Why are people in their 20s developing fissures and piles? Doctor reveals habits that may be putting you at risk

New Delhi: For many people in their 20s, rectal bleeding, pain or a lump around the anus can seem like a problem that belongs to a much older age group. But anal fissures and haemorrhoids, commonly called piles, can affect young adults too. Talking to News9 Live, Dr Prashant Kumar, Senior Consultant – General, Laparoscopic, GI & Robotic Surgery at PSRI Hospital, New Delhi, says bowel habits and lifestyle factors can play a major role in triggering these conditions.

The two conditions are often confused, although they are not the same. An anal fissure is a small tear in the lining or skin of the anus, whereas haemorrhoids are swollen vascular cushions in and around the anus and lower rectum. A fissure is particularly common in younger adults, the NHS notes that anal fissures are more common between the ages of 15 and 40, while the risk of haemorrhoids generally rises with age.

The constipation connection

The common thread between the two conditions is often the way a person passes stool.

Hard, dry or bulky stools can stretch and injure the anal lining, causing a fissure. The resulting pain can trigger tightening of the anal sphincter, making bowel movements even more uncomfortable and potentially creating a cycle in which the fissure repeatedly reopens. Severe or persistent diarrhoea can also irritate the area and contribute to fissures.

For haemorrhoids, repeated straining increases pressure on the veins and supporting tissues in the lower rectum. Chronic constipation and diarrhoea, a low-fibre diet and prolonged sitting on the toilet are recognised risk factors. “One of the biggest contributing factors is chronic constipation,” says Dr Kumar.

A large 2025 systematic review and meta-analysis covering more than 8.9 million people worldwide found haemorrhoidal disease to be common overall, while constipation was among the factors associated with greater likelihood of haemorrhoids. The study also found associations with obesity, pregnancy, diabetes and family history. Importantly, however, the researchers did not establish that haemorrhoids are becoming more common specifically among people in their 20s.

Why today’s lifestyle may be making bowel problems worse

Young adults often spend much of the day sitting, at a desk, in a car, in class or in front of a screen. That does not mean sitting itself inevitably causes piles, but prolonged toilet sitting and straining are recognised concerns.

Diet can also matter. A diet dominated by refined and highly processed foods may provide less fibre than a diet rich in whole grains, pulses, vegetables, fruits, nuts and seeds. The Indian Council of Medical Research–National Institute of Nutrition recommends fibre-rich foods as part of a healthy diet and notes that dietary fibre helps proper bowel function, reduces constipation and lowers the risk of developing piles.

Adequate fluid intake is also important, particularly when increasing fibre, because fibre works best when accompanied by sufficient fluids. Regular physical activity can additionally help maintain normal bowel function and reduce constipation.

Ignoring the urge to pass stool can further disrupt normal bowel habits. The NHS specifically advises people with fissures not to repeatedly ignore the urge to have a bowel movement.

The phone-on-the-toilet habit is not as harmless as it looks

There is now another modern habit worth paying attention to: taking the smartphone to the toilet and staying there long after the bowel movement is over.

A 2025 study published in PLOS One looked at 125 adults undergoing screening colonoscopy. Two-thirds reported using smartphones on the toilet. Smartphone users were more likely to spend longer periods there, and after adjustment for factors including age, sex, BMI, physical activity, straining and fibre intake, smartphone use on the toilet was associated with a 46 per cent higher likelihood of haemorrhoids. However, the study was small and cross-sectional, so it shows an association rather than proving that smartphone use causes haemorrhoids.

The finding nevertheless fits with established medical advice to avoid unnecessarily prolonged toilet sitting. “Spending excessive time on the toilet, particularly while using a phone, keeps pressure on the anal veins for longer and is a recognised risk factor for haemorrhoids,” Dr Kumar says.

In practical terms, the toilet should not become another place to catch up on social media, news or messages. Go when you need to, avoid straining and leave once you are done.

Fissure or piles? The symptoms can give clues

An anal fissure typically causes intense, sharp or burning pain during bowel movements. The pain can continue for minutes or even hours afterwards. Small amounts of bright-red blood may appear on toilet paper or on the outside of the stool.

Haemorrhoids can behave differently. Internal haemorrhoids commonly cause painless bright-red bleeding, while external haemorrhoids may produce itching, swelling, pain or a lump. A thrombosed external haemorrhoid can cause sudden, severe pain and a firm lump.

But there is an important caveat: rectal bleeding should not automatically be labelled as piles. “People should not assume that every episode of rectal bleeding is due to piles.”

The American Society of Colon and Rectal Surgeons recommends an appropriate anorectal examination for patients with suspected haemorrhoids and notes that selected patients with symptomatic haemorrhoids and rectal bleeding may require complete evaluation of the colon. Other conditions, including inflammatory bowel disease, polyps and colorectal cancer, can also cause rectal bleeding or changes in bowel habits.

What can people in their 20s do to prevent the problem

The goal is simple: make bowel movements soft, regular and easy to pass without straining.

That means:

• Eat more vegetables, fruits, pulses, whole grains, nuts and seeds.
• Increase fibre gradually if your current diet is low in fibre.
• Drink enough fluids, particularly when increasing fibre.
• Stay physically active.
• Do not repeatedly ignore the urge to pass stool.
• Avoid straining during bowel movements.
• Do not spend unnecessary time sitting on the toilet.
• Leave the phone outside the bathroom if it encourages prolonged sitting.

For an acute fissure, conservative treatment aimed at keeping stools soft is often enough to allow healing. The American Society of Colon and Rectal Surgeons recommends a high-fibre diet and, where appropriate, fibre supplementation, stool-softening measures, adequate water and warm baths or sitz baths. Most fissures do not require surgery.

Don’t keep treating the symptoms yourself

Because fissures and haemorrhoids can have overlapping symptoms, repeatedly buying creams or taking medicines without knowing the cause is not always the best approach.

Some over-the-counter treatments can be useful in appropriate circumstances, but prolonged or inappropriate use — particularly of steroid-containing preparations – should be avoided without medical guidance. Similarly, laxatives may be appropriate for constipation in some patients, but persistent constipation needs evaluation rather than indefinite self-medication.

A fissure that does not heal may become chronic and require prescription treatment to relax the anal sphincter and promote healing. Current colorectal guidelines include topical calcium-channel blockers or nitrates as medical options, with botulinum toxin and surgery considered in selected persistent cases.

When should you see a doctor

Young adults should seek medical evaluation if bleeding is recurrent, persistent or significant, or if symptoms are accompanied by severe pain, fever, pus or discharge, unexplained weight loss, black stools, weakness or a persistent change in bowel habits.

Heavy rectal bleeding, dizziness, fainting or light-headedness warrants urgent medical attention.

The bigger message is that piles and fissures are not simply an “older person’s problem”. Anal fissures are particularly relevant to younger adults, while haemorrhoids can occur at any age when bowel habits and pressure on the anorectal region create the right conditions. What may look like a minor lifestyle nuisance can become a recurring problem if constipation, straining and prolonged toilet sitting become part of the daily routine.