Awkward. Taboo. The stuff of juvenile comedy. That’s how many people would describe hemorrhoids, if they even talk about them at all. And if the emotional discomfort isn’t enough, they’re also pretty physically uncomfortable.
But for something we don’t talk about, a LOT of us experience them. One in two people will experience a hemorrhoid by the time they reach 50.
On this episode of Health Matters, gastroenterologist Dr. Sarah Umar — also known to her Mayo Clinic patients as the Queen of Hemorrhoids — joins us to answer all our burning questions about hemorrhoids.
Powered by RedCircle
Listen to Who’s the queen of hemorrhoids? here.
Find us online at Mayo Clinic Press for more health and wellness articles, podcasts and books.
Do you have feedback, questions or topic suggestions? Email us at mcppodcasts@mayo.edu.
Read the transcript:
Kristen Meinzer: This is “Health Matters,” a podcast from Mayo Clinic where we discuss the latest medical advice, news, and research to help you live a happier and healthier life. My name is Kristen Meinzer. I’m a writer and journalist. On this episode, we’re talking with “The Queen of Hemorrhoids,” Dr. Sarah Umar. Dr. Umar, how did you get this nickname and how do you feel about that?
How did Dr. Sarah Umar get the nickname “Queen of Hemorrhoids”?
Dr. Sarah Umar:I can frankly say, I don’t know where the nickname came from. I suppose it’s probably from one of my patients. But I’m fine being called the queen of anything, so we’ll go with the “Queen of Hemorrhoids.”
Kristen Meinzer: But you’re not just called the right hand man of hemorrhoids. You must be really good at it, or they wouldn’t use the word queen, right?
Dr. Sarah Umar: I hope I’m good at it. My clinics are fairly full of hemorrhoid patients and I just enjoy talking about them. It’s something that is very commonly suffered by people and not often talked about. It’s very rewarding when I can help folks with this often very bothersome symptom. Awkward. Taboo. Gross. That’s how many people would describe hemorrhoids, if they even talk about them at all. And if the emotional discomfort isn’t enough, they’re also pretty physically uncomfortable. They can cause pain, itchiness, or even bleeding.
But for something we don’t talk about, a lot of us experience them. One in two people will experience a hemorrhoid by the time they reach 50. If you have hemorrhoids, you might be wondering: do I really need to see a doctor? Am I making them worse? And… will they ever stop driving me nuts?? And if you don’t… well, what can you do to not get them?
To answer these burning questions, we’re talking with Dr. Sarah Umar, also known as the Queen of Hemorrhoids. Dr. Umar is a gastroenterologist at Mayo Clinic in Phoenix, Arizona. For her, hemorrhoids aren’t taboo – they’re just a typical Tuesday.
Kristen Meinzer: Dr. Sarah Umar, thank you so much for joining us today.
Dr. Sarah Umar: Thank you for having me. I’m really excited to be here.
What are hemorrhoids and are they dangerous?
Kristen Meinzer: Just as an entry point here, can you explain what hemorrhoids are?
Dr. Sarah Umar: Hemorrhoids are just vascular structures. They’re not pre-cancerous, they’re not dangerous, they don’t portend anything bad or terrible to happen to folks who have symptoms from hemorrhoids, but they’re just annoying. Sometimes they can be very, very bothersome, especially if they’re causing a lot of bleeding. They are a normal part of one’s anatomy. There are various risk factors for those who are going to develop problems from their hemorrhoids, and we can talk about that later.
What is the difference between internal and external hemorrhoids?
Hemorrhoids come in two flavors, internal and external. They’re both vascular structures. They just live in different places. When we’re talking about external hemorrhoids, they’re outside of the anal canal. Sometimes they are referred to as skin tags and they can be very small or they can swell and be very large. And then internal hemorrhoids are located just inside the anal canal, at the border of the anus and the rectum.
Kristen Meinzer: You’re saying that this has to do with the vascular system. Does that mean that a hemorrhoid is almost like a varicose vein, but that’s in our rectum or anus?
Dr. Sarah Umar: It’s not entirely the same thing because hemorrhoids are actually, the vessels are Both arterial and Venus, so it’s not just a vein, but it is a similar concept. It’s a vessel that is normally there. But it is behaving in a way that is bothersome to somebody. So in a simplistic way, I guess, yes, you could think of it as a varicose vein.
Kristen Meinzer: Let’s talk a little bit about the geography of this area for a moment because I think some people think anus and rectum are the same thing. Can you give us the lay of the land on that?
Dr. Sarah Umar: The rectum is the very bottom part of the colon. It is a reservoir for stool. It’s like a pouch where stool is stored until it is socially acceptable to evacuate. The anus is the small canal. It’s a couple of centimeters long. It’s quite short. That is essentially the canal through which stool moves to the outside of the body. They are different structures in that they have different nerves that occupy that area, they are lined by different types of lining. They are different structures, but they are in very close proximity.
Kristen Meinzer: Got it. And the hemorrhoids themselves. I did a Google image search on “what does a hemorrhoid look like?” and almost all of them were these candy-colored charts that didn’t really show me what they look like. Can you tell us more about visually and structurally what they look like and how large they are?
Dr. Sarah Umar: I tell my patients that hemorrhoids are like water balloons. They can inflate and deflate based on a variety of factors. Some people will have very small ones like the size of a pea. They can get large to the size of a cherry, for example. External hemorrhoids. These are the guys who live outside of the anal canal. If one has them they can look just like little flaps of skin. They can just look like extra skin tags and they’re skin colored.
If they get large and irritated, they can swell. If they are really irritated sometimes you can develop little blood clots in those hemorrhoids. They get large, like a cherry. They’re very firm and hard. They can be a purplish kind of color and be very painful in that case. These are the people who can’t sit down, they’re having to sit on a doughnut because it’s very uncomfortable to sit on them. That can last up to a week for some people if that happens to them.
Internal hemorrhoids are something that you can’t see if you can just somehow draft your neck around to that angle because they live inside the body. I see them very frequently when we’re doing our colonoscopies, for example. They’re pink like the lining of the intestine and they look like little cushions or little humps, if you will, right where the anus meets the rectum.
They can get larger, again, like the size of a cherry even or they can be very small. Or the people who don’t have any issues with hemorrhoids, it just looks like the normal blood vessels that are lining the colon.
How can you tell if you have hemorrhoids?
Kristen Meinzer: Hmm. And how would I know if I have hemorrhoids?
Dr. Sarah Umar: Many people don’t know that they have any hemorrhoids because they’re not bothering them. For external hemorrhoids, people may know that they have them because they can feel it, they can feel those little extra flaps of skin when they’re wiping for example, after having a bowel movement, or when they’re showering and cleaning.
If you’re having a flare of your external hemorrhoids if they’re engorged, they can be uncomfortable. They can feel like you’re sitting on something, like you can feel that extra tissue when you’re sitting. Sometimes they can be itchy or you can have a burning sensation. Those are the external hemorrhoids.
Can hemorrhoids cause rectal bleeding?
It is much less common to know one has any internal hemorrhoids unless they’re causing a problem at that moment. Internal hemorrhoids can cause and are usually the hemorrhoids that are responsible for any bleeding. If somebody is seeing blood streaks on the tissue paper after having a bowel movement, sometimes it can drip into the toilet or squirt into the toilet at the time of a bowel movement.
People can get itching from internal hemorrhoids as well. If you have a lot of that redundant internal hemorrhoid tissue in there, it doesn’t allow the anus to seal, if you will, as completely. And so you can get seepage of fluid outside and when it dries around the anal canal, it can be very itchy.
Internal hemorrhoids, if they get large and very swollen and engorged, they can actually fall out, what we call prolapse. You could actually have internal hemorrhoids that happen to intermittently become external, even though they technically live inside. And that can be uncomfortable. Sometimes they say it feels like a throbbing or kind of a pressure down there. Those are some common symptoms.
Kristen Meinzer: Is there like a severity scale that you have? Maybe a scale of 1 to 5 or 1 to 10?
Dr. Sarah Umar: The symptoms are what most people care about and there’s no specific scale for severity of symptoms. For someone’s symptoms, it’s really how much are they bothering you? How frequently is this bothersome to you? Are they keeping you up at night? Or is it just a little itch here and there during the day? Are you having bleeding once or twice a year, are you dripping into the toilet every time you’re sitting on the toilet?
We do grade internal hemorrhoids. And it’s purely a size thing. The way we most typically do that is at the time of a colonoscopy when we’re looking at them. That is a scale from one to four.
Kristen Meinzer: Interesting. If I were to get a colonoscopy and if you saw that there were hemorrhoids in there but you see them so often, would you even mention it or are they so nonconsequential that you don’t even bring it up?
Dr. Sarah Umar: Every time someone gets a colonoscopy, they should get a paper report that says everything the doctor saw and hemorrhoids should be listed on there. This is something you tell the patient they have. But in the same breath, you also say, if you’re not having any symptoms from your hemorrhoids, leave them alone. There’s no need to start using suppositories or going through procedures to eradicate them if they’re not bothering you.
Kristen Meinzer: I had my first colonoscopy last year and I now want to re-look at all the paperwork they gave me afterwards.
Dr. Sarah Umar: Yes. It’ll be on there if they’re there.
Kristen Meinzer: Hemorrhoids, at their most basic level, are vascular structures—meaning blood vessels that can get swollen. They can be internal, meaning inside the anus, or external, located outside the anus. When they’re not swollen, external hemorrhoids look like flaps of regular skin and might be about the size of a pea. But when they’re swollen or irritated, they can get large and purple from blood clots, as large as a cherry. You’re not likely to see internal hemorrhoids, unless they fall out – which can happen – or if you’re the one performing a colonoscopy.
Tons of people who have hemorrhoids don’t realize they do. And the good news is, if they aren’t bothering you, you can leave them alone! If they are, rest assured they generally won’t cause larger problems – just discomfort. Now let’s say I’m having symptoms and they are bugging me. I see over-the-counter medications, obviously Preparation H is a multi million dollar company, is that something I should do? Just start at the pharmacy? Should I go to the doctor? What should I do if I suspect I have hemorrhoids?
Dr. Sarah Umar: If somebody suspects they have hemorrhoids, it kind of depends on what the symptoms are. A lot of people have tried to treat themselves before they end up in my office. But a symptom like rectal bleeding, even if one assumes that it’s hemorrhoids, maybe they know they’ve been constipated for most of their life and statistically speaking, it’s hemorrhoids. But you should always seek care and bring that to the attention of your doctor if you’re having any departure out of the norm with your bowel habits, or if you’re bleeding.
If nothing else, it’s really important to just make sure that it is hemorrhoids, in fact, and that it’s not something else because hemorrhoids can also mimic other things and it can be potentially dangerous to assume it’s something as benign as hemorrhoids. If, say, you’ve already been to the doctor and they’ve confirmed it’s hemorrhoids, then yes, many people can get by with Tux and Preparation H, or Witch Hazel, or Vaseline and these over-the-counter remedies that can be very helpful for people with mild symptoms.
Kristen Meinzer: Now you were saying that hemorrhoids, it’s not always clear what they are or if maybe something else is going on. What are the other things going on that somebody might confuse hemorrhoids with?
Dr. Sarah Umar: If somebody is having rectal bleeding, there are certainly other things besides hemorrhoids that can bleed, and that can be potentially more urgent to evaluate and treat. Colon cancer or rectal cancer, for example, that can present maybe with a feeling of pressure in your rectum and some blood in the stool when you have a bowel movement. That’s, of course, the scariest thing and the least frequently seen, but you don’t want to miss it.
Anal fissures which are little cuts in the anus. Those can cause bleeding and discomfort down there and would be treated very differently than hemorrhoids. In patients who have the feeling of tissue coming out, it’s most likely hemorrhoids, but actually the rectum itself can fall out. There’s a condition called rectal prolapse, and I’ve seen patients come in with quote unquote hemorrhoids, and it’s actually not hemorrhoids that are coming out, it’s their entire rectum falling out of their body. That is a completely different treatment than would-be hemorrhoids. It’s really important to know before you start to embark on therapy to make sure you’re treating the right thing and not just assume.
Kristen Meinzer: Definitely important. Once we’ve ruled out more dangerous conditions, it sounds like people can try out different over-the-counter treatments. What are those over-the-counter treatments doing?
Dr. Sarah Umar: The ingredients vary a little bit, but the themes are the same. Some of them just provide some degree of numbing so you’re just not feeling the discomfort. Some of them have what we call vasoconstrictors, they kind of constrict that vascular tissue and shrink it. These hemorrhoids are engorged, and they’re inflated if you’re thinking of the water balloon. You want to shrink that down to try to relieve the symptoms.
That’s what a lot of these over-the-counter remedies can do. People use those for relief of symptoms of both internal and external hemorrhoids. They’re temporary though. If you continue to have the upstream issue of constipation we’ll say, yes, these over-the-counter remedies may help temporarily, but if you don’t modify the initial reason you have the hemorrhoids in the first place, often we’ll just keep being symptomatic.
Then there are steroid formulations that can be used for hemorrhoids. These are not over-the-counter. Usually these are available with prescription and you can use creams or uh, suppositories. And again, that’s just decreasing the inflammation and decreasing the size and the degree of engorgement of this vascular tissue because that’s what’s causing the majority of the symptoms for people.
Kristen Meinzer: Got it. But let’s say those treatments are not working. If preparation H isn’t doing it, what should I do next?
What should you do if over-the-counter hemorrhoid treatments aren’t working?
Dr. Sarah Umar: The treatment of hemorrhoids is like a spectrum. There’s Preparation H, Tux and Witch Hazel on one side and then on the other side of that spectrum is the operating room. If you’re still having problems despite having tried the over-the-counter measures, when you come into my office one of the first things I will talk to you about is what your bowel habits are doing. Are they normal? Are you constipated? Are you having diarrhea? Because what I tell people first and foremost is if there are any issues with your bowels, let’s fix that first because oftentimes the hemorrhoids will fall into line if we can get your bowels regulated.
I don’t want to do procedures on patients who don’t really need them. If they’re constipated, we’ll address that. Same thing with diarrhea. What’re your toileting habits? Are you sitting for a half hour? Reading your emails or playing Word on the toilet? If so, you need to stop doing that. And I tell people, you should really shoot for 5 minutes or less on the toilet. And if you need to sit and get away from it all, or your kids are bothering you, then get up, put the toilet seat down and sit on the toilet seat. Because at least then your pelvic floor is being supported while you’re in the restroom.
And once I do that, and then someone says, “Look, my bowel habits now are normal. They’re perfect. I’m not straining. I can have a complete evacuation. I’m not having to sit there for five minutes, but I’m still bleeding, for example, or I still have this excess tissue from inside that’s popping out and it’s bothering me,” well, that’s when we start thinking what are the next steps for this bothersome internal hemorrhoid symptoms?
What is rubber band ligation for hemorrhoids?
What we do here at Mayo Clinic is something called rubber band ligation. That is putting a tiny little rubber band around these internal hemorrhoids. We do that with a very simple procedure. It looks like a big syringe, actually. It’s a disposable plastic syringe with a rubber band on one end and like a plunger on the other.
You insert that into the rectum. You suck back on that plunger and draw that hemorrhoid tissue into the top of the device a little ways, and then you just fire a rubber band on top of it. You’re now left with this mushroom of tissue, if you will, that over the next three to four days loses its blood supply and it eventually sloughs off along with the rubber band. Most people don’t ever see that happen because it mixes with stool.
That’s the rubber band ligation procedure and it’s painless. It’s a little weird, like anything would be in that area, but it’s a simple procedure that doesn’t require any sedation. It doesn’t require any prep, takes 5 to 10 minutes here in the clinic, and there are no restrictions. You can go do whatever you want to do that day. It is very effective and it’s very safe.
Is hemorrhoid surgery ever necessary?
If rubber band ligation is not effective and in a small proportion of patients it’s just not enough, then the next step would be to go see one of the colorectal surgeons and they would do surgery. That’s when the surgeons will go in and surgically remove that excess vascular tissue.
When we’re talking about hemorrhoid therapy and interventions for hemorrhoids that we can do in GI, we’re only talking about internal hemorrhoids. We cannot put in rubber bands, for example, with external hemorrhoids. External hemorrhoids, if you started to put rubber bands on them, that would be exceedingly painful.
The only way to get rid of external hemorrhoid tissue is to have a surgeon remove that in the operating room. It’s an outpatient procedure, but you need anesthesia and there’s certainly recovery time and some discomfort associated with having surgery in that area of the body.
Can hemorrhoids cause long-term health problems?
Kristen Meinzer: Now, if, for some reason, somebody can’t afford to or doesn’t get their hemorrhoids treated, is there going to be bigger long term effects on that person’s life? What are the effects of not treating the hemorrhoids?
Dr. Sarah Umar: Again, these are not dangerous. If you don’t treat your hemorrhoids in the vast majority of cases, they are going to be annoying and you may continue to have issues with itching or feeling that extra tissue popping out, or a little bit of bleeding.
But it doesn’t put you at risk for anything bad. And it’s also not to say that if you have hemorrhoids now at age 55, by the time you get to age 65, they’re going to be 10 times larger and become uncontrollable. They don’t seem to work that way, and I don’t think we really know why, but it’s not necessarily going to continue to get bigger and more and more problematic if you don’t treat them. They may not go away, especially if there’s some modifiable risk factor for them being there and being bothersome in the first place.
The only case is a very small proportion of patients who can bleed quite a bit from their hemorrhoids. This is not a secret. It’s not something that you wouldn’t know is happening. And it’s just going to finally catch up with you years later. These are patients who have bleeding where it’s streaming out of their bottom.
It can be soaking through their clothes throughout the day. They can be having to wear a pad and they’ll become anemic from this degree of bleeding. Most hemorrhoids do not lead to that, but there are some and in those instances people don’t have much of a choice. They are bleeding so much that they’re going to have to have them treated.
If you’re having bothersome symptoms, it’s a good idea first to talk to your doctor to double-check it’s not something more serious. Once you’re sure it’s hemorrhoids, consider if your habits might be causing them. If you have constipation or diarrhea – aka spending a lot of time on the toilet – addressing that primary issue may help hemorrhoids resolve on their own.
When it comes to treating the hemorrhoids themselves, there’s a spectrum. You can start with over-the-counter treatments that numb or constrict the vascular tissue. If that’s not working, a doctor may put you on prescription steroids. On the more intensive end, there are procedures like rubber band ligation or even surgical removal. But what’s even better is not having hemorrhoids in the first place. And we do a lot of things that affect that part of the body. Let’s talk more about habits, what to do, and what not to do.
What causes hemorrhoids?
Kristen Meinzer: The next obvious question is, what causes hemorrhoids?
Dr. Sarah Umar: That’s the magic question and patients can have very obvious causes and say, I never had hemorrhoids before X, Y, or Z. and now I have them. Then some people develop hemorrhoids for no particularly good reason. It’s just because it’s a Tuesday afternoon.
What happens is over time, or with age, the connective tissue that holds these blood vessels in place starts to get weak just like all of our other muscles as we age. Sometimes they can get weak or if we’re pushing a lot and using them a lot or using them improperly. These vessels can then start to get engorged, they can start to fall in and out and that’s when they become problematic.
The most common causes for symptoms from hemorrhoids are pregnancy, that’s very common, just because for anybody who’s been pregnant, there’s a lot of pressure down there for many, many months, and so it’s that constant pressure on the pelvic floor that can really engorge those vessels. And you’ll hear, ”I’ve never had hemorrhoids and then ever since pregnancy, I had them.”
Another very common one is constipation primarily because patients who suffer from constipation often have to strain a lot in pushing down to evacuate their bowels. They often have to spend more time sitting on the toilet. And anytime you’re sitting over a hole, essentially, your pelvic floor is not supported. And so those blood vessels can get engorged and, and bothersome. People with a lot of diarrhea can get it, not because they’re having to push a lot because the stool is hard, but because they’re sitting on the toilet a lot more often than they otherwise may be.
Another common one is weightlifters. They may have no problems with their bowels, but they’re lifting heavy weights and they’re putting a lot of pressure on the pelvic floor while they’re doing it. That can be another reason for bothersome hemorrhoids.
Can you prevent hemorrhoids?
Kristen Meinzer: Knowing some of these causes, is there a way to actually prevent hemorrhoids?
Dr. Sarah Umar: If not prevent entirely, modify and keep them as minimally symptomatic as possible, because in a condition such as pregnancy, for example, one has no control over the amount of pelvic pressure that is going to be exacted. But you can decrease your likelihood of having issues with hemorrhoids. My children, for example, who sit on the toilet and read their phones, I’m always yelling at them, get off the toilet. And it’s prolonged sitting on the toilet, sitting and reading. Getting away from it all in the bathroom is a very common thing that is done nowadays, especially with easy access to entertainment on our phones, but controlling the amount of time one sits on the toilet is certainly something very easily modifiable.
If anybody has any issues with their bowel habits, be it constipation or diarrhea, making sure that we can intervene on that early before somebody has spent the next 10 to 15 years straining and sitting on the toilet for a half hour to 45 minutes a day to get their bowels evacuated.
Are Squatty Potties and bidets helpful for hemorrhoids?
Kristen Meinzer: Let’s talk a little bit more about that. All of these advertisements I’m getting lately for a squatty potty, would that fix this?
Dr. Sarah Umar: Squatty Potty which is a brilliant invention and we use it very often in our practice is very helpful for patients who do have any sort of toileting issues. If people are constipated or if there’s an issue with the pelvic floor muscles not working properly, Squatty Potty just helps to position your pelvic floor and your muscles to put them in the optimal position for a successful evacuation and minimizing the amount of straining somebody has to do. Does everybody need a Squatty Potty? No, they do not. And if you can’t afford a Squatty Potty, turning a wastebasket on its side or getting a kitchen stool or something like that also would suffice.
Kristen Meinzer: Do bidets have any effect on hemorrhoids ?
Dr. Sarah Umar: They can be very helpful for people who have symptoms from after a bowel movement, especially if you have a lot of that redundant tissue. And bidets can decrease the amount of wiping that you have to do by cleaning it off with water first.
It can help with hygiene. A lot of patients who have, for example, with a lot of external hemorrhoid tissue, it can be difficult to get yourself clean. And if you’re not clean, then you’re itchy and you just don’t feel great the rest of the day.
They’re not going to be harmful to hemorrhoids. Putting water in that area is not going to aggravate hemorrhoids.
Can certain foods or drinks affect hemorrhoids?
Kristen Meinzer: And let’s talk about the other end of the system about what I’m putting in my mouth, what I’m eating or drinking. Should I make changes in that area?
Dr. Sarah Umar: If you are not having any issues with your bowels, and you are feeling well and moving your bowels easily and regularly, you do not need to change your diet. That being said, many patients with hemorrhoids are suffering from bowel habit issues, and that’s an instance where we will talk to somebody about what they’re putting in.
If you are suffering from constipation, constipation fiber can be very helpful. We’ll talk to people about getting enough fiber in their diet and ways to supplement fiber.
A lot of people will notice that the amount of fluid they’re drinking can impact their bowels. If they’re not drinking enough fluid and say they’re very active and sweating then sometimes your bowel movements can be harder and then more difficult to pass and require more straining.
If somebody is getting a lot of artificial sweeteners or eating a lot of processed foods or really fatty foods, sometimes that’s causing their diarrhea. You have to address their upstream factors for why are you having these bowel habit issues? Is it something that you’re eating or not eating? Certain medications can cause a lot of bowel issues too. We run somebody’s medication list and make sure they’re not taking something that could be affecting them.
Can exercise impact hemorrhoids?
Kristen Meinzer: You mentioned exercise earlier, specifically weightlifting. Are there certain exercises that we can do that will help hemorrhoids or help prevent them?
Dr. Sarah Umar: Exercise in general helps bowel habits. In patients who have constipation frequent exercise will help keep things moving and keep you globally healthy overall and feeling well. There are no exercises in particular to help hemorrhoids once you have them.
When I’m talking about weightlifting, weightlifting is also a very good activity to do. And I’m not saying you shouldn’t be doing your arm workout going to the gym. What I’m saying is it’s the heavy weightlifting, the squats, lifting the bar. As you can tell, I’m not a heavy weightlifter, but you hear people grunting and really struggling. It’s that sort of weightlifting that can give someone problems with their hemorrhoids.
But everyday weights and part of a healthy lifestyle is a good thing and I do not tell people they need to stop doing that when they have hemorrhoid problems.
Does anal sex affect hemorrhoids?
Kristen Meinzer: Got it. Let’s talk about sex. Anal sex. Is that going to have any effect on hemorrhoids or anal play in general?
Dr. Sarah Umar: It should not. Anytime you are putting something up the rectum you can certainly tear the lining of the anal canal, which is called an anal fissure and can be very painful, but hemorrhoids alone should not be impacted by that.
Just like doing a colonoscopy, we put our scopes up there every day and we don’t make people’s hemorrhoids bleed or flare. But if somebody’s already having a lot of hemorrhoid troubles, potentially it may be aggravated by anal intercourse but it wouldn’t cause hemorrhoids.
But if it’s something that you practice and you find that maybe it’s bleeding more than it used to, then it might be just the friction from having something up there.
Kristen Meinzer: And as far as anal sex goes, are there certain techniques or tools that might help it to go better if we’re dealing with hemorrhoids?
Dr. Sarah Umar: I think making sure that there’s adequate lubrication to decrease the amount of friction in the anal canal and then up and inside the rectum is probably the best way. I would caution people to be putting anything else up inside the rectum, if you have big engorged veins there, and you’re putting a lot of pressure on them, especially if it’s for a protracted amount of time, but I think lubrication is probably key.
What should you do if you experience a hemorrhoid prolapse?
Kristen Meinzer: Got it. Let’s say I’m on the toilet and there seems to be some sort of prolapse or something happening there. What should I do then? Should I get my hands involved? Should I push things back in? What should I be doing in that instance?
Dr. Sarah Umar: I ask people that all the time, I say, do you ever feel like there’s something inside that’s falling out when you go to the bathroom or for some people it’s just when they’re up walking around. And then the next thing I’ll say is if yes, do you push it back in? And yes, you can absolutely push hemorrhoids back in if they’re falling out.
Oftentimes, that brings more comfort and relief of symptoms, because when they’re out, they can be uncomfortable. You can get that throbbing feeling or it’s just an unpleasant burning feeling. And pushing them back in relieves that. You’re not going to do any harm to yourself by pushing your hemorrhoids back where they belong.
Oftentimes they’ll stay there, but sometimes the next time you go to the bathroom, they’ll pop right back out again. And that’s okay. You just push them right back in again. I tell people just taking the pads of your index and your long finger and just gently push them back up.
I actually had a patient not too long ago who came in and he was carrying a golf ball and I asked him to get up on the table. He said, ”Here, do you mind holding my golf ball?” I said, okay, sure. I didn’t really know why he was bringing a golf ball, but I held it for him. Turns out that that was his hemorrhoid reduction device.
If he feels like his hemorrhoids are coming out, he would just take the golf ball and put it on a chair wherever he happened to be and sit on it. And that concentrated pressure there would help those hemorrhoids reduce back inside of his body.
I would caution people not to sit on things, especially small things without their clothing on in case it was small enough to be able to actually get inside the rectum. But if you are sitting there with your underwear on or with your clothing on, I wouldn’t be concerned about that. A wadded up washcloth, whatever works, you’re not going to hurt your hemorrhoids if you put them back where they belong.
Kristen Meinzer: That guy, he should patent that. A new use for golf balls.
Dr. Sarah Umar: That’s right. And not ask people to hold it without telling them why they’re holding his golf ball.
Kristen Meinzer: Yes. I think that sometimes the conversation around our butts is so taboo and can I put something in there? Can I put my fingers in there? In this case, does it make sense to push this back in? And it’s reassuring to hear you say, it’s all fine.
Dr. Sarah Umar: Yes, and it’ll probably make you feel better to push them back in.
What is the best advice for someone dealing with hemorrhoids long-term?
Kristen Meinzer: Finally, hemorrhoids are a thing people sometimes struggle with for a long time, as you’ve said. And a lot of people have hemorrhoids. For those out there thinking, Oh God, this has been going on so long. Am I going to have this forever? Do you have any words of encouragement?
Dr. Sarah Umar: The first step is just telling your doctor that these are driving you nuts. A lot of people are embarrassed to talk about it, or they don’t think it’s relevant. They’re going to their doctor for their yearly checkup. Why would I be talking about my hemorrhoids? But the first step is talking to your doctor because there are a lot of options out there and they can be very helpful for relieving symptoms.
I think it’s certainly possible to live in harmony with your hemorrhoids. They’re just annoying little guys or big guys, depending on how big they get, they’re annoying, but they’re not going to kill you. They’re just going to drive you nuts.
And we can help but we can’t help if we don’t know that they’re bothering you. Tell somebody. Make sure it’s nothing else that is dangerous that needs to be addressed first, but if you’ve established that it’s hemorrhoids, that’s great because we have lots of options to make them feel better for you.
Kristen Meinzer: I love that you’re bringing such openness to this. There’s no shame. Just talk to your doctor. I’m sure most doctors have heard about most things too, so.
Dr. Sarah Umar: Yes, nothing is gross. People are embarrassed to have me look at their bottoms. I say, this is what I do all day. It’s not embarrassing. And the more you talk about it the more you realize that you are in very good company and there are a lot of people who suffer from the same thing.
Kristen Meinzer: Dr. Sarah Umar, “Queen of Hemorrhoids.” This was fantastic. I’ve learned too.
Dr. Sarah Umar: Anytime. It’s been super fun. If you ever need anything, you let me know.
Kristen Meinzer: If you want to prevent hemorrhoids, there are a few things to keep in mind. The biggest one is don’t spend too long on the toilet! Whether you’re looking at your phone, or have bowel issues that are causing you to spend longer in the bathroom, sitting over a hole with your pelvic floor unsupported can cause or aggravate hemorrhoids.
A Squatty Potty or bidet can be helpful in some cases, as can be dietary changes. But if they don’t affect what’s causing your hemorrhoids or pain, you don’t need them. And if you lift weights or practice anal sex, you don’t need to stop doing those things – unless of course they’re making your symptoms worse.
If your internal hemorrhoids fall out, it’s okay to push them back in! But most importantly, talk to your doctor. The sooner you do that, the sooner you can get help managing your hemorrhoids. And they’ve already seen it all, trust me.
Okay, that’s all for this episode. But if you’ve got a question or topic suggestion, you can leave us a voicemail at 507-538-6272. We might even feature your voice on the show!
For more “Health Matters” episodes and resources, head to mayoclinic.org/healthmatters.
Thanks for listening and until next time, take care and stay healthy.
Relevant reading
Men's Health Bundle
Man Overboard! is a fun-to-read handbook on men’s health is written by Craig L. Bowron, M.D. who uses his years of education and professional experience to help you get through this pilgrimage, this magical journey of aging-while-male, not unscathed but with a sense of control and dignity. You can get…
