Real Talk: Haemorrhoids by Hayley Kava
Haemorrhoids… ah, lovely right?
The only push present I got for my second birth was a nice swollen grape in my lower rectum and anus. I hadn’t had one before in my previous pregnancy and postpartum experience so it was an extra special surprise.
Oddly, I couldn’t help myself to “nerd out” though, as a pelvic floor physical therapist, to learn how to best manage it, and to better help my clients navigate these nasty buggers in pregnancy and postpartum (or other times too!)
A haemorrhoid is essentially a varicose vein in the lower rectum. They can be internal or external. Which means you may be able to see them on the outside(external) or you may just have some of these symptoms without the external component (internal). However, if you have external haemorrhoids then you do have internal ones too.
They tend to happen frequently in the third trimester and postpartum due to hormonal shifts, increased intra-abdominal pressure, changes in lymphatic flow (fluid retention), changes in how our digestive system absorbs nutrients and the pace at which our body digests food. However, they can happen to anyone at any time. This being said, straining for bowel movements, constipation, digestive issues and over-active pelvic floor muscles can cause them outside of pregnancy or be the reason they won’t go away.
Symptoms of haemorrhoids 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 haemorrhoids, or you were told to “Just deal with it”, here are some of my best tips and tricks for breaking the horrible haemorrhoid cycle.
We want to break down healing and managing these buggers from all angles, I apologize as this is not the most brief article, but in order to really kick rhoids to the curb we want to think “P.OL.I.T.E”
PROTECT, OPTIMAL LOADING, TEMPERATURE, ELEVATION
P- Protect (Sitting, Cleansing, Lubricating, Compressing)
We want to create an optimal environment for healing with this category!
As best you can avoid sitting on hard surfaces. If sitting is particularly sore a circular "donut" pillow may be necessary. I also really like the “Kabooti” pillow which for many insurance will cover in pregnancy or you can use HSA/FSA funds on if you have them.
Avoiding wiping with dry toilet paper which can irritate skin, using gentle wipes, a peri-bottle or you can get fancy with a bidet, like the amazing “Tushy”. These will all be much more gentle on this sensitive skin, and help with healing.
Topicals like “Preparation H” or “Recti-care” can decrease inflammation, and pain and provide a bit of lubrication to protect skin in anus from rubbing on haemorrhoids with walking/moving. While they are often considered "safe" for pregnancy and postpartum, I recommend speaking with your provider before using any medication. Other topicals for lubrication, and symptom relief like mother love “roid” balm are a great option for pregnant and postpartum folks.
*Preparation H and Recti-care have not specifically been studied for safety in pregnancy/breastfeeding
Supportive underpants, leggings, the V2 Supporter and others like the the mamastrut (which can combine ice also) can help provide support to help veins heal and decrease downward pressure on PF. These may also be covered by your health insurance or be HAS/FSA eligible!
OL - Optimal Loading (Stool Consistency, Toilet Mechanics, Pressure Control)
Increasing stress/pressure over these tissues will continue to irritate them so we want to be as gentle as possible. How we move our body, pelvic floor and ESPECIALLY our bowel has a huge impact on haemorrhoids.
In order to decrease this irritation we need to make optimizing the consistency and minimize straining with pooping a priority! We can do this via our diet, as well as bowel movement mechanics.
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 (brussells sprouts, 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.
Ok, so now for the poop mechanics for optimal loading! This is a total game changer for those rhoids! We do not want to hold our breath and bare down adding strain and pressure on those sensitive tissues and our pelvic floor with BM’s!
Step 1: Squatty Potty! (or any foot stool)
Getting knees over hips while sitting on the toilet really helps to relax the posterior pelvic floor (Where poop comes out) – for many, this small adjustment makes a WORLD of difference.
Step 2: BREATHE it out!
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. I offer both in person, and virtual services, but you can also find PT’s in your area at pelvicrehab.com
Just like we don’t want to be bearing down on haemorrhoids 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 highly trained to help you improve
T: Temperature Change (ICE or HEAT?)
For some, ice packs can feel amazing - just make sure you aren't putting ice directly on anus. I also LOVE PADSICLES- aloe and witch hazel on a pad frozen in the freezer can be great for symptom relief. Tucks pads cooled in the fridge can also be amazing as the witch hazel helps with inflammation and pain.
However, for others warm sitz bath with Epsom salts or warm compresses are where it’s at. It’s ok to experiment and see what your body likes best in this case!
E: Elevate
As long as it is tolerated in pregnancy, placing 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. Other Inversions like the forward leaning inversion from “Spinning Babies” is another position to help use gravity to your advantage and minimize swelling. BONUS: could add compression and ice in these inverted positions!
If you have been trying conservative management for 1 month or more may be time to investigate more, and seek support from your healthcare team!
Hayley Kava PT, MPT, never wanted to be a pelvic floor physical therapist. She had been an athlete her whole life and working with athletes was her passion. She then gave birth the first time and realized that labor, birth and postpartum recovery was the most physically, and emotionally demanding thing she had ever done.
Through navigating her own recovery, she realized that all people with pelvic floors deserve more information and empowerment about how to address their common, but often taboo, issues. She created her business Hayley Kava, Physical Therapy from this passion to spread this information, and to ensure that no person feels alone is dealing with any pelvic floor problem. Hayley now works full time with clients of all ages and genders integrating her strong orthopedic history with postural restoration institute teachings and her study of the pelvic floor.
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