Exactly what is a hemorrhoid?
Postpartum hemorrhoids may be a favorite topic of conversation for—well, no one. But when you need to know, you need to know. Am I right?
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 the outside (below or surrounding the anus).
What causes postpartum hemorrhoids?
Similar to a lot of postpartum issues, there isn’t ONE cause for postpartum hemorrhoids, but here are some ideas:
- 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.
- 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, they 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 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.
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 that 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.
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 they are overworked. For more symptoms of pelvic floor dysfunction, take a look at this blog.
The pelvic floor muscles close the bottom of the pelvis. If they’re too tight, 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 be a cause of hemorrhoids, and it’s important to discover the reason behind the tight pelvic floor and thus, the constipation. Depending on the woman, this is a great situation for a pelvic floor physical therapist, but here are two common scenarios that can result in a tight pelvic floor.
- You have a habit of bearing down to stabilize. This can occur with an altered breathing pattern, where a woman inhales with her breath moving up and exhales with her breath moving down. Instead of stabilizing her spine by drawing up with her pelvic floor and her abs, she bears down because her exhale moves down. This can occur because of certain postures, pregnancy, or injuries.
- Another reason can be due to weak surrounding muscles. In this case, the pelvic floor gets tight because it’s trying to pick up the slack for muscles that aren’t working correctly, most commonly the hips or abs. The pelvic floor ends up trying to do their jobs, and since it really can’t, it just stays tight all the time.
One last note
If you need help solving problems such as these, a pelvic floor physical therapist is the gold standard. If you’re interested in doing some problem solving of your own while you find the time to see one, the Mama Made Strong program will teach you to assess your current function and guide you through how to change it. It covers breathing, pelvic floor, abs, hips, feet, and upper body; and it’s accessed by monthly subscription.
I always like to ask that if you found this blog to be helpful, please share it with the mothers in your life. But today, I know you’re highly unlikely to share. In fact, you’d probably prefer to never admit that you read today’s blog. That’s okay. I get it. Maybe if some weird friend of yours happens to ask you about hemorrhoids, you could just point them in my direction. Thanks.