Dietary habits associated with internal hemorrhoidal disease: a case-control study

Tunis Med. 2019 Apr;97(4):572-578.


Background: Pathophysiology of the internal hemorrhoidal disease is poorly understood but seems to be multifactorial. Some types of food and lifestyle have been assumed to increase the risk of internal hemorrhoidal disease. Aims: To identify alimentary habits that are associated with internal hemorrhoidal disease.

Methods: Fifty patients and 50 healthy controls matched for age and sex were enrolled in a case-control study. Food intake of patients and controls was assessed by a nutritionist using the 72-hour recall method and the food frequency questionnaire. Data regarding their eating behavior were also collected using an eating behavior questionnaire.

Results: Mean age of patients was 42 ± 11.8 years with a female to male ratio of 1.17. Prolapse and anal pain were the most common presenting symptoms. Constipation was found in almost all patients. High-fiber foods were less often consumed by patients than by controls with the difference being significant for vegetables, fruits and cereals. Regarding spicy aliments, consumption of pepper and chili powder was found to be significantly less frequent in patients than in controls. Multivariate analysis revealed daily fiber intake < 12 g (OR 7.08; 95%CI 1.24 - 40.30; p=0.027) and daily water intake < 2L (OR 8.68; 95%CI 3.07 - 24.51; p<0.001) significantly increase the risk of internal hemorrhoidal disease.

Conclusions: Internal hemorrhoidal disease was more frequently observed in patients with low-fiber diet and a reduced water intake. These dietary habits were described as precipitating factors of constipation which was found in almost all patients.

MeSH terms

  • Case-Control Studies
  • Constipation / etiology*
  • Diet*
  • Dietary Fiber / administration & dosage
  • Drinking
  • Female
  • Hemorrhoids / etiology*
  • Humans
  • Male


  • Dietary Fiber