By Malinda Wright
Hemorrhoids. About 75% of us will have one at some point in our lives,1 and half of us will have had one before the age of 50.2 Surprised? It’s not the kind of thing we like to discuss with our friends – until you actually have one, that is. Then you find out your buddy has had one too. Americans spend over $250 million annually on over-the-counter products, and 5 million Americans seek medical treatment yearly for their hemorrhoids.3 That’s a whole lot of Preparation H! At PHRC we see patients with hemorrhoids all the time. Fortunately, most of the time they don’t linger, and there are steps you can take to avoid them coming back.
So what exactly is a hemorrhoid? Here’s what the National Institute of Diabetes and Digestive and Kidney Diseases has to say:
“Hemorrhoids are swollen and inflamed veins around the anus or in the lower rectum. The rectum is the last part of the large intestine leading to the anus. The anus is the opening at the end of the digestive tract where bowel contents leave the body. External hemorrhoids are located under the skin around the anus. Internal hemorrhoids develop in the lower rectum.”
So, hemorrhoids are basically varicose veins in the anus.
Internal hemorrhoids may protrude, or prolapse, through the anus. Most prolapsed hemorrhoids shrink back inside the rectum on their own, but severely prolapsed hemorrhoids may protrude permanently and require treatment. Hemorrhoids look a bit like little balls, and are sometimes known as “piles” after a Latin word for ball. You might have noticed them when wiping.
Here’s an anatomy picture of the anus showing internal, external and prolapsed hemorrhoids.
Those of you sitting uncomfortably through this anatomy lesson are probably itching to hear about the treatment of hemorrhoids. Good news! There are a number of treatments. Starting with the things you can do at home, avoid constipation by keeping your stool soft and easy to pass. (Check out Put Your Constipation Woes Behind You) You can do this by eating a diet high in fiber, such as leafy greens and vegetables, drinking six to eight 8-ounce glasses of water per a day, and exercising 30 minutes per a day. Another thing you can do at home to treat hemorrhoids is use over-the-counter creams, ointments, and suppositories to help with the pain, itching, and swelling. A Sitz bath, or sitting in warm water for 10 minutes, will also help ease the discomfort and itching. An ice pack can help with any swelling.
If they don’t clear up on their own, you’ll want to consult with your doctor. Medical treatment options include rubber band ligation (also know as “banding”), sclerotherapy, stapling, and a hemorrhoidectomy, which is a medical word for surgically removing the hemorrhoid. Please see informedhealth.org for more information on what these treatments are.
For those of you who continue to have anal pain after the hemorrhoid has resolved, pelvic floor physical therapy can help. The continued pain may be due to muscle spasms in the pelvic floor musculature, and/or scar tissue hypersensitivity from where the hemorrhoid was. Please check out our blog on What Is A “Good” Pelvic Pain PT Session Like?
So, what causes hemorrhoids? How can we avoid them? There is no single cause, however, there are many factors. Straining with bowel movements is a common one. Sitting on the toilet seat for greater than 10 minutes can also cause them, because when we sit on the toilet and relax the anus, the veins pool with blood and this puts more pressure the veins themselves. Fellas (and ladies, too), I recommend keeping the smartphone and magazines out of the bathroom. Also, you might like to check out Shayna’s blog on What’s The Right Way To Poop. Other factors that can cause hemorrhoids are frequent constipation and/or diarrhea, obesity, frequent heavy lifting, poor diet, lack of exercise, and pregnancy.
The occurrence of hemorrhoids during pregnancy is quite common. The body circulates more blood as the uterus grows. This puts pressure on the veins, especially in the last trimester when the uterus is largest. The veins in the rectum become dilated and the increased blood and pressure can lead to hemorrhoids. Hormones, specifically progesterone, can also contribute. Progesterone increases during pregnancy and relaxes the smooth muscles in the body; including the walls of the veins allowing them to swell. Progesterone can also slow down the intestinal tract causing constipation. As we know from earlier, constipation and straining are one of the main contributors towards hemorrhoids. Straining and prolonged pushing during labor can also cause them. The good news is, hemorrhoids tend to disappear after the baby is born.
Hemorrhoids. They can happen to anyone, and often do. They’re a pain in the butt, but they’re easily treated, and with a few small changes in your daily routine, you can prevent them from coming back.
Malinda Wright, PT, MPT
- National Institute of Diabetes and Digestive and Kidney Diseases https://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/hemorrhoids/Pages/facts.aspx
- Health Line: Hemorrhoids
- Hemorrhoid Information Center: Digestive Health http://www.hemorrhoidinformationcenter.com/category/hemorrhoids/
- Hemorrhoid Information Center: Hemorrhoids During Pregnancy http://www.hemorrhoidinformationcenter.com/pregnancy-and-hemorrhoids/