And how to make them disappear.

Today marks the last day you will have to deal with those swollen veins that are lovingly named hemorrhoids. Don’t get me wrong, you may have flares now and again depending on your diet or the presence of illness-there is nothing like diarrhea, vomiting or constipation to really make you notice your downstairs situation. But if you follow the suggestions outlined here, you will notice a marked difference in frequency and severity of those tushy treats. Never again will they get in the way of how you prefer to ‘watch a movie!’

What exactly are hemorrhoids, anyway? These little beasts are actually overstretched veins that are either internal or external, located in the anus, rectal, or vaginal tissue. The vessel walls are essentially varicosed, or stretched, beyond their normal capacity and may have damaged valves that would normally keep veins healthy by preventing back flow of blood. Simplistically put, blood flow in a vein works with the pressure placed in the system by the heart contracting during each heartbeat, and in the time between beats a valve in healthy veins keeps blood from flowing backward (if you are upright, these valves are countering the effect of gravity since veins are responsible for returning blood to the lungs and heart for re-circulation). In a hemorrhoid, blood has pooled and is not moving forward in the system as it should.

Now that you’ve had your mini anatomy lesson, we need to determine the cause of the hemorrhoids in order to fix the situation. There are multiple causes, and some people have more than one contributing factor. Causes are as follows:

1. Pregnancy: the increase in progesterone to maintain a pregnancy relaxes the smooth muscle surrounding blood vessels, causing them to be less able to resist the pressure placed on them. This works to keep the uterus (also smooth muscle) from contracting until baby is ready to be delivered, so the function does have its benefits. On top of this muscle relaxation, you also have significant pressure in your torso that adds resistive pressure to vessels in your trunk. And, your blood volume has increased by 50% by your 34th week of pregnancy (at which point it levels off). So pregnancy is basically at least three contributing factors in one!

2. Bowel dysfunction: constipation encourages bearing down or pushing. There is nothing worse for hemorrhoids than this! This is something most people can control with increased fluid and fiber intake. Don’t let this happen to you! My tip: carry around a water bottle and set a goal for how many of them you can consume per day, then do it to keep your hydration up. If you succumb to the more watery end of the spectrum, soluble fiber can help you bulk things back up (see this list of options). Or if you were just sick, then you have to ride it out. But again, you want to fight the urge to push. It will only make things worse. When on the potty, just relax and let gravity be your friend.

3. Voiding posture: I have discussed this in multiple previous posts, but if you feel like a little kid on the potty with your toes barely touching the floor you are essentially setting yourself up for failure. Your puborectalis muscle is responsible for helping ‘eject’ your bowel contents, but it only works optimally when the hips are flexed to 90 degrees or greater. When your legs are dangling down, you are not only likely not relaxed in your pelvic floor (the muscles that all your voids must pass through) but the puborectalis creates a little curvature in your colon. Instead of working with gravity at optimal angles, you will be more likely to bear down to pass this kinked section of the colon. Get a squatty potty, little stool, or shorter toilets and lean forward with elbows on to knees. Your pelvis will thank you.

4. A tight pelvic floor: If you have a really tight bicep muscle you may notice difficulty straightening your elbow. In that same way you can hold tension in your pelvic floor. This can prevent full, healthy motion of the pelvic muscles that would typically allow passage of stool with ease and assist with ejection. This is something that typically requires professional help navigating to successfully down train the musculature.

5. Irritible Bowel Syndrome or other digestive concern: this is something to manage in concert with your physician or naturopath. And there is so much being discovered in regards to management with nutrition at this time that seeing a dietitician to optimize your healing is likely a good choice (and occasionally covered by insurance)! But the primary goals are still the same: whether it is consitpation or diarrhea type IBS, the goal is to normalize the stool consistency to reduce the impact to the pelvic floor. And some people with IBS and other digestive tract disorders are impacted by pelvic floor tension, which a pelvic floor physical therapist could help with.

There are other contributing factors to hemorrhoids, however these are among the more common causes. If you are in a flare up, in conjunction with using the appropriate tips above feel free to sit on an ice pack (with a barrier, that’s some sensitive tissue). And use a topical spray or cream if needed. This is an amazing witch hazel-based spray and this is a cream in the case of needing more numbing action. Don’t just live with your hemorrhoids, and don’t settle for movie-watching alone! Address the cause so you can ‘rent a movie and chill’ without having to make excuses for your sore bum!

*This post is not intended as medical advice. Always contact your medical provider regarding care specific to you.

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