Read on so you can sit down pain-free
BY DR.ED A: JAN 22, 2024
Just like everyone else on the planet, you have hemorrhoids.
Yep: You were born with them, and you’ll croak with them, but hopefully they won’t cause you too much trouble along the way.
That’s because hemorrhoids are actually a normal part of your anatomy.
“Hemorrhoids are nothing more than veins that are inside and outside your anal canal,” says Mitchell Bernstein, M.D., Director in the Division of Colon & Rectal Surgery at NYU Langone Health. “It’s when they become symptomatic that you have a problem.”
There are two types of hemorrhoids: internal and external hemorrhoids. With internal hemorrhoids, the most common issues are irritation that causes bleeding, and prolapse, which means they “drop” out of the rectum. For the latter, many patients simply tuck them back in manually and it’s fine, says Dr. Bernstein.
The external hemorrhoids—which develop under the skin around the anus—are the ones that grab all the attention, because when something goes awry there, they tend to become swollen and very painful. That’s when simply sitting down can start to hurt like hell.
If anything’s irritating your hemorrhoids or causing them to flare up, it can certainly be unpleasant. So that’s why playing the preventive game for hemorrhoids is extra-important. Here, 5 things that might be causing your hemorrhoids to become symptomatic.
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Why you get hemorrhoids: You’re sitting on the toilet too long
Look, we get it. Maybe toilet time is the only chance you get to scroll through social media or watch old Jackass clips on YouTube. You might think being on the toilet is the same as simply sitting in a chair. But that’s absolutely not true, says Dr. Bernstein.
“Hemorrhoids tend to become symptomatic whenever you have increased, downward pressure,” he says, noting that being on the toilet not only separates your butt cheeks, but the shape of the bowl and the way you sit causes a very slight suction effect. Basically, gravity is not your friend here.
“The longer you sit, the more your blood pools down in those veins, and the gravity creates more pressure,” says Dr. Bernstein. That creates inflammation that makes hemorrhoids flare. “Go in, do your business, and get out.”
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Why you get hemorrhoids: You wait too long to poop
Part of the major function of the colon is to remove water from fecal matter, according to Heather Bartlett, M.D. a family practice physician in Columbus, Ohio. If you abide by your body’s signals to evacuate, your water-to-poop ratio is usually fine, unless you’re dehydrated to some degree.
But if you tough it out, the colon will continue its water removal mechanism, making the stool firmer.
“With less water content, it’s like trying to get a brick to go through a Play-Doh maker,” she says. “That causes tears and fissures, and makes the veins more easily exposed. When you add straining in there, then you’ll become symptomatic.”
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Why you get hemorrhoids: You’re pushing too hard
Speaking of straining, it’s another top contributor to hemorrhoids becoming a problem. That’s because it’s a source of downward pressure, says Dr. Bernstein.
Trying to push the poop out can overtax the veins enough that it could damage a vein’s surface and cause it to bleed, or may be enough to push an internal hemorrhoid out.
Why you get hemorrhoids: You don't get enough fiber and water
Anything that limits your time in the bathroom and makes your stools more pliable is a good thing, says Dr. Bernstein. Fiber has been touted endlessly as a make-you-go tool, and for good reason: Fiber adds bulk to your digestive system, shortening the time it takes for waste to travel through the colon.
Water, too, speeds the process by keeping your intestines smooth and flexible.
Ideally, your poop should be soft and easy to pass, Dr. Bernstein says. Check out the Bristol Stool Chart for some insight on how you rate.
Anything that involves having to push is usually an indication that you’re not as hydrated as you could be, adds Dr. Bartlett.
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Why you get hemorrhoids: You squat too heavily, too quickly
This can be particularly true for those who don’t work their way up gradually, and aim to do all the squats, all in one day. Dr. Bernstein says leg presses can have the same effect, or even helping a friend move.
“It’s all about the sudden pressure as you’re pushing,” he says. “We often see people who’ve done a heavy workout come in with hemorrhoid issues.”
He advises warming up by doing lighter weight sets first, so you push less when you get to those heavier weights.
When to see a doctor for hemorrhoids
Symptomatic hemorrhoids are very common, but that doesn’t mean you shouldn’t keep an eye out for some signs that you might need to get checked out.
Dr. Bernstein says that any time you have rectal bleeding, make an appointment. It’s most likely that it’s hemorrhoids, but since that’s also a warning sign for colon or rectal cancer, it’s better to be safe (Here are 7 signs of colon cancer young guys should never ignore).
Also, if the pain becomes too intense or continues for more than a couple weeks, see your doctor for some relief. He or she can do therapies designed to cut off blood flow from the hemorrhoid, which cause it to shrink. In more advanced cases, you may need surgery to remove a hemorrhoid completely, or staple one that’s prolapsed back into place.