Hemorrhoids… a lovely symptom common in pregnancy and post partum but can pop up other times also!
A hemorrhoid is essentially a varicose vein in the lower rectum. They can be internal or external- meaning you may be able to see them on the outside or you may just have some of these symptoms without the external component. However, if you have external hemorrhoids then you do have internal ones too.
They tend to happen frequently in the third trimester and post partum due to hormonal shifts, increased intra-abdominal pressure, changes in lymphatic flow (fluid retention) as well as changes in how our digestive system absorbs nutrients and the pace at which our body digests food.
However, straining for bowl movements, constipation, digestive issues and over-active pelvic floor muscles can cause them even outside of pregnancy.
Symptoms of hemorrhoids include: pain or swelling around anus, itching, pain or even bleeding.
If you are having these symptoms, especially bleeding, please be evaluated by your healthcare provider to rule out anything else more serious before you begin to self manage.
If you have been cleared medically and you are diagnosed with hemorrhoids here are some of my best tips and tricks for managing those nasty buggers.
We want to approach their treatment from a lot of different angles so if they are in the "acute phase" meaning: swollen, bleeding, painful ect
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as best you can avoid sitting on hard surfaces- if they are very sore a circular pillow "donut" pillow may be necessary. I also really like the “Kabooti” pillow which if you have Tricare insurance you can get covered see the DME form HERE (scroll to bottom of page)
Topicals like “Preparation H” can decrease inflammation- and provide a bit of lubrication to protect skin in anus from rubbing on hemorrhoids with walking- usually considered "safe" for pregnancy and PP- but speak with your provider before using any medication.
*Preparation H has not specifically been studied for safety in pregnancy/breastfeeding
OL : Optimal Loading Increasing stress over these tissues will continue to irritate them so we want to be as gentle as possible however, we have to poop!
In order to decrease this irritation we need to optimize the consistency and minimize straining with pooping.
Often fiber is recommended but sometimes the types of fiber can increase bulk too much making pain worse.
I prefer to recommend whole foods high magnesium (brussels, broccoli,almonds, leafy greens ect), magnesium supplementation or if needed the use of a stool softener like miralax.
As always, before adding any supplements, or medications speak to your health care provider, especially in pregnancy.
Another way to decrease this irritation is to optimize your breathing and pelvic floor mechanics for bowel movements. We do not want to hold our breath and bare down.
Keeping jaw and throat open inhale and imagine your pelvic floor and anus filling with air to expand. Then keep this nice pelvic floor expansion as you exhale to create a bit of pressure with an open throat. Imagining you are blowing out candles or blowing into a balloon can help learn this.
If you are struggling with being able to “feel” the pelvic floor release and are having a hard time passing stools- that’s a good time to reach out to a pelvic floor PT.
Just like we don’t want to be baring down on hemorrhoids in the bathroom, we also want to decrease this strain and pressure down on our pelvic floor for other activities in our day. Exhaling with exertion and learning to properly coordinate your core and pelvic floor is another area that pelvic floor PT’s are trained to help you improve
T: Temperature Change
ice packs can feel amazing - just make sure you aren't putting ice directly on anus. I also LOVE PADCICLES- aloe, witch hazel on a pad frozen in the freezer can be great for symptom relief. Tucks pads in the fridge can also be amazing as the witch hazel helps with inflammation and pain.
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However, warm sitz bath or warm compresses can also really help with symptoms for some people.
Some research has supported warm sitz baths in combination with glycerine suppository before a bowel movement and morning dose of Metamucil (fiber) supplement MORE effective than topical medications for treating Hemorrhoids in pregnancy
C: Compress: supportive underpants, leggings the or a device like the mamastrut ( which can combine ice also) can help veins heal and decrease downward pressure on PF
The mamstrut is also available for little to no cost with Tricare insurance forms HERE
E: Elevate: as long as they are tolerated in pregnancy- legs up wall with support under pelvis can help take gravity off the pelvic floor and allow those veins to return to where they belong- you could add compression and ice in this position!
If you have been trying conservative management for 1 month or more may be time to investigate more or treated by MD.
Keep an eye on my social accounts over the next few days as I will be covering a few more tricks for all your "butt problems"