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.
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.
Warmly,
Malinda Wright, PT, MPT
References:
- 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
http://www.healthline.com/health/hemorrhoids#Overview1 - Hemorrhoid Information Center: Digestive Health http://www.hemorrhoidinformationcenter.com/category/hemorrhoids/
- Hemorrhoid Information Center: Hemorrhoids During Pregnancy http://www.hemorrhoidinformationcenter.com/pregnancy-and-hemorrhoids/
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.
Comments
If you are not squatting right, you are most likely putting excessive strain at your anus. You should try to squat right and poop right. Using a squat stool at our nursing homes have helped to ameliorate the constipation and hemorrhoid problems for the elderly. Thanks.
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