“Hemorrhoids.  Ugh.”

That’s what most people might think when they think about hemorrhoids, but I also think, “what a great opportunity for self-care!”- which, I know, is weird. Then again, I am a postpartum doula and lots of strange things seem like opportunities to me . Nobody wants hemorrhoids, and so many of my clients are surprised when they show up during pregnancy or postpartum- and let’s be honest - some you who haven’t had babies, men and women, have had hemorrhoids too! 

3 out of 4 adults will experience hemorrhoids. Since they are a very real part of many pregnancy journeys, for today’s blog I’m putting on my postpartum doula hat and talking about how to care for “down there” when things get disrupted. 

As a reminder before we begin - I’m a postpartum doula and not a medical professional so before you keep reading, if there is something you are uncertain about or bleeding near your anus, please check with your midwife, OB, or MD for diagnosis. Do not write off pain. It is always worth knowing what is going on and getting intervention or treatment when needed!

First, why do people get hemorrhoids? 

Hemorrhoids come from pressure on the pelvic floor and anus. How does this happen? It can be from straining to poop due to improper pooping technique or constipation, pressure on the pelvic floor from the weight of the uterus during pregnancy, pushing during birth, or even hypertonicity (aka tight muscles) in the pelvic floor. I have a powerpoint all about these pelvic floor muscles, but I’ll save that for another day. ;)

What are hemorrhoids? 

Mayo Clinic defines hemorrhoids as, “swollen veins in your anus and lower rectum, similar to varicose veins”. They can be internal or external and might be recognized by their itchiness, general discomfort and pain, or bleeding. Again, as a massage therapist and postpartum doula, I don’t offer internal work, so you will want to head over to your pelvic physical therapist or your primary care provider to get a diagnosis. 

What can you do at home?

This is the part of the blog where it is important for me to remind you, again, that I am not a doctor so I’m here to share the accumulated wisdom of many prenatal and postpartum bodies and what I have seen tried over the years with a little bit of internet research as backup. Your health is in your hands!

For simple hemorrhoids that many people experience during pregnancy and postpartum (and many in the general population too) there are some simple at home helpful hints: 

• Get plenty of fiber. There are lots of foods you probably already eat that have a good fiber content. Oats, avocados, raspberries, pears, apples, bananas, and carrots to name a few. Some people find a fiber supplement helpful. The fiber is to help you have healthy bowel movements, which leads to our next point.

• Don’t strain when you poop. People strain because of constipation, pregnancy, and even poor pooping posture. Treat constipation at its root with the support of an acupuncturist, naturopath, or functional health practitioner. They may be able to help you sort through the causes of constipation like overall digestive tract health, hydration, and supplements you may be taking that cause constipation. Pooping posture can be supported with a stool or something like a squatty potty to elevate the feet and create a more comfortable physiological posture for pooping. Reducing strain is important because it helps to…

• Reduce your time on the toilet. Traditional toilets and toilet posture puts a strain on the pelvic floor and blood flow to the area exacerbating the discomfort. This goes for folks who bring a book or like to take their “alone time” on the toilet (looking at you - parents who finally get to shut a door!). I get it. In some households, this is the only place for a little privacy, but for the health of your hemorrhoids please find a new reading spot.

• While we are thinking holistically about hemorrhoids, it is possible learning and regularly applying Mayan abdominal self-massage can support hemorrhoids over the long term by optimizing blood flow to and placement of abdominal organs relieving stagnation and pressure. We teach self-massage as an integral part of every client’s first mayan abdominal massage session so you have these tools.

• Consider a bidet. If you have external hemorrhoids wiping may aggravate your hemorrhoids making them extra itchy or sensitive. A bidet is a hose or seat attachment for the toilet that sprays the bum clean and then you can pat dry avoiding painful wiping. The fanciest ones have warm water and can blow dry your bum, but there are plenty of less expensive options (including travel bidets).

• Try a sitz bath. A sitz bath is a basin in which you soak your sitz bones and by proxy everything around them including your anus, vulva, and pelvic floor muscles. You can get the inexpensive shallow soaking dish that fits into most toilets at drugstores and then you simply fill it with warm water and a handful of epsom salts and soak. You can also soak in a sitz bath infused with herbs (like a hot tea). Since herbs are outside my scope of practice I recommend asking at Little Herbal Apothecary or Rebecca’s Apothecary locally about their sitz baths for hemorrhoids or postpartum vulva/perineal care. Sitz baths can be done multiple times a day for 5-15 minutes or even weekly as maintenance.

• Vaginal steams can also be good for hemorrhoids. Please talk with an herbalist or vaginal steamer before putting steamy herbal water near your sensitive tissues because herbs are powerful and there are some rules and individual considerations, especially for those of you who are pregnant or postpartum.

• Finally, after you poo or soak in your sitz bath there are over-the-counter products for cooling the itch (often including witch hazel) or helping to shrink the hemorrhoids in natural and homeopathic varietals as well as stronger pain-relieving medications.

For more serious hemorrhoids or those that develop clots, there are surgical and medical interventions. Talk to your provider or read more.

What has your experience been with hemorrhoids and recovery? Do you have any hard-won wisdom that you would like to share? Feel free to leave a comment below.