  • Smoking
  • Excessive red meat (e.g., more than 3 portions per week)

What are sources of fiber?

Fiber is found in fruits, green leafy vegetables, beans, peas and grains like oats. There are two types of fiber:

Soluble fiber dissolves in water and may slow digestion, making you feel full. Soluble fibers may help lower cholesterol, but may increase intestinal gas. Sources of soluble fiber include oat cereals, lentils, apples, oranges, pears, oat bran, barley, strawberries, flaxseeds, beans, psyllium, celery  and carrots.

Insoluble fiber does not dissolve in water and may  have a laxative effect by adding bulk to the diet and helping to prevent constipation. These fibers tend to cause less gas. Sources of insoluble fiber include whole wheat, wheat and corn bran, brown rice, leafy vegetables and other grains.

More information about dietary fiber can be obtained from the Dietary Guidelines for Americans, published by the U.S. Department of Agriculture and U.S. Department of Health and Human Services.

Your doctor may also recommend taking one of several commercially available fiber products one to three times a day. These fiber products are available in powder, pill and wafer form. It is important to drink plenty of fluids throughout the day when taking fiber supplements. It is also important to realize that it may take months before you notice an improvement in your bowel habits when you change your diet. The bowel is difficult to regulate over a short period of time.

What are hemorrhoids?

Hemorrhoids are blood vessels (veins) in the anus and rectum. When these blood vessels become swollen or enlarged, symptoms may develop. Many people have hemorrhoids without any symptoms.

How common are hemorrhoids?

Hemorrhoids are very common. By age 50, nearly half of Americans have hemorrhoids. Nearly 1 in 20 (about 15 million) people in the US have sought medical care for symptomatic hemorrhoids. Many  more have problems with hemorrhoids, but never seek formal medical attention.

What are the different types of hemorrhoids?

External hemorrhoids are dilated veins covered by the skin near the anal opening. They may be felt as bumps or lumps at the anus and cause symptoms when swollen and enlarged.

Internal hemorrhoids are dilated veins inside the rectum (inside the anal opening). However, they may enlarge and can protrude (prolapse) out through the anus.

What are the symptoms of hemorrhoids?

Symptoms of external hemorrhoids include pain, itching, pressure and bleeding. They can also cause fecal seepage and mucus discharge. They can often be felt as a bulge in the skin near the anal opening.

Internal hemorrhoids may cause painless rectal bleeding, which usually is seen as bright red blood on the toilet paper or in the toilet bowl.

How do hemorrhoids occur?

Hemorrhoids may develop after longstanding constipation, prolonged diarrhea or repeated straining during bowel movements. They are also seen commonly in any condition that leads to increased pressure inside the abdomen such as pregnancy, lifting heavy weights and prolonged sitting.

Does diet affect hemorrhoids?

There are no foods or diets known to cause hemorrhoids. Reducing constipation by drinking plenty of fluids and eating a well-balanced diet with  at least 20-25 grams of fiber a day may decrease the chances of developing hemorrhoids.

How are hemorrhoids diagnosed?

External hemorrhoids may occasionally be seen when the doctor examines the anus and rectum. A full rectal exam includes both a visual inspection of the anus and usually, insertion of a gloved finger into the rectum.

Internal hemorrhoids may be identified externally if they protrude with straining. They may also be detected using a flexible or rigid tube with a light and camera that is inserted into the anus to see inside the anal canal and lower rectum. The rigid tube is called an anoscope and the flexible tube is a sigmoidoscope.

How are hemorrhoids treated?

Most hemorrhoids resolve on their own or by taking a few simple steps. These steps include avoiding straining during bowel movements, limiting prolonged time on the toilet and treating hard stools or constipation with increased fluid intake, increased fiber in the diet, stool softeners or laxatives. For inflamed hemorrhoids, over the counter or prescription creams and suppositories are also available. Cleansing the anal area with a moist towel after a bowel movement may be helpful. A sitz bath can help relieve hemorrhoidal irritation as well. Sometimes hemorrhoids persist even if these steps are followed and may require further medical treatment. These treatments include placing rubber bands around the hemorrhoid, injecting chemicals, applying heat to the hemorrhoids or surgery. These treatments must be performed by a physician who is specially trained in these techniques.

Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.