Are you trying to avoid repeat hemorrhoid problems?
Are you seeking long-term solutions to avoid hemorrhoid surgery?
These 10 Pelvic Floor Physiotherapist techniques and exercises help you towards long-term hemorrhoid relief.
1. Pelvic Floor Exercises
Regular pelvic floor exercises can provide a long-term solution to hemorrhoids.
Strong pelvic floor muscles can help you empty your bowels and avoid straining.
Pelvic floor exercises can also help to promote your anal sphincter control.
2. Relax Your Anal Sphincter
Hemorrhoids can result if your anal sphincter is unable to relax during bowel movements.
The anal sphincter should relax during normal bowel movements to allow emptying and prevent too much pressure developing within the anus.
Part of the anal sphincter blends with the pelvic floor muscles. Learning how to relax your pelvic floor muscles during your bowel movements can help you reduce your need for straining and make bowel emptying easier.
3. Get Your Stool Consistency Right
Getting your stool consistency right is an essential step towards alleviating hemorrhoid discomfort and preventing recurrent episodes.
Two Stool Problems Cause Hemorrhoids
1. Stool too hard
If your stool is too hard this can cause constipation, straining and hemorrhoids.
Take steps to soften your stool if it looks too hard or lumpy making it difficult to pass.
2. Stool too soft
If your stool is too soft this can cause incomplete emptying or diarrhoea that increases pressure in your anal canal.
Get your stool just right
The ideal stool consistency is smooth and well formed or Type 3-4 on the Bristol Stool Chart similar to the correct stool consistency shown right.
Normal bowel emptying ranges from 3 times/day to 3 times/week.
4. Avoid Unsafe Exercises
Regular general exercise promotes healthy bowel movements.
Some exercises can make hemorrhoid problems worse and cause recurring problems.
General exercises to avoid with symptomatic hemorrhoids:
- Heavy weight lifting – use pelvic floor safe strength training techniques
- High impact exercises with both feet off the ground simultaneously e.g. running, jumping or skipping
- Intense core abdominal exercises – increase downward pressure on the pelvic floor cause pelvic floor muscle tension making it difficult to relax e.g. some Pilates exercises
- Deep squats – increase pressure on rectum causing hemorrhoids e.g. Yoga poses involving deep squats
5. Empty Your Bowels Without Straining
Using the correct position for bowel movements helps to reduce pain, promote healing and reduce straining long-term.
- Sit on the toilet seat (never hover over the seat)
- Place your hands on your thighs to support your upper body
- Move your legs apart so that your hips are wide
- Lean forwards maintaining the inwards curve in your lower back
- Some women find that positioning the knees higher than the hips by placing each foot on a wrapped toilet roll may help with bowel emptying however this varies from one woman to another, do what works best for your body
- Next use the correct bowel emptying technique to empty your bowels with minimal discomfort and without straining
For more information view how to empty your bowels video now (above)
The ‘Brace and Bulge’ technique is the most effective technique for relaxing the anal muscles to reduce pain and straining with hemorrhoids.
When you feel an appropriate urge to empty your bowels:
- Sit on the toilet in the leaning forwards supported position described above
- Use deep breathing technique in this position for 4-5 breaths to help relax the muscles in and around your anus
- Make your waist wide and bulge your belly (lower abdomen) forwards – this action of bulging the abdomen forwards opens the anal sphincter. If you pull your abdomen inwards, the anal sphincter tightens, thereby worsening hemorrhoid problems
6. Use Good Bowel Habits
Good bowel habits are important for preventing and managing hemorrhoids.
a. Never strain
Straining increases pressure on the veins in the rectum causing hemorrhoids and delays healing.
If your bowel s don’t move within a few minutes, stand up and resume your normal activity- avoid prolonged sitting and/or straining.
A short term remedy can be a warm drink and walking around. If you can’t empty your bowels speak with your pharmacist or health practitioner for assistance.
b. Obey the urge
Try to be aware of the correct or normal sensation of needing to empty your bowel.
Avoid holding on and deferring the normal urge to empty your bowels.
When you feel the normal urge to empty then go to the toilet (unless you are living with faecal incontinence and have a hypersensitive bowel in which case you may be retraining your bowel by deferring).
c. Don’t sit for too long
If your bowel doesn’t empty within a couple of minutes resume your normal activity. Prolonged sitting on the toilet can cause and/or aggravate hemorrhoids.
Try to establish a regular bowel emptying routine.
Know when your bowels usually empty and take the time you need to relax to empty rather than rushing or alternatively deferring the urge to empty if you are busy. If you know you are out of routine using your bowels and haven’t emptied your bowel for 3 days then appropriate medication may be required to help you resume your normal bowel routine.
Anticipate events or activities such as holidays or certain foods at restaurants that cause changes in your regular bowel habits and routine. If you know that you are prone to becoming constipated on holidays, take appropriate action to prevent this happening and causing hemorrhoids.
7. Avoid Heavy Lifting
Heavy lifting increases the load on the pelvic floor including the rectum.
If repeated over time or with single episodes of heavy lifting the pressure of heavy lifting can cause hemorrhoid problems or aggravate existing hemorrhoids.
Safe lifting techniques can help to reduce the load on the pelvic floor as well as avoiding heavy lifting where possible.
8. Manage Your Body Weight
Being overweight is a risk factor for hemorrhoids- abdominal body fat loads your pelvic floor, thereby contributing hemorrhoids.
The load associated with abdominal fat is transferred to the pelvic floor increasing pressure in the rectum and anus.
Managing your body weight and losing abdominal body fat if you are overweight is a positive step you can take towards managing hemorrhoids long-term.
9. Avoid Prolonged Squatting or Sitting
Prolonged sitting or squatting can both increase pressure within the anus and contribute to hemorrhoid problems.
Take regular breaks from sitting particularly if your work involves prolonged sitting – stand up and walk around every hour. Deep squatting increases pressure on the rectum and anus.
Lunging or kneeling are both preferable alternatives to squatting to minimize pressure on hemorrhoids.
10. Don’t Smoke
Smoking is a bowel irritant and can therefore increase the frequency of bowel movements.
Coughing associated with smoking increases the load on the rectum and weakens pelvic floor muscles that support and encircle the anus.