Don’t be ashamed. Almost everyone has ’em.
By Sarah Klein for Prevention
March 17, 2017
About a month ago, at an event for health journalists, I heard a colorectal surgeon say something that nearly made my eyeballs bug out of my face. “All of us have hemorrhoids, all the time,” she said.
Uh, no, nope. There’s no way. All these healthy-looking people sitting comfortably on their bums around me have hemorrhoids?! (Here are 5 things your butt is trying to tell you.)
So I called her up after the event and asked her what she meant by that inflammatory (sorry) comment. Never in my life did I think I’d spend 45 minutes on the phone casually throwing around phrases like “anal canal.” I also didn’t know there was so much to learn about hemorrhoids. Here are the dirty details everyone should know.
I know, I’m horrified, too. “I love telling people that,” says Alexis Grucela, M.D., the colorectal surgeon who first mentioned this idea, who is also an assistant professor of surgery at NYU Langone Medical Center. “It’s usually so shocking to them!” Indeed. But hemorrhoids are totally normal, she explains. “They’re anal tissue that gives us extra support in the anal canal,” she says. Just like pelvic floor muscles help keep urine from leaking out when you, say, cough or laugh, hemorrhoid tissue does the same for stool and gas. “It’s only when they become symptomatic that people start noticing them,” Grucela says. “Usually, they just do their job.”
Something has to go very, very wrong for that normal anal tissue to become the angry, itchy, painful protrusions you’re probably picturing by now. The key culprit is abdominal pressure, Grucela explains, whether that’s from straining to go to the bathroom because of chronic constipation, excess belly weight, pregnancy, or even lots of long-distance running. (Torch fat, get fit, and look and feel great with Women’s Health’s All in 18 DVD.) “We think the pressure causes the tissue to stretch out and weaken over time,” Grucela says. That stretching causes the blood vessels in hemorrhoids to dilate, bringing more blood to the area, which causes hemorrhoids to swell and potentially bleed.
Around one in 20 Americans have symptomatic hemorrhoids, and your risk increases as you age. About half of people ages 50 and up are dealing with this painful problem, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
That would be internal and external, and they’re pretty much exactly what they sound like. External hemorrhoids occur right at the anal opening, Grucela says, and they’re covered with skin. Because they’re covered with skin, they also have nerves, which means external hemorrhoids are the ones that can come with sensations like pain, itching, and burning. Internal hemorrhoids on the other hand are inside the anal canal. You (obviously) can’t see them, and because they’re not covered with skin, you won’t feel any symptoms from them, either. However, internal hemorrhoids are more likely to bleed, and, if the situation gets really dire, they can prolapse, or fall out of the anus.
Okay, so that description certainly sounds miserable, but the faint glimmer of good news here is that hemorrhoids aren’t going to cause any direct harm to your health. They’re not
People are quick to think any symptoms back there must be hemorrhoids, then grab an OTC treatment and deal with the pain. But don’t write off a visit to a doc just yet, Grucela says. “Especially with internal hemorrhoids, where you can’t see where the blood is coming from, it could be something more serious,” she says. “Anybody with new bleeding or blood in the stool should talk to their doctor. We hope it would be something basic like a hemorrhoid, but the symptoms can be similar in colorectal cancer.” (Watch for these 5 common signs of colorectal cancer.) Plus, lingering symptoms could actually be due to other causes, like fissures or warts, she says, which would warrant different treatment.
The toilet may be a porcelain throne, but you should not treat it like your personal zen palace, Grucela says. “I see people who act like it’s an escape from work, life, everything,” she says. “People tend to spend a long time sitting on the toilet, even if they aren’t necessarily constipated, reading or playing on their phones.” Besides that being pretty filthy (maybe that’s why 16 percent of cell phones carry traces of fecal matter) it’s also bad for your bum: With your cheeks spread over the toilet seat, the pressure grows on anal tissue, contributing to blood pooling in hemorrhoids and making them swell. “A good bowel regimen is the first step of treatment for people with hemorrhoids,” Grucela says. “Limit time on the toilet, don’t bring reading materials, and leave the phone at the door.”
All that straining and pushing increases the pressure that can lead to inflamed hemorrhoids. Treating any constipation is the second step in standard hemorrhoid treatment, Grucela says, and the easiest way to do that is getting hydrated, fast. The more parched you are, the more parched your poop is. Eating enough fiber (or taking a fiber supplement, whether in old-school powder form or newfangled gummies) helps bind water to stool. “That way, it will be softer and pass through less traumatically,” she says. The ideal: The kind of poop that glides out so effortlessly you almost don’t even need to wipe. If you’re still stopped up, constipation meds may help, Grucela says, “but most people will get better by increasing hydration and fiber.”
You’ve cringed at the embarrassing ads, but you can probably save face at the pharmacy by avoiding over-the-counter hemorrhoid creams. “Most patients don’t find them that helpful,” Grucela says. If you’re looking for quick symptom relief, draw yourself a warm bath, she says. Soaking the area can help soothe some irritation. Wiping with witch hazel may also help, she says.
In rare instances, serious hemorrhoids may need to be removed. Doctors use a number of different techniques to do so, including ligation (which uses rubber bands to essentially “choke” a hemorrhoid until it falls off), stapling, infrared light treatment, and, as a last resort, surgery. “The surgery is simple, but the recovery is miserable,” Grucela says. “Before we go down that road, we make sure we’ve maximized every other option.”
Spicy foods can cause their fair share of digestive issues, but hemorrhoids aren’t one of them. Your favorite jalapeño guac won’t exacerbate hemorrhoids, but it can cause a similarly itchy bottom all on its own. In fact, that feeling is pretty much the same burning sensation you feel in your mouth, Grucela says.
Travelers who end up with hemorrhoids have been known to blame it on their road trip, Grucela says, when sitting for a long time really has little to do with it (unless that sitting is atop the toilet). “People tend to get constipated while traveling,” she says. “They’re drinking and eating differently, they may be dehydrated, and then they’re straining and pushing and hemorrhoids flare up,” she says. (Here’s why flying can make you a bloated, constipated mess.) “Drink plenty of water while traveling, and consider taking a fiber supplement or constipation medication with you.”
The article 11 Things Every Woman Needs To Know About Hemorrhoids originally appeared on Prevention.
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