A dietitian’s guide to surviving piles

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  • Piles or haemorrhoids are physically uncomfortable and embarrassing to talk about.
  • What you eat increases or decreases your risk of developing piles.
  • Here are some tips from a dietitian to ease the pain and discomfort of piles. 

Piles result from swollen veins in the lower anus and rectum and can cause pain and bleeding during bowel movements. Registered dietitian Nicki de Villiers recommends a high fibre diet with lots of water. 

"Piles are usually preceded by constipation, so the main thing is to follow a diet that is moderately high in fibre. If there's pain and bleeding, it is important that you don't eat excessive fibre, but if it is 'normal' piles, the thing that will help and also help with prevention, later on, is a high fibre diet and quite a bit of fluid with that," she explains. 

"We need to ensure that the stool is soft, and you can do that by increasing especially soluble fibre, the main sources of which are oats, fruits, vegetables and legumes. That means that the fibre will absorb fluids and cause a softer stool which is easier to pass," she continues. 

Types of fibre

  • Soluble fibre: This is a kind of fibre that dissolves in water and occurs in foods like oats, peas, beans, apples, citrus fruits, carrots, barley and psyllium.
  • Insoluble fibre: This does not dissolve in water and is found in foods like whole-wheat flour, nuts, beans and vegetables like cauliflower. 

"The insoluble fibre in foods like Provita or All-Bran, is also good and should increase the bulk of the stool, but won't necessarily cause a soft stool. That's why the most important thing is soluble fibre," explains de Villiers. 

Watch out for seeds

People can have problems with the intake of excessive amounts of little pips, seeds, popcorn husks, seeded bread and crude fibre. If these aren't thoroughly chewed, they can end up intact in the colon. The problem with that is that the stool tends to form little lumps around these objects, leading to a stool that is broken and not continuous. In the acute stages (of piles), we stay away from crude fibre and increase the soluble and insoluble fibre with an increased intake of fluid. 

So, what foods cause piles? 

De Villiers says that although there are no foods that directly cause piles, highly refined carbohydrates like white flour foods should be enjoyed in moderation. 

"There is no food that will primarily cause an increased risk of piles, it's more the deficiency of fibre. So, some people will say avoid white flour foods like a pizza crust, scones and white bread, but they won't cause piles if you eat, for instance, white toast in the morning, but then, for the rest of the day, consume foods with enough fibre. However, it becomes problematic if you eat only refined foods," she explains. 

One day meal plan

For breakfast, de Villiers recommends oats with milk and a little bit of honey or any high fibre cereal.

"A wholewheat bread without pips and seeds is also good, like brown bread with the crushed whole wheat," she says. 

In serious cases of piles where patients are given only white bread, de Villiers recommends adding soft fruit like pawpaw or soft prunes. 

Lunch can be guided by what you have for dinner.  

"If you had whole wheat pasta for supper, you can use the leftovers as a base for a pasta salad or a rice salad. You can add feta cheese, whole wheat couscous or tuna to the pasta salad," says de Villiers. 

For dinner, she recommends brown rice with chicken or fish and two vegetables (e.g. a green and an orange veg) or a big salad. 

As a snack, de Villiers recommends fruit with yoghurt, which stimulates the growth of gut bacteria. 

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