A Conversation with Gastroenterologist Trisha Pasricha
Hemorrhoids are among the most frequent gastrointestinal complaints in the United States, sending millions of people to clinics and emergency rooms each year and costing the health system hundreds of millions of dollars. Despite their prevalence, the causes remain poorly defined. Constipation, straining, pregnancy, and low-fiber diets have all been implicated, but physician-investigator Trisha Pasricha, MD, MPH, and colleagues wondered whether the modern habit of lingering in the bathroom with a phone might also play a role.
In a study of 125 adults undergoing routine colonoscopy at Beth Israel Deaconess Medical Center (BIDMC), the team surveyed participants about toilet habits, smartphone use, diet, and activity levels, then compared responses with direct colonoscopy findings. The results revealed some surprising patterns:
- Two-thirds of participants admitted to using their phones on the toilet.
- Smartphone use on the toilet was associated with a 46% increased risk of having hemorrhoids.
- Phone users were five times more likely to sit for more than five minutes per trip.
- Younger adults were especially prone to the habit.
- Smartphone users reported less weekly exercise than non-users.
We asked Dr. Pasricha what these findings, published in PLOS One mean for patients and how they might change the way we think about everyday bathroom routines.
Q: What inspired your study on hemorrhoids and smartphone use?
A: I'm a gastroenterologist and I'm also writing a book that's coming out in the spring called You've Been Pooping All Wrong. And one of the chapters I'm writing is about hemorrhoids.
My colleagues and I in GI, we all tell our patients not to spend longer than a couple minutes on the toilet. We all have this sense that spending too long on the toilet is bad for you. But when I was writing this book chapter, I went back to literature to see what is this five-minute rule really based on? And the data is pretty sparse out there.
I was struck by this fantastic old study from 1989 in The Lancet on hemorrhoids and reading the newspaper on the toilet. It was a very simple study of about 100 patients. They looked at how many patients read the newspaper on the toilet and then doctors had a look to see how many of them had hemorrhoids. That made it into The Lancet!
But that study did find that there was this association. More hemorrhoids were found amongst people who spent time reading on the toilet. Now in 2025, I don't think anyone's reading the newspaper, but we know everybody's on their phones in the bathroom. So I thought we needed to update this literature for the modern TikTok era.
Q: What did your team investigate and what did you find?
A: In our study, about two-thirds of people reported using smartphones on the toilet. When we asked those users whether they ever sat on the toilet longer than they intended because of their phone, only about half said yes.
But here's the interesting part: smartphone users were five times more likely to spend more than five minutes on the toilet compared to non-users. So clearly, people are spending more time — but only half of them recognize that their phone is the reason.
We also looked at whether constipation or straining might explain the extra time, but there were no differences between the groups. That suggests the phone itself is driving the behavior. I think what's happening is that time sort of slows down when you're scrolling, and people don't realize just how much longer they're sitting there. Half admit it, but the other half are still doing it without making the connection.
Q: Let's go back to basics — what even are hemorrhoids? How serious are they?
A: Well, they're more of a nuisance than a something that's really going to, you know, kill you, but they can really impact somebody's quality of life. In terms of healthcare expenditure, they are the third most common reason people see their doctors.
We all have hemorrhoid cushions — vascular cushions made of blood vessels, connective tissue, and smooth muscle — right at the end of our GI tract. That's a normal part of our body. It's only when they get engorged that we notice them and that that's when they become symptomatic and they're called hemorrhoids.
Hemorrhoid cushions serve this purpose where they help provide a barrier between all of the stool and gas that's in your body and the outside world. They can kind of tell the difference between solid, gas, liquid, and help detect when it's safe to pass gas but not have a whole bowel movement in public. They are a cushiony barrier that that saves you from. . . social embarrassment.
When they become engorged internally, they often bleed and become uncomfortable. The external ones are the ones that can cause itching. It can feel like there's a bump, it can feel like there's something there and they're difficult to clean. And then that kind of like causes this vicious cycle of like more discomfort, more irritation. The more angry they get, the more likely they are to bleed. It can really just spiral.
Q: How do social dynamics — particularly sex differences — influence bathroom habits and related health issues?
A: I love that you asked that. Let me just say it: we did suspect there was going to be a sex divide. We stratified our data by sex and you can see there's a trend that men are spending more time on the toilet. That surprised absolutely nobody in our in our group. But we were underpowered to really prove that statistically, so I think that is the question we should ask for our next study.
There's also something to be said about how in general with GI concerns, women are more likely to get help. Actually, they're more likely to seek treatment in general, and sometimes men are a little bit less likely to get help and talk to their providers. We often see men who come in having been dragged in by their wives and they're like, "I actually don't have a problem." And their wives say, "You spend 40 minutes in the bathroom every morning. There's a problem."
Sometimes hearing it from another person can make you realize what you are experiencing is not normal.
Q: Why is it important to normalize conversations about gut health and other 'embarrassing' topics?
A: I went into gastroenterology because I saw as a med student and early on in my life that you can have almost everything you want in life, but if you can't eat the food you love and poop it out comfortably, you don't have a quality of life. And if we can't bring ourselves to even talk about it, we can't get help and physicians can't help our patients.
It's a big passion of mine to try to normalize these conversations. The gut is just like any other part of your body and I think we need to treat it with respect and love.
