A new study reveals that scrolling on your phone while on the toilet may increase the risk of hemorrhoids, with the time spent seated emerging as a stronger predictor than straining.
Study: Smartphone use on the toilet and the risk of hemorrhoids. Image Credit: sale.man / Shutterstock
In a recent study published in the journal PLOS ONE, researchers in the United States investigated the association between the use of smartphones on the toilet and the odds of having hemorrhoids visualized during colonoscopy. Smartphones have become an integral part of everyday life, influencing personal hygiene and health behaviors. There is a growing trend of using smartphones on the toilet, which could have health implications. Hemorrhoids represent the third most common gastrointestinal (GI) diagnosis, with more than $800 million in annual healthcare expenditure.
More patients seek care for hemorrhoids than for irritable bowel syndrome, colon cancer, inflammatory bowel disease, or diverticular disease. While straining with defecation and constipation have been historically associated with hemorrhoids, protracted sitting on the toilet is also suggested as a risk factor for hemorrhoids.
About the study
In the present study, researchers evaluated the associations between the use of smartphones on the toilet and the prevalence of hemorrhoids. Adults aged 45 years and older undergoing a screening colonoscopy between August 1, 2024, and December 15, 2024, were recruited. Questionnaires on lifestyle factors, dietary habits, and demographics were administered online.
Participants were asked about their smartphone habits, including the duration and frequency of use, as well as specific activities performed while using the toilet. The Rome IV questionnaire was administered to assess GI function and symptoms. Endoscopic reports of participants were reviewed to determine the presence of hemorrhoids. In a sensitivity analysis, two blinded endoscopists also reviewed rectal retroflexion images, showing substantial agreement (Cohen’s κ = 0.62). A chi-squared test was used to assess the differences in categorical variables between smartphone users and non-users.
For continuous variables, linear regression was used to examine the association between smartphone use and the prevalence of hemorrhoids, controlling for sex, body mass index (BMI), fiber intake, and physical activity. The odds ratios (ORs) for hemorrhoids associated with using smartphones were estimated using multivariate logistic regression.
Findings
Of the 143 participants invited, 125 completed the survey and were included in the analysis. Of these, 66% used smartphones on the toilet. Smartphone users were younger and had significantly less physical activity than non-users. No differences were observed in BMI, sex, and Rome IV criteria for functional constipation or irritable bowel syndrome between groups.
Approximately 93% of smartphone users reported using their device at least once or twice a week, with 55% indicating that they used their smartphone most of the time. Smartphone users spent more time on the toilet than non-users. About 37.3% of smartphone users and 7.1% of non-users spent more than five minutes on the toilet per visit. Among smartphone users, males tended to spend at least six minutes more on the toilet than females, but this difference was not statistically significant.
Moreover, 35% of smartphone users acknowledged that their use of smartphones led to spending more time on the toilet at least once or twice weekly. Hemorrhoids were visualized on colonoscopy for 43% of respondents. There were 46% higher odds of hemorrhoids on colonoscopy among smartphone users after multivariable adjustment (p=0.044). Reading news and social media were the most common smartphone activities on the toilet.
Conclusions
In sum, the findings suggest a higher prevalence of hemorrhoids among individuals using smartphones on the toilet. Smartphone users spent substantially more time on the toilet than non-users. While hemorrhoids have been historically linked to increased straining, the current results do not support it, as no differences were observed in straining between non-users and users.
The multivariate model also indicated that straining did not independently predict the presence of hemorrhoids. Besides, the two groups had no differences in the Rome IV criteria. As such, time spent on the toilet might predict hemorrhoids more accurately than straining. This increased time may be related to the passive engagement facilitated by smartphones.
Prolonged sitting outside the toilet, e.g., at a desk, involves some support to the pelvic floor through a couch or chair. The authors posit that sitting on a toilet seat with no support to the pelvic floor results in a disproportionate increase in pressure in hemorrhoidal cushions. These cushions may become engorged over time, resulting in noticeable hemorrhoids.
The authors note that their findings are cross-sectional, limited to a single screening-colonoscopy cohort, and partly reliant on self-reported behaviors, which may affect the generalizability of their results. Additional limitations include the potential for recall bias in questionnaire responses and the fact that the study population (adults aged 45 years or older undergoing colonoscopy) may not be representative of younger or healthier groups. They suggest counseling patients to limit toilet sitting to under five minutes, especially when using smartphones.
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