Hemorrhoids? How can pelvic floor PT help?
Not an area a lot of people are comfortable talking about but so many people suffer from hemorrhoids. I unfortunately found myself frustrated and dealing with them after the birth of my first daughter. Having a natural birth was intense but having a bowel movement with hemorrhoids and anal fissures was excruciating. After having my own experience managing these conditions it has motivated me to learn more about this area and how to treat it!
What are hemorrhoids? Hemorrhoids are swollen veins in your anus and lower rectum that develop inside the rectum (internal hemorrhoids) or under the skin around the anus which are known as external hemorrhoids. About half of people over 50 will have hemorrhoids (2). Sitting for long periods of time, chronic diarrhea or constipation, straining during bowel movements, obesity, pregnancy, anal intercourse, poor diet, or regular heavy lifting can increase risk (1).
What are anal fissures? Anal fissures are tears or cracks in your anus resulting from stretching of your anal mucosa beyond its normal capacity. This can happen when you are passing hard stools due to constipation and can easily be confused with hemorrhoids. Once a tear happens it can lead to repeated injury where the internal sphincter muscle is now exposed and goes into spasm. This can cause severe pain (3). I remember going to my primary care and she had suggested all sorts of medications to try to help manage the symptoms and then she mentioned that baby diaper rash cream with zinc can also work really well. Since I was breastfeeding and nervous about medications at the time my symptoms started, I used the diaper rash cream and couldn’t believe how well it worked to manage my symptoms. It is important to talk to your doctor and see what options may be available for you, and get assessed to determine if you have hemorrhoids, anal fissures, both, or something else going on.
Treatment includes addressing the activities that may be causing the hemorrhoids or anal fissures. If you're constipated, improving your bowel habits can help significantly. Using a bidet can help if wiping is irritating this tissue. Check in with your fiber intake, hydration, improving bowel habits including avoiding straining while on the toilet, listening to urges to go to the bathroom, exercising, and avoiding long periods of sitting.
If you are a heavy weight lifter, learning to manage your pressure during lifting can be very helpful in managing hemorrhoids. Learning to focus on your breath and coordinating pelvic floor relaxation and contraction at proper times can help decrease pressure in your abdomen and pelvic region. This will help avoid bearing down which is when we “bulge” or press out of the pelvic floor. There are times where we may utilize this for example with a bowel movement or while birthing of a baby but we want to avoid doing this regularly throughout the day especially when lifting loads. This can stretch or strain your pelvic floor muscles and lead to more noticeable hemorrhoids or problems. Check in if you are regularly clenching your glutes or pelvic floor muscles since this also can increase the pressure in this area. In pelvic floor therapy we typically focus on relaxation of the pelvic floor muscles to help treat hemorrhoids or help healing of fissures, and then start to progress into more functional strengthening. Pelvic floor therapy with a combination of other conservative management techniques can give a lot of relief to people.
During pregnancy since we have the extra weight of the baby on our pelvis, this can result in hemorrhoids or while pushing during labor. There are strategies that we teach in pelvic floor therapy to avoid straining and focus on relaxation of the pelvic floor muscles after about 36 weeks to teach the body how to relax these muscles which can be helpful during labor. We also focus on breathing properly to help decrease unnecessary stress to this area and bring attention to the brain when we are bearing down or straining throughout the day.
Unfortunately sometimes we can do everything right and still get hemorrhoids or anal fissures. Luckily most of the time we can treat them at home with medications, wipes, sitz baths, use of a bidet, or pelvic floor therapy. Sometimes people opt for surgery when the hemorrhoids are disrupting everyday life for the individual or not being managed well with conservative approaches.
I’ve had so many people over the years come into therapy young, old, or postpartum frustrated beyond belief with chronic hemorrhoids and fissures and I am always so amazed how much we as pelvic floor therapists can help. Getting someone's symptoms to decrease or resolve in this area can be very rewarding since we all deserve to have a good bowel movement without severe pain! I’ve also seen numerous clients post hemorrhoidectomy or Fissurectomy, some who get a lot of relief from surgery and some who are worse after. Reach out to your medical team to see if pelvic floor therapy may be a good adjunct to your current treatment protocol for hemorrhoids or anal fissures.
Sources:
https://www.hopkinsmedicine.org/health/conditions-and-diseases/hemorrhoids
https://www.hopkinsmedicine.org/health/conditions-and-diseases/anal-fissures#:~:text=Anal%20fissures%20are%20tears%2C%20or,result%20from%20passing%20hard%20stool.