Can Khat Cause Hemorrhoids?: Understanding the Link and Health Risks

October 6, 2025 •

4 min read

Chronic khat chewing is strongly associated with high-grade hemorrhoidal disease, with one study showing 90% of chronic chewers developed hemorrhoids compared to 25% of non-chewers. The physiological mechanisms behind this association involve several factors, including khat's impact on gastrointestinal motility, vascular tone, and lifestyle habits.

Quick Summary

Chronic chewing of the stimulant khat can significantly increase the risk of developing hemorrhoids and worsen their severity through multiple physiological pathways, including severe constipation, increased anal sphincter tone, and prolonged sedentary behavior. This practice is linked to a higher incidence of surgical intervention and post-operative complications.

Key Points

Direct Causation: Chronic khat chewing is strongly and independently associated with a significantly higher prevalence of severe hemorrhoidal disease.
Multifactorial Mechanism: Khat causes hemorrhoids through a combination of pharmacological effects (severe constipation, increased anal sphincter tone, vasoconstriction) and behavioral factors (prolonged sitting).
Severe Constipation: The astringent tannins and amphetamine-like cathinone in khat inhibit intestinal motility and delay gastric emptying, leading to chronic, severe constipation and straining.
Vascular Damage: Cathinone's vasoconstrictive and hypertensive effects, combined with increased anal sphincter tone, enlarge and damage the rectal veins over time, exacerbating hemorrhoid formation.
Exacerbated Surgical Risk: Khat chewing significantly increases the likelihood of requiring a hemorrhoidectomy and raises the risk of post-operative complications, including severe pain and bleeding.
Lifestyle Contribution: The long, sedentary chewing sessions inherent to the practice directly increase intra-abdominal and vascular pressure, further contributing to hemorrhoid development.
Public Health Concern: The strong link between khat and hemorrhoids, particularly in endemic regions, highlights the need for targeted public health strategies and clinical management tailored to this population.

The Pharmacological Mechanisms Behind Khat-Induced Hemorrhoids

Khat leaves contain psychoactive alkaloids, primarily cathinone, which is structurally similar to amphetamines. In addition to its stimulant properties, khat also contains tannins, which are known for their astringent effects. The combination of these chemical properties leads to a cascade of physiological changes in the body that can significantly increase the risk of hemorrhoid development and progression.

Impact on the Gastrointestinal Tract

One of the most direct ways khat contributes to hemorrhoids is through its effects on the digestive system. The tannins present in khat are astringent, which can inhibit intestinal peristalsis and lead to chronic constipation. The amphetamine-like properties of cathinone also delay gastric emptying and reduce intestinal motility. This combination of effects results in harder, drier stools that are difficult to pass. The frequent and prolonged straining during bowel movements then puts significant pressure on the veins in the rectum and anus, causing them to swell and become inflamed.

Vascular Effects and Anal Sphincter Tone

Khat's active ingredients have significant cardiovascular effects. Cathinone is a sympathomimetic agent, meaning it increases sympathetic nervous system activity, which raises heart rate and blood pressure. This also causes vasoconstriction throughout the body, including the peripheral and anal vascular systems. This persistent vasoconstriction, combined with the delayed intestinal motility, can lead to increased anal sphincter tone. A high resting anal pressure forces the hemorrhoidal cushions against the sphincter, causing further vessel enlargement and increasing the likelihood of developing symptomatic hemorrhoids.

Lifestyle and Behavioral Factors

The ritual of khat chewing itself exacerbates the physiological risks. Chewing sessions often last for several hours and are typically performed while sitting. This prolonged, sedentary posture increases vascular filling in the lower extremities and abdomen, and raises the pressure within the rectal veins. This behavioral factor, combined with the underlying physiological changes, creates an ideal environment for hemorrhoid development and worsening.

Evidence from Clinical Studies

Numerous studies have documented the strong link between chronic khat use and high-grade hemorrhoidal disease. These findings are particularly prominent in regions like Yemen and Ethiopia where khat consumption is widespread.

Yemeni Study (2025): A prospective cross-sectional study of 1,896 patients found that 90% of chronic khat chewers developed hemorrhoids, with 75% requiring surgery, compared to only 25% of non-chewers. The odds ratio (OR) for developing hemorrhoids in chewers was a staggering 27.04.
Ethiopian Study (2013): A cross-sectional study of university students found that 48.6% of khat chewers suffered from constipation, while 14.4% developed hemorrhoids, both significantly higher rates than non-chewers.

Potential Complications and Surgical Outcomes

Beyond just causing hemorrhoids, khat use can complicate both their management and surgical treatment. The increased severity of hemorrhoidal disease in chewers often necessitates surgical intervention, known as hemorrhoidectomy. However, the same physiological effects that cause hemorrhoids can also complicate surgery and recovery.

Increased Post-Operative Bleeding: Khat's vasoconstrictive effects on blood vessels, combined with its potential to increase blood pressure, can increase the risk of post-operative bleeding in patients undergoing hemorrhoidectomy.
Enhanced Post-Operative Pain: Increased anal sphincter tone and delayed gastric emptying can exacerbate post-operative pain and discomfort.
Impaired Recovery: Chronic constipation and straining, if not properly managed, can stress the surgical site and interfere with proper healing.

Comparison of Risk Factors for Hemorrhoids: Khat vs. Common Factors

While many factors can lead to hemorrhoids, khat introduces a unique combination of pharmacological and behavioral risks. The following table compares the mechanisms of khat-induced hemorrhoids with those of more common causes:


Factor	Primary Mechanism	Khat-Specific Contribution	Severity	Management Complexity
Khat Chewing	Pharmacological effects (tannins, cathinone) causing severe constipation, increased anal sphincter tone, vasoconstriction, and prolonged sitting.	Combination of multiple compounding effects leading to higher grades of hemorrhoidal disease.	High	Very Complex (Requires addressing addiction, lifestyle, and physiological issues)
Chronic Constipation	Frequent straining to pass hard stools.	Is a primary symptom of khat chewing, intensifying the pressure on rectal veins.	Moderate to High	Standard dietary/lifestyle changes, potentially medication
Pregnancy	Increased intra-abdominal pressure from the enlarged uterus and hormonal changes.	None (unless the person chews khat during pregnancy, adding further risk).	Variable	Usually resolves postpartum, but requires management during pregnancy.
Sedentary Lifestyle	Prolonged sitting increases pressure on rectal veins.	The act of chewing khat itself entails prolonged sitting, directly contributing to this risk factor.	Low to Moderate	Primarily addressed through increased physical activity.
Low-Fiber Diet	Lack of fiber leads to harder stools and straining.	Poor dietary habits often accompany khat chewing, aggravating the constipation caused by khat.	Low to Moderate	Dietary modification with increased fiber.

Conclusion

While traditional risk factors like constipation and a sedentary lifestyle are well-known causes of hemorrhoids, chronic khat chewing presents a unique and particularly potent risk profile. The combination of its pharmacological effects—including severe constipation, increased anal sphincter tone, and vasoconstriction—with the behavioral factor of prolonged sitting during chewing sessions, creates a powerful mechanism for developing high-grade hemorrhoidal disease. Research has conclusively shown a strong association, highlighting that chewers face a significantly higher prevalence of hemorrhoids and often require more complex medical and surgical management, with increased risks of complications like post-operative bleeding. Addressing this issue requires not only managing the hemorrhoids themselves but also tackling the underlying khat dependency and its multifaceted health impacts.

For individuals seeking help with khat cessation or managing related health issues, reputable resources like the National Institute on Drug Abuse (NIDA) can provide guidance and support.

Further Research and Public Health Needs

Given the strong association demonstrated by studies, there is a clear need for greater public health awareness regarding the risks of khat chewing. Educational campaigns, particularly in communities where the practice is culturally common, are crucial to inform users of the gastrointestinal and surgical complications. Furthermore, healthcare providers in these regions need tailored clinical approaches to manage hemorrhoidal disease in patients with a history of khat use, as their treatment and recovery can be more complex. More prospective cohort studies are also needed to establish clearer causality and dose-response relationships between chewing habits and hemorrhoid severity.

Frequently Asked Questions

Khat chewing causes constipation primarily through two mechanisms: the astringent properties of its tannins which inhibit intestinal peristalsis, and the sympathomimetic effects of cathinone which delay gastric emptying and slow intestinal motility.

While the link is most pronounced with chronic and heavy use, any instance of khat chewing can cause constipation and straining, which are immediate risk factors for hemorrhoids. Frequent, prolonged, or heavy use drastically increases the likelihood.

Khat's active compounds cause vasoconstriction and an increase in blood pressure and heart rate. This increases pressure on the rectal veins and, combined with increased anal sphincter tone, significantly contributes to the formation and worsening of hemorrhoids.

Yes. Khat is chewed for several hours in prolonged, sedentary sessions. This increases vascular pressure in the pelvic area and rectum, which directly contributes to the development of hemorrhoids.

Besides constipation and hemorrhoids, khat use is associated with other gastrointestinal issues. These can include gastritis (inflammation of the stomach lining), oral ulcers, dental problems, and loss of appetite.

No, the risk is not uniform. The severity and duration of the chewing habit, the amount of khat consumed, and individual health factors can influence the level of risk. Chronic and heavy chewers face a much higher risk of developing severe hemorrhoidal disease.

The most effective way to reduce the risk is to stop or significantly reduce khat consumption. Other mitigating strategies include increasing fiber and fluid intake to combat constipation and avoiding prolonged, sedentary chewing sessions.