Hemorrhoids are a pain in the butt | Buttpillow.com

Hemorrhoids are much more prevalent in the Western World as compared with Third World Countries. Hemorrhoids are associated with constipation, heavy physical work and the effects of erect posture. Hemorrhoids are common during pregnancy. In addition to hemorrhoids, industrialized countries are at an increased risk for colorectal cancer. If you suspect you have hemorrhoids, always talk to your doctor. Do not self-diagnose!

Hemorrhoids

Hemorrhoids are one of the most frequent problems people in westernized countries face.  An estimated 50 percent of those over the age of 50 years require some type of conservative or operative therapy.  (4)

There are estimates of up to 75 to 90 percent occurrence rates of hemorrhoids in the U.S. population (1, 2, 3, 4, 5).

The cost to the community, both financial and in lost work days, is great; and by any standards, this condition must be considered a major health hazard (7).

The thinker sitting on a cactus - representing people with hemorrhoids
It’s hard to think when you sit on your hemorrhoids. Sit Better, Feel Better.

Hemorrhoids have plagued men and women for centuries, inflicting pain equally on individuals at all levels of society and of all occupations: Emperors (Napoleon); U.S. Presidents (Jimmy Carter); baseball sluggers (George Brett); judges; policemen; truck drivers; cab drivers; and jockeys (6).  It has been said that Napoleon’s hemorrhoids were troubling him during the battle of Waterloo (7, 9).

“I saw a sign one time that said ‘Hemorrhoids awareness week’ at the doctor’s office.  Let me tell you, if you got hemorrhoids, I am sure you are aware of it.  You don’t need a sign to tell anybody about it.”

Larry the Cable Guy

What are hemorrhoids?

A hemorrhoid is defined as “a mass of dilated, tortuous veins in the ano-rectum involving the venous plexuses of that area.”

Taber’s Cyclopedic Medical Dictionary, Edition 18
Info-graph of Hemorrhoid symptoms and treatments
Hemorrhoids line icon Infographics. Symptoms, Treatment. Vector signs for web graphics.

There are internal hemorrhoids and external hemorrhoids.  Internal hemorrhoids are higher up in the rectum and cause rectal bleeding.   External hemorrhoids protrude into and beyond the anal opening and cause itching, swelling, bleeding and pain.  People with external hemorrhoids seek relief from products such as “Preparation H.”  

Hemorrhoids in The Western World 

Today, hemorrhoids are considered to be one of the most common ills of men and women, a judgment made by those with vision limited to the Western World (7).

Hemorrhoids in “Third World Countries”

The high rate of hemorrhoids in westernized societies contrasts sharply with Third World countries.   Only about one in 25 to one in 30 individuals is thought to have hemorrhoids compared to one in two individuals in Westernized societies. One doctor recounted in 30 years’ practice in Africa, one of the only two patients he saw with severe hemorrhoids was a prince taking a semi-European diet (5, 7).

What causes hemorrhoids?

Hemorrhoids are thought to be caused by, or associated with, increased intra-abdominal pressure resulting from:

  • chronic straining to pass constipated stools,
  • heavy physical work, or
  • the effects of erect posture (3).

If constipated, hemorrhoids tend to worsen.  Try not to strain when you have a bowel movement.  Eat a diet high in fiber; and, if necessary take a fiber supplement daily with a lot of water.  

Dalmatian dog with red glasses on toilet reading newspaper - hemorrhoids
Dalmatian dog sitting on a toilet seat with digestion problems or constipation that could lead to hemorrhoids if human.

Pregnancy is a risk factor for hemorrhoids

“About 40 percent of pregnant women develop symptoms they attribute to hemorrhoids (Simmons, S. C. 1972).” 

Pregnancy may predispose women to hemorrhoids because of:

  • a) increased intra abdominal pressure from the pregnant uterus, 
  • b) constipation, 
  • c) hormonal venous dilation (hemorrhoidal tissue contains high levels of estrogen receptors, Saint-Pierre, A., et al., 1982), and 
  • d) increased circulating blood volume (3).
Pregnant woman holding back in pain
Pregnancy Pain. Pregnant Woman Feeling Back Pain, Discomfort.

Hemorrhoid problems are more common in pregnancy.  The large uterus can compress veins which return blood from the legs and rectum promoting swelling.   Also labor and delivery generates tremendous stress on hemorrhoids.  Manage hemorrhoids the best you can before and after labor and delivery of your baby.

Hemorrhoids are common among driving workers  

External compression from poorly designed seating concentrates forces on small areas of the body. This results in high localized pressure. 

The pressure can compress nerves, vessels, and other soft tissues, resulting in tissue-specific damage. These changes may themselves result in disease or predispose other tissues to damage.

Medical studies have shown a high rate of hemorrhoids among truck drivers, cab drivers, and even police officers.  This could be due to the additional ergonomic risk factor of vibrations during driving.  

Trucker Standing in front of a Truck. Driving and hemorrhoids, prostatitis.
Driving is a risk factor for hemorrhoids and prostatitis.

Heavy lifting, standing in the cold and medications can aggravate hemorrhoids

Heavy lifting aggravates the problem.  Try to avoid it.  

Standing out in the cold with insufficient clothing causes you to shiver and tense your abdomen, which is considered to be straining by some doctors.  The recommendation is to stay bundled up when standing out in the cold.

 Also medications, such as codeine, can cause constipation which could cause a hemorrhoidal flair up.

Lifting can cause hemorrhoids
Heavy lifting can cause hemorrhoids and back pain

Minimize external compression to reduce risk factors for hemorrhoids

Preventative measures to reduce risk factors for the development of hemorrhoids should be taken before it is too late.  It is important to minimize external compression from poorly designed seating as much as possible. 

Defective chair upholstery being repaired
Poorly designed seating can cause hemorrhoids

Standing can cause hemorrhoids to swell

“Also, when you are standing, the pressure in your hemorrhoids increases, and they tend to swell more.  Periods of rest — sitting and especially lying down — can be very beneficial if you are suffering with hemorrhoids.” 

Joseph R. Duba, M.D., “Understanding Hemorrhoids”
Toilet paper guy surprised standing is a risk factor for hemorrhoids while holding a roll of toilet paper.
Toilet paper guy is surprised standing is a risk factor for Hemorrhoids.

Hemorrhoids are the most common cause of rectal pain and/bleeding

The term hemorrhoids can be misleading because patients often attribute all rectal complaints to hemorrhoids.  Rectal pain and/or bleeding are common complaints among the general population.  Hemorrhoids are the most common cause of these complaints.  

Discuss hemorrhoidal symptoms with your doctor

The public and some members of the medical profession deem these symptoms, which are commonly attributed to hemorrhoids, harmless.  However, the same set of symptoms can herald serious colorectal disease.    Feelings of embarrassment or apprehension about treatment may make individuals reluctant to discuss rectal symptoms with their physician (4). 

Do not be embarrassed to discuss rectal problems with your care-giver because if it is discovered to be colorectal cancer, and it is detected early, there is an 85 percent cure rate (2).

Industrialized Countries at Increased Risk of Colorectal Cancer

Industrialized countries are at a relatively increased risk (for colorectal cancer) compared to less developed countries that traditionally had high fiber/low fat diets.  

“This point is exemplified by the fact that persons from a low risk country who migrate to the United States over time develop colorectal cancer rates similar to those among native U.S. citizens.”

Fry, R., et al., 1989;  Levin K., et al., 1991

Smoking Increases Risk of Colorectal Cancer

“Cigarette smoking and alcohol consumption have been reported to increase the relative risk of an individual to develop colorectal cancer, (Kune, G., et al. 1992; Martinez, M., et al., 1995).” 

Complaints that can be Confused with Hemorrhoids

“Anorectal disorders represent some of the most common yet poorly understood conditions in primary care.” (2)  Patients often attribute all anorectal complaints to hemorrhoids.

Cartoon man with pained expression holding his low back & butt
Cartoon man holding holding his lower back and butt with a pained expression

Other conditions include:

  • Anal fissures (tares);
  • Anorectal abscesses (infection);
  • Fistula (channel) ;
  • Incontinence;
  • Pruritus ani (itching and burning of the anal skin);
  • Infectious proctitis (rectal inflammation);
  • Hidradenitis suppurativa (disease of sweat gland);
  • Condyloma acuminatium (genital warts); 
  • Anal carcinoma (cancer).

Anal fissures

Anal fissure – A fissure is a crack or tear in the anal mucosa usually caused by the passage of a hard stool.  “Nearly half of the patients present with the complaint of hemorrhoids,” (Mazier, WP, 1994).

Anorectal abscess

Anorectal abscess – An anorectal abscess results from cellulitis or infection  (Stahl T.H., 1992).  Anorectal abscesses usually are obvious, producing diffuse swelling, redness, and pain around the anus.  Most abscesses are aggravated by sitting, coughing, sneezing and defecation (Goligher, J., et al., 1984).

Anal fistula

Anal fistula – A tract from the rectum to the surrounding skin that bowel contents can escape from.  Anal fistulas are predominantly found in middle aged men. (Goligher J. et al., 1984)

Anal incontinence

Anal incontinence – Loss of control of flatus and feces.  Young patients with incontinence may suffer enlargement of the colon from chronic constipation or trauma to the anal sphincter apparatus (Goligher, J. Et al. 1984).

“Older women are particularly at risk for incontinence due to progressive denervation (loss of nerves) of the pelvic floor musculature (muscles) from prior birth-related injury.”

Toglia, M.R., 1996

Pruritus ani 

Pruritus ani – intense itching and burning discomfort of the perianal skin.

Excessive cleaning of the anal area with soap and water can cause big problems if you are suffering with hemorrhoid pain / irritation because you remove the natural oils from the area.  The area should be kept lubricated with Vaseline if necessary.  

  When you are having external hemorrhoid pain/irritation, make sure that you use toilet tissue with added lotion, (for example Puffs Plus).

Guy holding toilet-paper making ok gesture
Toilet paper guy says it will be okay. With luck, your Hemorrhoids will go away.

Proctitis 

Proctitis – an inflammation limited to the distal 10 cm of the rectum (Centers for Disease Control and Prevention, 1993).

Hidradenitis suppurativa

Hidradenitis suppurativa – a chronic inflammatory disease of the sweat glands of the skin (Goligher, J. Et al., 1984).   It is usually common in people with oily skin.

Anal condylomas 

Anal condylomas – warts are caused by the human papilloma virus (HPV).  It is known that HPV is linked to cervical cancer in women. “Anal warts appear to be most common in young men especially those engaging in anal intercourse,” (Tedesco, F., et al., 1980).

References:

1. Primary Care, Volume 26, Number 1, March, 1999, “Hemorrhoids,” by Joy N. Hussain, M.D., Cairns Base Hospital, Australia.

2.  Family Medicine Principles & Practices, 1998, Fifth Edition: Chapter 91, “Diseases of the Rectum and Anus,” by Thomas J. Zuber; 2b.

3. Family Medicine Principles & Practices, 1998, Fifth Edition: Chapter 92, “Colorectal Cancer,” written by Gregory L. Brotzman and Russell G. Robertson.

4. MJA, Vol. 167, July, 1997, Clinical Practice, “Hemorrhoids: A Clinical Update,” written by Adrian L. Polglase, M.S., FRACS, Clinical Associate Professor and Colorectal Surgeon, Australia.

5. American Family Physician, September 1, 1995, “Non-surgical Treatment Options for Internal Hemorrhoids, written by John Pfenninger, M.D., and James Surrel, M.D.

6.  Surgical Clinics of North America, Vol. 65, No. 6, December, 1988, “Hemorrhoids, Non-operative Management,” written by A. R. Dennison, M.D.; D.C., Wherry, M.D.; and D.L. Morris, M.D., Ph.D.

7.  Southern Medical Journal, Vol. 81, No. 5, May, 1988, “Alternatives in the Treatment of Hemorrhoidal Disease,” by Emmet F. Ferguson, Jr., M.D., University of Florida, School of Medicine, Jacksonville, F.L., U.S.A.

8.  Postgraduate Medical Journal, September, 1975, 51, 631-636, “Hemorrhoids – Postulated Pathogenesis and Proposed Prevention,” written by D. P. Burkitt, C.M.G., M.D., F.R.C.S., F.R.S., and C.W. Graham-Stewart, MS, F.R.C.S.

9.  The American Journal of Proctology, Vol. 21, No. 3, June 1970, “An Epidemiological Investigation of Hemorrhoids, written by John Philpot, Ph.D., Rutgers, The State University, New Jersey, U.S.A

10.  “Napoleon’s Hemorrhoids and Other Small Events that Changed,” History by Phil Mason

Woman laughing holding Buttpillow™ at beach
Anka holding Buttpillow™ at the beach when we had photoshoot for “How to Become an Inventor” by Mr. Daniels