Hemorrhoids are swollen veins which look like small bumps that can appear internally or externally around the anal region. They are caused by increased pressure in the area due to straining when trying to have a bowel movement, pregnancy, or from being overweight.
Fun fact! All humans have hemorrhoids! These hemorrhoids are internal and help to control bowel movements. They are unproblematic until they start to swell and more pop up in the rectal region and classic symptoms of itching, discomfort and bleeding take place.
So, why does this matter for IBD? Increased inflammation in IBD can result in diarrhea for many, although constipation is also a common symptom. Both can result in hemorrhoids due to irritation from wiping and straining to have a bowel movement.
The following are risk factors for the development of hemorrhoids:
- sitting for long periods of time
- pushing/straining using the rectal muscles with bowel movements
- diarrhea and excess wiping
- a low fiber diet
- frequent exertion (ie: when lifting heavy objects)
How do you know if it’s IBD or Hemorrhoids?
Rectal bleeding is a common symptom for those with IBD. More specifically, for people with ulcerative colitis. But, how does one know if the bleeding that has occurred is due to hemorrhoids or flare?
We can never be 100% confident which is which, however, here are some things to be mindful of:
- If inflammation markers (CRP, fecal calprotectin, lactoferrin) are stable, there is a good chance the bleeding is from the hemorrhoid(s)
- Blood from hemorrhoids and IBD can be found when wiping, drops in the toilet water, and blood streaked through the stool. Bright red blood can be indicative of either a hemorrhoid or IBD. Darker red blood usually indicates that bleeding is coming from higher up in the gastrointestinal tract. However, if there is any bleeding present, please check with your doctor for further investigation
Note: always check with your doctor to determine if a physical exam or further treatment is needed. Stay up to date on lab work and your treatment plan to ensure inflammation is under control
Medications such as steroids, or suppositories may be needed to clear up the hemorrhoids and should be discussed with your doctor. Common prescriptions include mesalamine enemas, hydrocortisone, and lidocaine.
Sitz baths are also common to help soothe irritation, itching, and pain caused by hemorrhoids. The warm water from the bath can increase blood flow to the region which helps decrease pain and increase healing. Epsom salt baths can also be helpful.
If the hemorrhoids are due to constipation, increasing fiber, fluids, and movement can be helpful.
Hot tip: go low and slow when introducing fiber.
Fiber: If you are struggling with fiber intake with IBD, start with soluble fibers first as they are better tolerated. Food sources of soluble fiber include: avocado, oatmeal, black beans, zucchini, sweet potato, squash, banana, and applesauce.
Fluid: When someone begins to increase their fiber intake, fluid intake must also be considered. Adequate fluid intake can help hydrate, and work to flush the system of waste. A general rule of thumb is to consume 2L of water a day for the average adult. Speak with a dietitian to see what fluid intake is best for you.
Movement: Movement helps our bowels move! If you are stagnant all day, so are your intestines. A light walk, or gentle yoga may be all you need to move the bowels, especially if feeling low in energy.
Lastly, let’s talk about bowel habits:
- It’s important to realize that if you ignore the cue to use the bathroom, this can increase your chance of constipation. So, when you feel the urge, use the toilet.
- A squatty potty (or stool) can be helpful for increased defecation due to the position your body is being placed in when using it. When this tool is used, your knees are higher which angles your rectum for better bowel release
- If you find yourself straining to have a bowel movement, try breathing in instead of “pushing down”. The pressure of breathing in can help push stool out