Hemorrhoids can be annoying and reduce your quality of life, but they can also be dangerous, especially if you’re an older adult. For instance, they can masquerade as colorectal cancer (at the anal region) or anal melanoma, an aggressive form of cancer that can be treated only in the early stages.
So, if you’re feeling excruciating pain and rectal bleeding, reach out to your doctor at once because your hemorrhoid might not be what you think.
However, if everything’s greenlit on the doctor’s side, but you’re still finding it challenging to manage internal and external hemorrhoids — which is understandable — you may be looking for ways to make your life easier without surgery.
After all, while hemorrhoid surgery doesn’t sound as gloomy as patients with gastric cancer undergoing gastrectomy, it’s still risky business.
Fortunately for you, we’ve covered everything you need to know about hemorrhoids and old age. Let’s get into it.
How many older adults have hemorrhoids?
While hemorrhoidal data on elderly patients is limited, statistics indicate that people between the ages of 45 to 65 are more likely to experience hemorrhoids. Plus, Caucasian people are 1.5 times more likely to have hemorrhoids than African Americans.
But hemorrhoid prevalence declines steeply after age 65, with no difference in its occurrence between the sexes. So, most older adults — if we define them as people above 60 — may not experience hemorrhoids as commonly as people in their forties.
Why do older adults develop hemorrhoids?
Despite having a low likelihood of developing hemorrhoids, older people can still get them because of age-related tissue changes, hypervascularization, chronic constipation, and medication side effects.
1. Age-related tissue changes
Hemorrhoids develop when the anal cushions deteriorate or disintegrate. This usually happens when the collagen fibers and elastin tissues distort and rupture in old age, causing the anal canal lining to slide down and abnormally displace the anal cushions. Plus, surgical risk factors — such as anal tissue damage due to a previous operation — also play a role.
If you have a history of hemorrhoids, the terminal branches of the superior rectal artery (which supply blood to the anal cushions) increase in diameter and have greater blood flow as you age.
This increase in arterial flow can cause blood to coagulate in your anal cushions and cause painful hemorrhoids, which can redevelop even after surgical removal.
3. Chronic constipation
While hemorrhoid prevalence decreases after age 65, chronic constipation (CC) incidence actually increases, with 15% to 30% of people being diagnosed with the condition. This is because of chronic medical conditions, physical inactivity, GI disorders, and chronic medication use. And straining and hard, lumpy stools are one of the major risk factors for hemorrhoids.
4. Prolonged sitting
Anal resting pressure in patients with hemorrhoids is higher compared to normal people. These people also experience lower rectal compliance, which might lead to straining (and hemorrhoids as a result).
Moreover, even if you’ve never had hemorrhoids, prolonged sitting can contribute to them. However, further research is needed to prove this claim.
5. Medication effects
Some medications can lead to constipation, impact blood clotting, and affect bowel movements. These include nonsteroidal anti-inflammatory drugs (NSAIDs), hypertension medications, and antidepressants.
For instance, anticholinergic drugs like scopolamine, glycopyrrolate, and benztropine can contribute to or worsen constipation, which can lead to straining and the development of hemorrhoids.
How do hemorrhoids interact with common health conditions in old age?
What happens if you get hemorrhoids and have a health condition like diabetes or heart disease? How do these diseases influence the development of hemorrhoids and vice versa? Let’s find out.
1. Coronary heart disease
Coronary heart disease (CHD) occurs when the arteries that supply blood to your heart are blocked with fatty deposits. On the surface, hemorrhoids and CHD may not have a link. However, studies have shown that people with hemorrhoids are more likely to get CHD compared to those without hemorrhoids.
For instance, a 12-year cohort study found that the incidence rate of CHD was 1.36 times higher in people with hemorrhoids than in people without the condition.
Uncontrolled blood sugar or diabetes can cause dehydration and lead to poor circulation. This can contribute to constipation, a classic risk factor for hemorrhoids. In severe cases, diabetes can disrupt gut contractions and may make patients strain, leading to hemorrhoids.
3. Irritable bowel syndrome
Irritable bowel syndrome (IBS) is a disorder that affects the gut. It can cause constipation, diarrhea, and sometimes both. And several studies have proven the link between hemorrhoids and IBS.
For instance, in a 2009 study, IBS patients were shown to have a 33.3% likelihood of having hemorrhoids, compared to a 15.7% likelihood for those without IBS.
How to manage hemorrhoid symptoms in old age?
Now that you’ve learned why you might get hemorrhoids when you’re older, let’s look at ways you can manage them:
1. Use topical treatments
If your hemorrhoids are painful and you don’t want to take medications that conflict with any ongoing drugs, you can start with topical treatments like ointments, wipes, and creams.
Topical solutions like Preparation-H® and PP110 Gel contain anti-inflammatory agents, corticosteroids, and anesthetics, which have been shown to reduce the pain, swelling, itching, and discomfort that come with hemorrhoids.
2. Take sitz baths
A sitz bath is the second thing you should try if you’re struggling with hemorrhoids. If you have a bathtub, use that. But if you don’t have a tub, you can purchase a dedicated sitz bathtub. Once you have it on hand, here’s what to do:
- Fill your bathtub with four inches of lukewarm water. It can be on the colder side.
- Use non-slip shoes when moving in and out of the tub. You don’t want to risk a fall.
- Sit in the bath for ten minutes per session, two or three times per day.
3. Develop good bowel habits
Sitting on the toilet for too long and too many times a day can cause hemorrhoids. So, if you find yourself going to the bathroom every few hours and straining for more than two or three minutes, walk out and try again.
Also, try not to hold it in because stools can get backed up and cause constipation, which can last for days and cause you to need an enema.
4. Increase physical activity
People with low to moderate physical activity are 1.24 times more likely to have hemorrhoids than those with higher levels of exercise.
So, if you have stopped walking or exercising because you’re afraid that you’ll trip, start working out for 20 to 60 minutes three to five days a week. It can improve circulation, promote regular bowel movements, and strengthen pelvic muscles, which will keep your system “regular.”
You could perform aerobic activities like swimming and walking or controlled-movement exercises like yoga. Try to avoid exercises that place pressure on the core, lower back, and backside, such as rowing, weightlifting, and cycling.
5. Eat more fiber
Fiber improves stool consistency and bowel function. This is especially true for soluble gel-forming fiber, which can hold water to make sure it isn’t absorbed by the colon. An example of a soluble fiber that softens hard stool in constipation and firms up liquid stools in diarrhea is psyllium husk.
So, if you have a gastrointestinal condition that causes constipation or diarrhea, you can benefit from consuming more fiber because both lead to an increased risk of hemorrhoids.
What are the medical treatment options for hemorrhoids in old age?
If you’re unable to manage hemorrhoids with topical treatments or lifestyle changes, you can go for rubber band ligation, sclerotherapy, or infrared coagulation for old-age hemorrhoid treatment.
1. Rubber band ligation
A rubber band ligation is when a physician at a colon and rectal surgery center wraps a rubber band around the base of first- to third-degree internal hemorrhoids to stop their blood supply. This causes them to shrink and slough away within a week.
Since this procedure is minimally invasive, non-surgical, and can be performed at the office or out-patient clinic, old age isn’t considered a contraindication for it. This means you can easily get it done as an older adult.
Sclerotherapy is a 15-minute non-invasive procedure that involves a doctor injecting a hypertonic salt, 5% phenol in oil, or a 5% quinine and urea solution into your hemorrhoid. It damages the blood supply to the hemorrhoid, causing it to shrivel and fall off.
Just like rubber band ligation, this procedure is relatively painless, can be performed on older patients, and can improve almost 90% of hemorrhoid cases within six weeks.
3. Infrared coagulation
Infrared coagulation is a procedure that uses infrared light fired in 0.5 to 2-second pulses to damage the blood supply to first- to third-degree hemorrhoids. It has a success rate of 67% to 96%, and doctors use it to remove two to six hemorrhoids at once.
And since it isn’t invasive, older adults are ideal patients for this procedure.
Hemorrhoids and old age: now you know what to do
Managing hemorrhoids may seem like a headache when you’re above 60. But you can make the process easier by understanding why they occur in the first place and taking steps to make sure you don’t perform activities that cause you pain.
You can also make use of sitz baths, topical treatments, and dietary changes to ensure you become pain-free. But if your hemorrhoids don’t go away and remain inflamed, nonoperative treatments like rubber band ligation may get you the relief you’re looking for.
Frequently-asked questions about hemorrhoids and old age
Are hemorrhoids common in the elderly?
If we define elderly people as those above 75 years, then no, they do not experience hemorrhoids as often as those in the 45 to 65 age bracket. That’s because the incidence of hemorrhoids declines after 65.
Can hemorrhoids go away with age?
No, hemorrhoids don’t go away with age. While people below 20 and those above 65 typically don’t get hemorrhoids, they absolutely can get minor ones or even major ones because of a low-fiber diet, poor bathroom habits, and constipation.
Can older adults have hemorrhoid surgery?
Yes, older adults can have hemorrhoid surgery if nothing else works. The risk and incidence of postoperative complications (like acute pulmonary embolism) are similar in both older adult (<75) and elderly (≥ 75) patients. However, older patients undergoing surgery are generally at a higher risk of complications than younger ones.