Does eating spicy foods -- red hot chili peppers, specifically -- exacerbate hemorrhoid symptoms?

This study found no evidence to support the popular contention that spicy foods, including red hot chili peppers, exacerbates hemorrhoid symptoms. Clinicians need not warn patients with hemorrhoids to avoid spicy foods. (LOE = 1b)

Altomare DF, Rinaldi M, La Torre F, et al. Red hot chili pepper and hemorrhoids: The explosion of a myth: Results of a prospective, randomized, placebo-controlled trial. Dis Colon Rectum 2006;49:1018-1023.  [PMID:16708161]

Randomized controlled trial (double-blinded)

Self-funded or unfunded

Concealed

Population-based

Spicy foods are frequently blamed by patients and clinicians for deleterious and explosive exacerbations of hemorrhoid symptoms. The investigators identified 50 adults (aged 37-57 years) affected by second-degree or third-degree hemorrhoids. Subjects randomly received (concealed allocation assignment) 2 identical blue capsules containing red hot chili pepper powder or placebo cellulose. The quantity of red hot chili pepper powder equaled the amount necessary to make a normal dish "spicy enough," as defined by the Association of Teachers of Italian Cuisine (equal to the "tip of the knife"). After baseline evaluation, patients consumed 1 of the capsules during the course of a regular meal. One week later, they repeated the treatment taking the other capsule. Subjects were instructed to avoid other foods potentially related to gastrointestinal symptoms, such as alcoholic drinks, coffee, and chocolate. Using a 10-cm visual analog scale, subjects scored the severity of hemorrhoid symptoms, such as bleeding and swelling, itching, pain, and anal burning before and 6, 24, and 48 hours after capsule ingestion. Both patients and clinicians remained unaware of the content of each capsule. Fortunately, hemorrhoid symptoms were low at baseline and remained low in all patients throughout the study, with no significant differences detected between the red hot chili pepper or placebo groups. The study was 90% powered to detect a 5% difference in hemorrhoid symptoms.