Postpartum hemorrhoids are a favorite topic of conversation for—well, no one. But when you need answers, you need answers.
Exactly what is a hemorrhoid?
A hemorrhoid is actually a normally occurring part of the anatomy, although we usually use the term to refer to a problematic condition. The normal part of the anatomy is a combination of blood vessels and smooth muscle that help to close the anus (aka, butt hole) and protect the sphincters when pooping. If you’d like more info, you can find all sorts of pictures and statistics here.
However, the problematic condition occurs when the blood vessels are under too much pressure. This consequently causes them to enlarge. Depending on the degree of pressure or enlargement, they can also bleed, swell, or itch. Hemorrhoids can be found on the inside (above the opening of the anus) or on the outside (below or surrounding the anus).
What causes postpartum hemorrhoids?
Similar to a lot of postpartum issues, there isn’t ONE cause for hemorrhoids, but here are some possibilities:
- Constipation – If it’s hard to get the poop out, you’re more likely to strain. Straining to poop increases the pressure on the blood vessels, and this increased pressure is really what causes hemorrhoids.
- Diets low in fiber – High fiber diets make poop softer, and conversely, low fiber diets make poop harder. Hard poop means more straining to get it out and thus, more pressure.
- Increased pressure due to the weight of obesity or pregnancy – A greater body weight means there’s more pressure down on these veins.
- Hormonal changes during pregnancy – Hormones make the walls of the blood vessels weaker during pregnancy, and consequently, they become more susceptible to expanding or swelling under pressure. Hormones also slow down the digestive tract, so more nutrients can be absorbed for babe. But this results in more water being absorbed as well and thus, harder stools, which cause more straining.
- Increased pressure during a vaginal delivery – Straining during a vaginal delivery can cause increased pressure on the blood vessels, resulting in postpartum hemorrhoids.
- Pelvic floor dysfunction – The pelvic floor is a group of muscles that closes the bottom of the pelvis and surrounds the openings of the urethra, vagina, and anus. If there is dysfunction in these muscles, it can affect the pressure on the blood vessels.
What to do for postpartum hemorrhoids
First, keep the area clean. This might go without saying, but when the blood vessels enlarge, there are more folds of skin than under normal circumstances. Moistened wipes or water can be gentler than normal toilet paper and do a better job of cleaning all of the folds. Clean skin reduces itching, burning, and skin breakdown.
Second, ice, hemorrhoid cream, or hemorrhoid pads can be used to relieve symptoms. Witch hazel is a common ingredient used in creams or pads to reduce the itching, burning, or discomfort.
And most importantly, don’t strain. To be clear, straining can occur with childbirth, pooping or lifting. It creates the downward pressure that causes hemorrhoids. This is why there is a correct technique for childbirth, pooping, and lifting. Are you familiar with these?
Here’s how to avoid straining
While delivering babies
Let’s be serious. There isn’t room in a blog post to properly explain delivering babies, but if you haven’t delivered yours already yet and you plan on a vaginal delivery, it’s important to learn. A pelvic floor physical therapist is the professional most qualified to impart this knowledge.
The nutshell version is that the uterus has the ability to contract and will push the baby out. While this is occurring, the mother needs to exhale by moving her breath up and out, so she doesn’t bear down. Bearing down isn’t good for her pelvic floor, in general, and is the force that can cause a multitude of problems, including hemorrhoids but also incontinence and prolapse.
Basically, soft poop is important. If you don’t already, drink lots of water. Try to eat fruits, veggies, and whole grains because they have more fiber than foods like graham crackers or Cheetos. Fiber makes poop softer, and softer poop is easier to poop. Additionally, you can take a stool softener if you need one.
Squatting, or a knees-to-chest position, is good for delivering babies and for pooping because it lines up the objects that need to be expelled with the openings through which they need to travel. This is the reason why squatty potties work, but if you don’t have one, you can also prop your feet on a step stool or a trash can lying on its side. Either of these bring your knees higher than your hips and make it easier for the poop to exit.
Just as with delivering a baby, it’s also important to exhale when actually passing the poop. The exhale needs to move up and out because this motion will prevent bearing down on the pelvic floor or creating the downward pressure that causes hemorrhoids. Your exhale should be similar to blowing out a candle or humming loudly.
If you have to hold your breath to lift or carry something, you are likely generating downward pressure on your pelvic floor. Similar to childbirth and pooping, you should be strong enough to exhale when you lift something. Otherwise, that object is probably too heavy for you to lift safely. Your exhale needs to move up and out to prevent straining. This technique will protect your pelvic floor and decrease the chances of causing hemorrhoids.
Sometimes, this is as simple as relearning your technique. But other times, you may need to alter your breathing pattern or strengthen your abs, hips, or pelvic floor, so that you can prevent that downward pressure.
Your pelvic floor and postpartum hemorrhoids
Constipation can be a symptom of a pelvic floor that is doing too much. If you remember, the pelvic floor is a group of muscles, and just like any other muscles, they can get tight or tense when overworked. For more symptoms of pelvic floor dysfunction, you might appreciate this article.
The pelvic floor muscles close the bottom of the pelvis. If they can’t relax well, it’s as though the exit door is closed. When the door is closed, the poop can’t get out. Hence, constipation occurs.
In this case, chronic constipation can definitely cause hemorrhoids, and it’s important to discover the reason the pelvic floor stays tense. This might be a question best answered by a pelvic floor physical therapist, but here are some common scenarios that can result in such pelvic floor dysfunction.
- You have a habit of bearing down to stabilize. This can simply be a matter of training the muscles with an ineffective strategy, or it can occur with an altered breathing pattern. In a breathing pattern where the breath moves up on the inhale and down on the exhale, the pelvic floor can regularly be subjected to excessive downward force. When loading regularly occurs in this way, it can be difficult to let go.
- Another reason to have a hard time relaxing is weakness in surrounding muscles. In this case, the pelvic floor tries to make up for other muscles that aren’t doing their jobs well. Common culprits are the hips or abs. The pelvic floor ends up trying to substitute for these weak muscles, and since it really can’t, it stays overworked instead.
- A third reason someone might consistently hold tension in their pelvic floor is that this is how they have learned to manage stress. Some people hold tension in their jaws or shoulders, others do the same with their pelvic floor. In this case, meditation can help as well as strengthening of surrounding muscles.
Any of these scenarios can be the result of training habits, certain postures, pregnancy, or injuries. Regardless, it’s important to get behind the specific reasons for any individual. This is the fastest, most effective way to retrain pelvic floor muscles and to put in end to constipation and hemorrhoids.