Yearly Archives: 2020

The late Joe Rella, pictured in June of 2019 with Comsewogue School District Superintendent Jennifer Quinn. Photo by Kyle Barr

There are only so many people who could have done the job that Dr. Joe Rella, the former Comsewogue superintendent, did — teacher, principal and finally head of schools. If the scores of affectionate tributes posted to social media are anything to go on, Rella is one of the few folks you could point to that has made the Port Jefferson Station/Terryville community what it is today.

Rella died last Friday at the too-young age of 69. He had been dealing with a diagnosis of bile duct cancer for the last few years, but still he kept at the job until he finally retired last year. Community members know there wasn’t a day that went by where Rella did not put himself forward for the benefit of the community, whether it was his weekly online story times or his constant attendance as the “piano man” at district concerts. Many in the community can point to examples of outreach and help he bestowed upon employees and students in the district.

North Shore residents often rightfully complain of their high taxes, the majority of which stem from school districts, but Rella showed that a school district can become the heart of the local hamlet and the epicenter for every goings-on in the area. It can become the source of pride and culture for residents, not only the entity that simply teaches students for 13 to 14 years at a time.

What we found in reporting on Comsewogue is that doors were always open. Most of the time, officials did not hesitate to speak on either positive events or district issues. In an age where there seems to be more and more red tape between district/school administrators and both journalists and the public, Comsewogue, under Rella’s guidance, showed just how effective being open to public comment could be. In a final interview with Rella before he retired, he spoke to one newbie editor of how important it was to listen to community feedback, no matter if it was negative and no matter if you may disagree with it. As a former music teacher, who brought music into everything he did, he said the important thing was to listen.

Rella was named one of TBR News Media’s People of the Year in both 1995 and 2010 for music and education, respectively. Though the papers have changed editors since then, the editorial staff was amazed reading those old articles, seeing just how much of the same man was in stories 25 years old as he was in articles written about him little more than half a year ago. There is a sense of compassion, of simply wanting to be there, to spread an awareness of purpose amongst students and staff and to act selflessly and to help define a community around a sense of selflessness and compassion.

Other supers have also made the list of People of the Year, including Elwood’s Ken Bossert — formerly Port Jeff superintendent — who has shown a similar sense of community engagement. 

Of course, we do not wish to diminish the hard work of the many heads of schools in our coverage areas, and we know many who have shown strides in district leadership. What we instead ask is for more people to look at the example Rella left in not just defining a school district, but defining neighborhoods and neighbors, of being the precedent which every student and even most residents could look toward. He was the one who looked to building trust not by demanding loyalty, but by creating a space everybody feels they’re on the same side and that all are working toward goals that benefit everyone. 

Rella will be missed, but his example remains one that all should live by.

The White House

By Daniel Dunaief

Daniel Dunaief

I want the weakest possible president in 2020.

As a representative democracy, the United States uses a system of governance that relies on checks and balances. Everything about the history of the country makes it clear that a collection of leaders, each with limited power, should reflect the diverse nature of the country, with states that have small populations getting equal representation in the Senate.

Whenever one of the three branches of government oversteps its bounds, the other two have the opportunity to keep that one in check. If, for example, the executive branch, through the president of the United States, takes actions that the legislative or executive branches find objectionable or questionable, Congress or the Supreme Court can hold that president accountable.

So, how do we ensure those checks and balances? Where do we find exactly the right kind of weak president who can do just his or her job without trying to tell the courts what to do or legislate new laws favorable to the officeholder?

Most presidents, including every candidate who seems to be running now, appear to be convinced that he or she will be a strong leader with a vision for the country that takes us to greater heights or that makes us a better nation.

That’s lovely, but no president can do it alone. The government should be a team effort, pulling together people with a drive to contribute to the world through public service and to represent not only personal opinions, but the values, goals and concerns of the entire nation.

That seems almost impossible, given the divided nature of the country as we enter the 2020 election, right? Someone is always winning and someone is always losing.

That doesn’t have to be the case if a president sees and understands the limits of their power.

While this may seem like a direct rebuke of President Donald Trump (R), it is not. If Vermont Sen. Bernie Sanders (I), who seems to be gaining momentum with each passing primary, wins the Democratic nomination and then becomes president, I don’t want him to be powerful, either.

Some of his ideas, like free college and Medicaid for all, seem compelling on the surface, but many Democrats, Republicans and Independents wonder how exactly he’ll pay for all of those ideas. I enjoy reading dystopian fiction, like “1984,” “The Giver,” and “Fahrenheit 451,” to name a few. The conclusions of all of them are that utopia doesn’t work and big government creates even bigger problems, particularly for the individual.

The idea of Medicaid for All may seem appealing because of the frustration so many people feel with their medical insurance, until they imagine the bureaucratic machine known as the federal government making decisions about their medical coverage. Many of us want to make informed choices.

That brings me back to the choice for president. In the next eight months or so, as we prepare for the onslaught of advertisements telling us how and why the other candidate may ruin our lives, We the People can do something about it. If we truly believe a Democrat will win the White House, we can vote for Republicans in Congress. If we believe Trump will continue to share his inspirational Twitter messages wishing everyone well — just a bit of sarcasm here — we should vote Democratic in all the other races.

I don’t want Sanders expanding government and running up a tab that even higher taxes seem incapable of paying, while I also don’t want Trump getting a free pass to follow his impulses where they take him and the rest of the country. For me, the best 2020 choice is a weak and controlled president.

Regina Miano and Karen Romanelli, pictured with publisher Leah S. Dunaief, accept the Reader's Choice Award on behalf of the Long Island Museum in Stony Brook. Photo by Beverly C. Tyler

By Leah S. Dunaief

Leah Dunaief

As many of you know, because we have been publicizing it and because it created a bit of a buzz in town, we recently had a reception at the Three Village Inn for well over 100 guests. The purpose was to celebrate the winners of the Readers’ Choice contest in which their customers voted these select businesses the best in their business categories. It was a relaxed and fun evening where everyone seemed delighted to be there and party together and, in some cases, even to do business with each other. We had our talented videographer filming the proceedings.

What you may not know is that the video, with the winners walking the red carpet to accept their awards and to explain how they got into their respective businesses, is now up on our website for viewing. Just go to our website tbrnewsmedia.com and you will find the window, labeled TBR Readers’ Choice 2019 Reception Videos, on the top right-hand side of the home page. When you click on that, it will open to reveal a choice. You can just watch the film in its entirety, fairly long, or by clicking on the prompts you can bring up the playlist and advance to any one of the recipients or hopscotch throughout the video. You can also pause anywhere to watch the rest later or to share.

I hope you enjoy this second look if you were there — or perhaps first look if you weren’t — at this jolly community event, which we will make an annual. It is an index of some of the best businesses in the local area and, I hope, an encouragement to shop locally.

We are now clearly in the events business. Readers’ Choice was our third theme, the other two being the longstanding reception for People of the Year, our 44th, coming up March 22 at the Three Village Inn, and Cooks, Books & Corks, our other annual event, at which we have delicious tastings from local restaurants combined with books presented for sale by local authors. “Corks,” of course, refers to the libations that accompany the meals. CB&C will again be held in September at the Bates House in Setauket.

Now you might be surprised that we have wholeheartedly embraced the events business. It certainly is a wonder to me. We started our professional life here on the North Shore of Long Island as a community newspaper. I liked to write, didn’t like to be edited up the line, as I was when I was working at Times Inc. in New York City, loved the villages and meeting residents, and felt we had something to offer that wasn’t already here. Over the past four-plus decades, we have taken pride in advancing the interests of our hometown, communicating the news, issues and entertainment offerings, and strengthening the sense of community. We have also struggled mightily to stay afloat financially so that we could do all those things.

We all know that newspapers — and other news media as well — have been totally disrupted by progress. The publishing industry has changed; retail, the backbone of newspapers, has been disrupted by the digital world, and we have had to grow and change, too. Those who resist change are left behind.

So just as we are now in the moviemaking business (“One Life to Give,” prequel to the Culper Spy story — be sure to see it when it screens next as it’s quite a story and will make you proud of where you live), and the video business, we can assert that we are in the events sector. These activities fit with our mission to inform our residents because they offer something of interest, and they enhance our sense of community. They also help us to do our main job of relaying the news and to pay our bills. Therefore, we are beginning to plan for our next event, Rising Stars, and you will be hearing and reading more about that soon. Please stay tuned.

'At the Gallery' by Ludovico Abejar

Celebrate the exceptional talent of Long Island artists at the Annual Invitational Exhibition at the Atelier at Flowerfield, 2 Flowerfield, Suite 15, St. James. The juried show runs from March 5 to April 30.

Exhibiting artists  include Ludovico Abejar,  Lucia Alberti,  Ross Barbera, Marta Baumiller, Marlene Bezich, Nariman Boyle, Al Candia Kenneth Cerreta, Anthony Davis ,Paul Edelson, Dan Fusco, Shelley Holtzman, Frances Ianarella, David Jaycox, Jr Laurence Johnston, Liz Jorg Masi, Raymond McGraime, Jane McGraw-Teubner, Fred Mendelsohn, Joseph Miller, Annette Napolitano, Meriel Pitarka, Irene Ruddock, Oscar Santiago, Lori Scarlatos, Ilene Silberstein, Rosario Stine-Barry, Judy Stone, Angela Stratton, and Helena Weber.

Meet the artists at an opening reception on Thursday, March 5 from 5:30 to 7:30 p.m.

For more information, call 632-250-9009 or visit www.atelierflowerfield.org.

Mather is one of four separate Northwell hospitals approved for a catheterization lab. The hospitals are looking to compete for services amongst some of the larger health entities in New York state. Photo from Northwell

Mather Hospital in Port Jefferson will soon be joining nearby Stony Brook as one of the few places on Long Island to contain a cardiac catheterization lab to provide less invasive heart-related services.

New York State approved Northwell Health, which includes Mather in its group, to open four cardiac labs at different locations in New York. Alongside Mather, Lenox Health Greenwich Village, Plainview Hospital and Northern Westchester Hospital in Mount Kisco have been approved for labs. The lattermost was approved in December.

According to a Northwell release, these labs specialize in using X-ray guided catheters help open blockages in coronary arteries or repair the heart in minimally invasive procedures — ranging from stenting to angioplasty and bypass surgery – that are less traumatic to the body and speed recovery. 

The approval means a big leap for the Port Jefferson hospital, which plans a $11.4 million, 3,644-square-foot addition that will include catheterization and electrophysiology labs. The construction is expected to finish and both labs be open by early 2021.

“With the investment in these four new PCI programs, we are able to advance our mission of improving access, as well as bringing high quality complex cardiovascular services to our patients in their local communities,” William O’Connell, executive director of cardiology services at Northwell Health, said in a release. 

Mather president, Kenneth Roberts, has said in a previous interview with the Port Times Record that a big reason the hospital signed on with the health care network is to have the ability and room to innovate at the hospital and keep up with the times. He echoed that sentiment in a statement.

“With Northwell’s guidance and the diligence of our Mather team, Mather received approval from the New York State Department of Health to provide advanced cardiology programs which include cardiac catheterization, PCI and electrophysiology services,” he said. “Approximately 150 patients every year are [currently] transferred from Mather or St. Charles to have these services elsewhere.”

The Rocky Point Fire Department building in Shoreham. Photo by Kevin Redding

The Rocky Point Fire District will soon extend its coverage area to include the Village of Shoreham. 

Town of Brookhaven officials have already scheduled a public hearing later in the month for the resolution, which is expected to pass. In conjunction, as part of the village merging into the fire district, officials passed a resolution that authorized the tax assessor to consolidate the district’s three separate tax zones into one. 

Town Councilwoman Jane Bonner (R-Rocky Point) said both the Town and fire district could not get it done without the other. The change in tax zones will essentially make for a more streamlined process for the district.

“After the public hearing, if it was supported by my colleagues, [the fire district] would include the Village of Shoreham,” said Bonner. “It is essentially an easier process and less paperwork for both of them.” 

The two latest decisions come after a months-long process where Shoreham officials requested home rule applications to extend the fire district boundaries to encompass the 0.5-square-mile village. In May 2019, Gov. Andrew Cuomo (D) signed a bill introduced by state Sen. Ken LaValle (R-Port Jefferson) and Assemblyman Anthony Palumbo (R-New Suffolk) that authorized the fire district extension. 

Rocky Point Fire District attorney, the Port Jefferson-based Bill Glass who represents the fire district, said the change wouldn’t affect the day-to-day operations of the fire departments and district.

“Operationally there will be no change at all within the district,” he said. “There will not be a significant change to the amount the village already pays for emergency services.” 

Glass said the process should be seamless as the village has contracted out to the fire district for the past decade. He said he doesn’t expect the tax rates for residents to change that much and would probably be similar to the amount that they paid when Shoreham was contracting them. 

On the subject of the consolidation of the three tax zones, the lawyer said the decision was necessary as there was no point in having three separate tax districts anymore. 

“The tax zones were put in place because at one point there were three different water companies [in the area] who had their own tax rates,” Glass said. “That stopped with the Suffolk Water Authority — this helps streamline a lot of things.”

For Shoreham, being a part of the fire district could allow the village budget to decrease as they are not using funds for fire/emergency services. 

A representative from the village could not be reached for comment.

In addition, bringing the village into the fold would allow Shoreham residents to run for positions like fire commissioner. 

The Town will hold a public hearing for the fire district extension Feb. 27. 

The 2020 U.S. Census could be pivotal for New York, which could potentially lose one or two U.S. reps from a general loss of population. Stock photo

It’s a once-in-a-decade request, and this year’s census could determine just how much local schools, governments and nonprofits get in aid from the federal government. Not to mention, this year’s count could determine if New York could be sending one or two less U.S. representatives to Washington out of its current total of 27.

It has enough officials worried that New York State is funneling money around to different counties to get people to fill in the survey. Suffolk County is expected to receive $1.019 million toward its efforts. Officials have called for additional funds toward the census in this year’s budget, though most don’t expect the money to materialize before the census starts rolling in mid-March. New York State has made $20 million available of a total of $60 million to go toward engagement efforts in local municipalities. $15 million is going to the state’s 62 counties. 

“It’s the principle that we count, and we should be counted.”

— Martha Maffei

This year, galvanizing the populace to take the census has become a phenomenon, with players at the state, county and local level putting a heavy emphasis on this year’s survey. On the line, advocates say, is a correct political representation on a federal level as well as $675 billion annually in federal funds for prioritizing road work, school aid, grants and Medicaid funding.

Due to the 2010 census, New York lost two congressional seats, and some have said this year’s count could lose the state one or two more. Local groups, both small and large, have the task of energizing enough people to gain an accurate headcount. 

Like herding cats, that’s much easier said than done

Suffolk County Complete Count Committee was created in 2019 in part by the nonprofits Health & Welfare Council of Long Island and Long Island Community Foundation to generate engagement for those efforts.

Rebecca Sanin, president of HWCLI, said they have around 300 groups, including nonprofits, religious organizations, business organizations and governments, participating at least to some degree in outreach among 11 subcommittees. The nonprofit has also established guidebooks and graphics for everyone from immigrant leaders to hospitals to senior citizens.

“We’re really trying to build momentum, where the end is a 10-year funding impact to our region,” Sanin said. 

The committee has become a hub for joining up the disparate groups looking to promote the census. The state has its own CCC, and other counties have been encouraged to create their own committees. County Executive Steve Bellone (D) was named to the New York State Complete Count Committee by Gov. Andrew Cuomo (D). 

“Suffolk County is not only the largest suburban county in the state of New York, but we have the fourth largest and hardest-to-count populations in New York state,” Bellone said during a 2019 meeting with the Suffolk Complete Count Committee. Approximately 40 percent of county residents live in hard-to-count areas, he said.

People will start to see this year’s census mailed out in mid-March, and the census process continues for the next several months. Stock photo

County officials have hosted census job fairs this year and last, with positions paying $17 to $23 an hour.

Governments at both county and town level have started putting notices of the census in official emails and releases. Brookhaven Councilwoman Valerie Cartright (D-Port Jefferson Station) had been drafted to partner with the complete count committee. She said the town is working on a project with the tax receiver’s office to send out a reminder in the midyear tax receipts that goes out to every household in Brookhaven. They have also started to include information about the census in town programs hosted this year and had representatives from the census table at town events.

“Undercounting of communities can have a domino or ripple effect on community projects and issues for years to come,” the councilwoman said in an email. “A complete and accurate count of your community can result in improved infrastructure and schools, better community health and programs and much more.”

Steven Collins, who works for the U.S. Department of Commerce as a partnership specialist for the census in Suffolk, said the big game changer this year is the now-four different ways residents are going to be able to respond to the census. People can now respond over the internet, over the phone or using the usual mailed in paper survey. The fourth way is when all other options are exhausted, and when census operators have tried to reach an individual by several other means, an enumerator will knock on one’s door. 

Though not all see the incentivized online component as a good thing. Sanin said there are many who have a general distrust of putting information online, due to the many examples of private companies being hacked to get access to a user’s personal data. There is also a large digital divide, and many still do not have easy access or understanding how to use the online component.

Despite the online component, census promotion still requires boots on
the ground

Stony Brook University has been active in trying to get students signed up for the count but have also started concerted efforts to encourage indigenous groups, especially those living on Long Island’s South Fork, to sign on for the census.

Despite how seriously census takers have been in requesting surveys, that still has not stopped multiple areas coming back with low response rates, some barely above 50 percent. 

In Suffolk County presentations to the complete count committee, some communities are shown as much harder to count than others. While much of the North Shore shows a response rate of 70 percent or better, a large area in Huntington and Huntington Station, with sizable minority populations, have a response rate of 60 percent, at worst. 

At www.censushardtocountmaps2020.usa, researchers have used previous census data to track which areas showed lower census participation.

In Brookhaven, one area with low turnout happens to be around the hamlets of Ridge and Upton and in Selden and Centereach, especially in the area along Route 112 that has a previous response rate of only 60 to 65 percent.

There are portions of Long Island with much worse representation. There are certain parts of West Babylon with a response rate as low as 0 to 60 percent.

SEPA Mujer, a nonprofit immigrants rights advocacy group, has chapters in several of the areas that show low response rates, including Riverhead, Huntington Station and Patchogue. Martha Maffei, the executive director of the nonprofit, said they have formed coalitions at two of their three chapters specifically to energize the community for the census. Many of their organizers and members have advocated for local immigrants to take the census which comes with the task of convincing the immigrant community the information will not be used against them by immigration enforcement.

“It’s the principle that we count, and we should be counted,” Maffei said.

Usually, she said, organizers take the tack of arguing that filling out the census will mean more funding for their school districts and how it will offer them better political representation. 

The complete count committee has organized 13 total groups on the immigration subcommittee who have all pledged to move through these communities. The issue, she said, is money, compounded with the amount of ground these volunteers have to cover, with only the some $1 million to be spread amongst all of Suffolk.

“Fear nurtures an undercount, and an undercount nurtures our continued inequity.”

— Rebecca Sanin

Still, she’s optimistic these hard-to-count areas will be more active than 2010. 

The census is meant to track everyone, including those undocumented immigrants, in order to get a full understanding of total population, but in 2019 the potential for a citizenship question to appear on the census created a tornado of partisan bickering, with opponents saying such a citizenship question would specifically target Latino groups and incentivize them to not respond to the census, thereby limiting the political capital such groups could wield. Officials said the pro-citizenship question was needed to enforce the Voting Rights Act of 1965, designed to help blacks overcome legal barriers to voting during the Jim Crow era.

In November of last year, The New York Times reported on disclosures from the White House hinting that Republican strategists had political reasons for encouraging a citizenship question, that it would increase Republican influence and political power once totals for the census were drawn by undercounting residents in largely Democratic areas.

Judges ruled the question illegal under Title 13, which states the government can only use data from the census for statistical purposes. Collins reiterated there will be no citizenship question on this year’s census, and all information is kept extremely confidential and secure. 

Yet the idea still lingers in the minds of some residents, and it is something census advocates said they have had to work around.

Sanin and Maffei said the citizenship question has undoubtedly had a cooling effect toward the census, though to what extent is hard to gauge. 

“We feel we are going from one attack to another,” Maffei said. “There is a lot of trauma in this community.” 

The general distrust in government and in government systems is high, and trying to encourage people “living in the shadows,” as Sanin put it, is where much of the past year’s efforts have gone.

“Fear nurtures an undercount, and an undercount nurtures our continued inequity,” she said. 

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The Royals WIN 42-28 for the Suffolk Class B title at Centereach High School defeating Mattituck Feb. 21. Bill Landon photo

The Port Jefferson Royals broke out to an early lead and never took their foot off the gas in the Suffolk County Class B championship game Feb. 21, ending Mattituck’s season 42-28 at Centereach High School.

Ahead by six at the half, the Royals pulled ahead by a dozen points after three quarters. They were led by Evelyn Walker, a junior, who swished three triples, a field goal and a pair of free throws to lead her team with 13 points. Sophomore Abigail Rolfe banked nine and senior Samantha Ayotte netted seven as did freshman teammate Lola Idir.

The Royals live to play another day when they take on Pierson for the right to contest the overall small school Suffolk title Feb. 25 at St. Joseph’s college. Game time is 5:30pm.

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SWR Also Gives Strong Showing

Mustangs wrestling gave it their all at this year’s Division II wrestling championship Feb. 14. Photo from Mel Jacoby

Center Moriches High School was home to the Dr. L Robert “Doc” Fallot Memorial Suffolk County Division II Wrestling Championship Friday, Feb. 14. Competing in the tournament were teams from Mount Sinai, Shoreham-Wading River, John Glenn, Mattituck, Hampton Bays, Bayport-Blue Point, Port Jefferson, Southampton and Babylon. 

A capacity crowd was in attendance to watch the boys compete for the coveted championship and a trip to Albany for the New York State Championship finals. 

In a close battle at 99 pounds, Brayden Fahrbach of Mount Sinai narrowly defeated a tough Chris Colon from Shoreham-Wading River 2-1.

At 106 pounds, Craig Jablonski of Shoreham-Wading River took down Anthony Mirando of John Glenn 2-1 in a tight battle. 

At 120 pounds, Joe Sparacio of Bayport-Blue Point outlasted Connor Pierce of Shoreham-Wading River, 8-3. 

The 126-pound match featured Jordan Titus of Center Moriches, who ranked third in the nation, against Jack Tyrell of Mount Sinai. Titus won in a tech fall 18-3.

The boys from Mt. Sinai won the next two matches with Brenden Goodrich outlasting Jake Jablonski of Shoreham-Wading River 6-2 and Mike O’Brien overwhelming River Orlando of Hampton Bays 15-4.

Mount Sinai powerhouses Matt Campo, at 170 pounds, and Joe Goodrich, at 182 pounds, who have been pinning machines all year, won their respective matches by pins. Campo stuck it out, winning over Ben Brown of Southampton in 1:25, with Goodrich defeating Ethan Schmidt of Mattituck in 4:53.  

Mount Sinai’s five winning wrestlers will compete in Albany Feb. 28 and 29.

The Rick Herrmann Most Outstanding Wrestler Award in the tournament went to Joe Sparacio of Bayport-Blue-Point, while the Jack Mahoney Champion of Champions Award went to Goodrich of Mount Sinai. The Most Pins in the Least Amount of Time Award went to Campo of Mount Sinai, ending with a total of four pins in 2:7.

The Bill Knapp Award went to the Mustangs, whose team score was 261 to Shoreham-Wading River’s 248. John Glenn had 219 while Mattituck had 201.

The New York State Championship will take place Feb. 28 and 29 at the Times Union Civic Center in Albany. Mount Sinai will be sending the most wrestlers from either Division I or Division II to the tournament. 

Stock photo
Increasing fiber can reduce hemorrhoid inflammation

By David Dunaief

Dr. David Dunaief

Many of us have suffered at one time or another from inflamed hemorrhoids. They affect men and women equally, though women have a higher propensity during pregnancy and child birth. For some reason, there’s a social stigma associated with hemorrhoids, although we all have them. They’re vascular structures that aid in stool control. When they become irritated and inflamed, we have symptoms – and often say we “have hemorrhoids” – when we really mean our hemorrhoids are causing us pain. 

When they’re irritated, hemorrhoids may alternate between itchy and painful symptoms, making it hard to concentrate and uncomfortable to sit. This is because the veins in your rectum are swollen. They usually bleed, especially during a bowel movement, which may scare us. Fortunately, hemorrhoids are not a harbinger of more serious disease.

There are two types of hemorrhoids: external, occurring outside the anus, and internal, occurring within the rectum. 

How do you treat external hemorrhoids? 

Fortunately, external hemorrhoids tend to be mild. Most of the time, they are treated with analgesic creams or suppositories that contain hydrocortisone, such as Preparation H, or with a sitz bath, all of which help relieve the pain. Thus, they can be self-treated and do not require an appointment with a physician. The most effective way to reduce bleeding and pain is to increase fiber through diet and supplementation (1). However, sometimes there is thrombosis (clotting) of external hemorrhoids, in which case they may become more painful, requiring medical treatment.

How do you treat internal hemorrhoids?

Internal hemorrhoids can be a bit more complicated. The primary symptom is bleeding with bowel movement, not pain, since they are usually above the point of sensation in the colon, called the dentate line. If the hemorrhoids prolapse below this, there may be pain and discomfort, as well. Prolapse is when hemorrhoids fall out of place, due to weakening of the muscles and ligaments in the colon. 

The first step for treating internal hemorrhoids is to add fiber through diet and supplementation. Study after study shows significant benefit. For instance, in a meta-analysis by the Cochrane Systems Data Review 2005, fiber reduced the occurrence of bleeding by 53 percent (2). In another study, after two weeks of fiber and another two-week follow-up, the daily incidence of bleeding was reduced dramatically (3).

There are several minimally invasive options, including anal banding, sclerotherapy and coagulation. The most effective of these is anal banding, with an approximate 80 percent success rate (4). This is usually an office-based procedure where two rubber bands are place at the neck of each hemorrhoid. To avoid complications from constipation, patients should also take fiber supplementation. 

Side effects of the procedure are usually mild, and there is very low risk of infection. However, severe pain may occur if misapplication occurs with the band below the dentate line. If this procedure fails, hemorrhoidectomy (surgery) would be the next option.

How do you prevent hemorrhoids?

Adding more fiber to your diet will help prevent hemorrhoids.
Stock photo

First, sitting on the toilet for long periods of time puts significant pressure on the veins in the rectum, potentially increasing the risk of inflammation. Though you may want private time to read, the bathroom is not the library. As soon as you have finished moving your bowels, it is important to get off the toilet.

Eating more fiber helps to create bulk for your bowel movements, avoiding constipation, diarrhea and undue straining. Thus, you should try to increase the amount of fiber in your diet, before adding supplementation. Fruits, vegetables, whole grains, nuts, beans and legumes have significant amounts of fiber. Grains, beans and nuts have among the highest levels of fiber. For instance, one cup of black beans has 12 g of fiber. 

Americans, on average, consume 16 g per day of fiber (5). The Institute of Medicine (IOM) recommends daily fiber intake for those <50 years old of 25 to 38 g, depending on gender and age (6). I typically recommend at least 40 g. My wife and I try to eat only foods that contain a significant amount of fiber, and we get approximately 65 g per day. You may want to raise your fiber level gradually; if you do it too rapidly, be forewarned – side effects are potentially gas and bloating for the first week or two.

Get plenty of fluids. It helps to soften the stool and prevent constipation. Exercise also helps to prevent constipation. It is important not to hold in a bowel movement; go when the urge is there or else the stool can become hard, causing straining, constipation and more time on the toilet. 

If you have rectal bleeding and either have a high risk for colorectal cancer or are over the age of 50, you should see your physician to make sure it is not due to a malignancy or other cause, such as inflammatory bowel disease. The message throughout this article is that Americans need to get more fiber, which is beneficial for inflamed hemorrhoid prevention and treatment.

References:

(1) Dis Colon Rectum. Jul-Aug 1982;25(5):454-456. (2) Cochrane.org. (3) Hepatogastroenterology 1996;43(12):1504-1507. (4) Dis Colon Rectum 2004 Aug;47(8):1364-1370. (5) usda.gov. (6) Am J Lifestyle Med. 2017 Jan-Feb; 11(1):80–85.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.