It's an uncomfortable thing to discuss, but the reality of hemorrhoids is even more uncomfortable than the embarrassment. In truth, everyone has hemorrhoids — a cushiony cluster of veins just below the mucous membranes that line the lowest part of the rectum and anus — but normally, they are internal, and you don't even know they're there.
When the veins get swollen and distended, little pockets can pop out of the anus, causing significant discomfort and occasional bleeding. You may hear hemorrhoids referred to as "piles" in a more informal setting. They're a huge pain in the rear, but they're really just overgrown “varicose” veins.
Contrary to middle-school name-calling, hemorrhoids actually serve a purpose — they protect the sphincter muscles and help keep the anal canal closed when your abdomen is under intense pressure, such as when you cough or sneeze.
It's when the abdominal pressure is sustained (such as when pregnant or severely overweight) that these cushions can engorge to the point they pop out due to disruption of the supporting elements and subsequent dilation. Really, they're simply overachieving what they're meant to do.
According to a review authored by Caroline Sanchez, MD, and Bertram Chinn, MD, both colorectal surgeons, hemorrhoids affect around 10 million Americans yearly.¹ Caucasians in a high socioeconomic class are diagnosed with this disease more often than any other demographic, and there has been some supposition that hemorrhoids are diet-related.
This research considers access to health care a factor in seeking help. It concludes that there is no direct correlation between being white and middle-class and developing hemorrhoids — although previous studies have established these as risk factors due to possible confounders such as sedentary office work. They did consider any conditions that increase abdominal pressure — pregnancy or constipation, for example — as contributing factors.
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Sanchez and Chinn concluded that the pathophysiology of hemorrhoids not only includes pressure but also aging and genetics. The NIH estimates that about half the adult population will have some sort of hemorrhoid problem by the time they're 50.²
Other studies indicate that people with hemorrhoids may have a higher anal sphincter tone — that is, their normal resting tightness is squeezier than normal.³ When these hemorrhoid patients strain or have constant abdominal pressure, internal hemorrhoids push against the sphincter. Eventually, the connective tissue that keeps those vein cushions in place weakens, which causes the external hemorrhoids to bulge out.
Age is also a factor in weakening connective tissue.
Contrary to old wives’ tales, this particular pain in the rear is not caused by eating spicy foods. Some factors that may cause hemorrhoid flare-ups include:
Sitting for long periods of time
Straining during bowel movements
When you realize you've gotten a hemorrhoid, you want relief fast. Many doctors recommend using an over-the-counter hemorrhoid cream for a week or so before coming in — most internal prolapsed hemorrhoids go away on their own.
Once that immediate itching and pain is under control, there are other steps you can take to ease the pain and mitigate the risk of a recurrence. You can try the following:
Take a stool softener or fiber supplement — psyllium is recommended. This will help you avoid straining on the potty.
Low fiber intake is a risk factor, and vegetables typically are high in fiber. Broccoli, beans, oat and wheat brans, fresh fruit, and whole-grain foods are all good. Stay hydrated with lots of water or other non-alcoholic liquids — fruit juices and clear soups.
Sit in a warm tub a few times a day to relieve pain — this is what your grandmother called a sitz bath.
Acetaminophen, ibuprofen, or naproxen may also help with the pain.
Sit on a supportive cushion to prevent further pressure.
Wear cotton underwear and loose-fitting clothing to keep the area dry. Any moisture can cause more itching and irritation.
As it happens, you've probably been going to the bathroom wrong ever since you were potty trained. Parents who recognize the telltale squat of a toddler pooping in their diaper, take note: research indicates that is the correct position for a good, strain-free go.
A team of Japanese doctors and researchers published a paper, the Influence of Body Position on Defecation in Humans, in the medical journal Lower Urinary Tract Symptoms (LUTS) that confirmed yes, there is an optimal potty position for adults.⁴
Medical professionals have defined three basic sitting, or defecation, positions: sitting, sitting with hip flexion, and squatting.
Sitting is the default position in most countries where the pedestal toilet is the standard. But research indicates that's the worst possible way to poop — you literally twist your gut into a knot, making it almost impossible to complete a quick and clean getaway.⁵
Sitting with your hips flexed at a 60° angle relaxes the puborectalis muscle, which creates a straight line to the exit.
Squatting is the ideal position: knees up and legs a bit apart, creating a V-shape from your bowel to your knees. This angle creates the least amount of stress on the sphincter muscles.
The results of this study indicated that the squatting position was best across the board. A straight line in the rectal canal not only lessens stress and pressure on your bottom but also completely empties the bowel — something that doesn't always happen when you're sitting with your feet on the floor. That's all just basic gravity when your body is at the correct angle.
There are several portable footstools on the market designed to change your position from a sit to a squat when you're on the toilet.
The results from other studies in the US and abroad concur with these findings.⁶
If you're curious about buying a defecation posture modification device (DPMD), the Squatty Potty was the device of choice in the research the Journal of Clinical Gastroenterology conducted.
Although hemorrhoids are generally more of a nuisance than severe health complications, they're not without some risk. If you have chronic hemorrhoids, there's a chance that your blood count drops to the point you become anemic. Also, the blood flow from a prolapsed (hanging out of your bottom) hemorrhoid can get cut off, which is quite painful and may require surgery.
But, generally, hemorrhoids are not serious and can be treated at home. You can lower your risks of developing the external nodes by having a diet high in fiber, exercising, and maintaining a healthy weight. If your hemorrhoids are the byproduct of pregnancy, they will usually go away with the other pregnancy-specific symptoms.
If you've been treating hemorrhoids at home for more than a week and haven't had success, it's time to call your doctor.
Definition & facts of hemorrhoids | NIH: National Institute of Diabetes and Digestive and Kidney Diseases
Hemorrhoids and what to do about them | Harvard Health Publishing
Treatment of hemorrhoids | NIH: National Institute of Diabetes and Digestive and Kidney Diseases
Hemorrhoids | NIH: National Institute of Diabetes and Digestive and Kidney Diseases
Search open payments | Open Payments Data
Are you pooing properly? | Queensland Health