Haemorrhoids are, as I’m sure you’ve heard the joke, a real pain in the bum. They are really a problem. For people who not only have constipation but also diarrhoea. I think there’s a misconception, I’m going to put straight out there, that only people who’ve been straining hard on the toilet, get haemorrhoids.
Multiple causes of haemorrhoids
You can get them for a whole variety of reasons and we’re going to look at why that happens. As well as what kind of things you can do with your diet and the way that you eat. And the way you sit on the toilet in order to try and prevent a flare up. I’ll also talk a little bit about some of the medical approaches to haemorrhoids if you can’t manage it through these first line approaches.
Although I said they’re very common, I guess we don’t really know exactly how common haemorrhoids are because a lot of people will just treat them with creams they get from a chemist without actually seeing a doctor. It’s estimated in the UK somewhere between 13 and 36 percent of everyone have had haemorrhoids at some point.
What are haemorrhoids?
Basically, they are blood vessels that are around your anus, and they can be internally, externally, or prolapsed, so which is when they’re internal but they’re hanging out.
Internal haemorrhoids
The difference is, the internal ones, like if you think about the tube of your exit pipe, they are inside there and they won’t be hanging out. A bulge from the inner wall of your rectum will be poking out into that tube.
External haemorrhoids
And then you can have them externally as well. So just around your bottom, like they will just bulge out and then you can probably feel them with your finger.
Then you can also have internal ones that have come out and hanging down, through the body.
Grading haemorrhoids
Those are the three sort of types that you can get. They’re also graded into, the first degree, second degree, third degree, and fourth degree, which is basically the worst they are.
So first degree ones, they bleed, but they’re not, like, bulging out too much. Secondly, they might bleed. And prolapse a little bit when you’re straining, but then they’ll go back in again.
The worst kind, when you’ve got type four is when the prolapse will just stay outside your body the whole time. They never go back in and it’s just sort of dangling there. It can be really uncomfortable, really irritating, and can also cause other problems if it’s not treated.
What do haemorrhoids feel like?
Most people who do have them and have had a large haemorrhoid are very, very aware of them because the symptoms include like a burning, itching, you might get a lot of pain and irritation.
Because they are so heavy with blood, they can bleed every time you go to the toilet. And typically, the blood could be bright red. Could just be a small amount when you wipe, you might notice it on the tissue. Or it could literally be dripping into the toilet with a lot of blood.
Piles a cause of incontinence
Because the haemorrhoids or the bulge into your rectum may be stopping the muscles properly closing if they’re very large, then you may also get some seepage.
So that is some mucus or maybe small amounts of stool into your underwear. These are quite common.
Piles causing itching
The itching may be down to the mucus secretion or the fact that there’s like little amounts of poo around the anus. Around the skin that can then really irritate the skin all around your bottom, around the perineum.
That can be a big problem with haemorrhoids, and then you also might get this feeling of incomplete evacuation or fullness in the rectum. So you’re always feeling like you never quite empty yourself. Again can be just because there’s something bulging there that is irritating the nerves and sending a message to your brain saying, ‘hey, there’s something there we need to go’.
But actually it’s just a part of your body. It’s not waste product. Okay, so that is what a haemorrhoid is.
Why do haemorrhoids happen?
People used to think that haemorrhoids were a bit like varicose veins that have just bulged out, but I think we know a little bit more about them now. It’s basically down to the veins having abnormal dilation. They’re opening, the veins are bulging out a little bit in the wall of your rectum around the anus. You can also get higher amounts of clotting and maybe there’s some breakdown in the collagen fibres.
Collagen breakdown
Collagen is like the kind of matrix of our body that holds everything together. Think about your skin, your tissues. Where that protein is starting to break down, then things can bulge in and out and change a little bit.
So that’s like, you might notice it when we get wrinkles, for example, on your skin. That is also down to a breakdown in collagen production, and that’s just naturally occurring from about 20 as we age.
But when we’re thinking about, you know, what is physically happening when you’re getting piles it’s down to the veins. More blood being there than normal and that could be because they are opening up too much. They’re dilating too much or maybe you just genetically have more blood vessels in that area than normal. So some of this is just down to your genetics, your makeup.
It might run in your family for example.
Autonomic system impact on haemorrhoids
Also, we know that the smooth tissue of veins is regulated by our autonomic system. Anything that happens without our control, like digestion, your veins moving the blood through the body, breathing, we don’t have to control that. It just happens, we don’t have to think.
This autonomic system relies on certain nutrients or certain, things being made in our body like nitric oxide. And other elements that are controlling the flow of blood through our body. Some of them are constricting the veins and some of them are opening the veins and relaxing them. This depends a little bit on the levels of inflammation in your tissues, in the lining of your veins.
Some people are more predisposed to get issues with with their blood and with their heart. And that can also apply to the veins that are in the rectum and the whole anus. The whole last part of our digestive tract.
That’s how your Haemorrhoids are bulging out, so you’ve got a lot of excess blood in the veins, they’re pushing through and then that is causing additional mucus secretion and the blood is very near the surface so it can bleed very easily.
So if we’re thinking, right, that’s the mechanism by, you know, what a haemorrhoid is, Then actually, how do we get that?
Lifestyle causes of haemorrhoids
What kind of things are we doing in order to make that bulge of blood and the vein popping out? There’s a couple of things. I’m going to talk about some lifestyle changes and about sitting on the toilet and that sort of thing. Some things about diet and also some key specific nutrients that you might be interested to focus on if you want to change your diet in order to help with haemorrhoids.
Get checked out by your doctor
Before I go into those kind of things that can help, it is worth getting checked out by your doctor if you have sudden bleeding that you haven’t noticed before and that’s never been looked at.
So it’s important for your doctor to check and say that they are just haemorrhoids, something we can deal with, before you just assume. Because if you’re seeing blood, and especially if there’s quite a lot of it, it may be related to something else. You want to get that checked out.
Treatment for haemorrhoids
The doctor will typically take a look. They might put their finger up to feel it. And if you can’t manage with some of these first line treatments, if there’s no improvement, then the doctors can treat them by putting a little rubber band around the haemorrhoid so that they kind of dry up and fall off. That’s one approach.
There’s also surgery where it’s really bad. And so, depending on how it’s affecting you, your pain levels, your levels of, like, soiling that may be affecting the skin around the whole area. There’s a whole treatment scenario depending on your different symptoms. So that is important to go and get checked out.
Obviously like small little haemorrhoids that just come and go you don’t necessarily need to worry about. But if you are seeing bleeding on your poo or when you’re wiping is important to get that checked out.
Sitting for too long can contribute to piles
Some of the things that really cause that blood pooling into that whole pelvic area might be sitting for long periods and standing for long periods. So basically you’re just like stagnating. You’re not increasing the blood flow. You need to get that blood flowing back towards your heart, get it pumping around your body.
Doing not enough exercise, like being too sedentary, can be a trigger for this. So people who sit down a lot, people who stand for a long time. Perhaps you’re working in a shop or on your feet all day, those kind of things may be a trigger for haemorrhoids.
Straining on the toilet
Also might be straining on the toilet. So sitting on the toilet for hours, not hours, obviously, but sitting on the toilet for longer than 10 minutes. I really advise my clients if you can’t go within five to ten minutes, you need to get up, do something else, come back when the urge is strong. Do not sit on the toilet for long periods of time, because that position is pushing a lot of blood into that area.
And also if you are straining a lot, a potential cause of haemorrhoids. The other thing that can kind of cause them through straining is lifting really heavy objects or also weight training. Maybe you are overly straining at the gym. That can happen to bodybuilders as well.
Sitting position on the toilet
Sitting on the toilet correctly, which is where you want to have your knees up higher than your hips. Using a little step to get your feet raised up. That reduces the straining and can massively impact on the ease of going to the toilet. Makes things much much better for you.
If you’re someone who sits down a lot at your desk job, try to look at getting a standing desk so you can have periods of standing up during the day. And also just try and get up, move around. Go make a cup of tea. Run up and down the stairs a couple of times, just get the blood flowing.
Keep moving
It really does make an impact on the amount of circulation that you can get just by moving your body. When your skeletal muscles, like your arms and your legs are moving. That helps pump the blood back to your heart, helps keep it moving.
Diet for haemorrhoids
Let’s have a little think about diet. When we’re trying to think about what will help stools be well formed but soft, easy to pass. That is going to help you with reduce the amount of straining that you do. Reduce the amount of time you’re sitting on the toilet. And if you’re someone who gets diarrhoea maybe reduce the frequency with which you’re having to go to the bathroom. We want to get a high fibre diet. We want to try and reduce fat and try to get a mix of a variety of types of fibre as well. One way to do this would be to try and get as many different types of fruits vegetables beans, pulses, whole grains. All of these things really help to create a soft but easy to pass stool.
So a high fibre diet helps keep the bowels moving, but also it’s important that the variety is there. You’re having some fibre that gives you the bulk, the insoluble fibre. Some soluble fibre that is going to help make it softer, easy to pass and will retain some of the water.
High fibre diet
Interestingly, in places in the world where they don’t really have many haemorrhoids, like it’s not a common condition, their diet is naturally very high in fibre and roughage. They’re eating a lot of vegetables and pulses. This is an indication that having a low fibre diet may be exacerbating your condition.
Also good to remember that changing your diet and increasing your fibre, may not give you immediate relief in terms of your symptoms, but it will change your gut bacteria over time. We know that eating a higher fibre diet with more fruits and vegetables, more variety, all the different polyphenols, that is good for your overall gut health.
Gut bacteria and haemorrhoids
When I was doing the research for this episode, I saw a couple of studies about people who have had a haemorrhoidectomy, so that’s like surgery, to repair and treat haemorrhoids in hospital. They found that in the wounds of some of these people who’d had this surgery, they had specific types of bacteria. E coli, Staphylococcus aureus, which is normally like a skin bacteria, Pseudomonas, Klebsiella. These are also known to be common in people who have SIBO. Some of them are linked to similar types of IBS symptoms like excessive gas production, abdominal pain. Some of these bacteria were there in the wound of where people have had their haemorrhoids surgically repaired.
Now that just goes to show that maybe there is some gut bacteria, you know, dysbiosis, whatever we want to call it, some upset with the gut bacteria. That is not only causing some of the conditions that allow haemorrhoids to take place. Maybe higher frequency of bowel movements through diarrhoea, so maybe you’re having to go to the toilet all the time. That is increasing the amount of stool passing through the rectum, which irritates the gut lining and that could maybe be, exacerbating your haemorrhoids.
Same with constipation. If you’re straining a lot, pushing a lot, then that could also be causing the haemorrhoids. So maybe it is also linked up to the bacteria in your gut.
Metronidazole after haemorrhoidectomy
Just knowing that even if you don’t get relief through a higher fibre diet, what you will be doing is helping to crowd out some of these bacteria that have been associated with people who have haemorrhoids. What was also interesting is that some people who had pain after their haemorrhoidectomy. When they had took metronidazole, which is an antibiotic that is given to people who have intestinal methanogen overgrowth, (where people have got constipation, slow transit time and overgrowth of methane).
Sometimes they’re given metronidazole, an antibiotic, and that actually reduced the the pain in people who were recovering from this type of surgery. Metronidazole is an antibiotic and it’s got antibacterial effects and that may, affect the ability of your body to do the wound healing. So, in this case, people who’d had this operation, the people who were treated with metronidazole had less pain and healed a bit quicker.
Reduce fat for haemorrhoids
So overall diet advice is to prevent haemorrhoids, but also if you have haemorrhoids is to try and increase your fibre, increase the fibre variety. I did mention to reduce a high fat diet as well, and that is down to the speed of transit time. Where people have got IBS, if you have a very high fat diet, it’s likely that that high fat is making your symptoms worse.
If you have fast transit time, high fat can speed it up. If you have constipation, high fat can slow it down. So either way, you don’t want to go fat free, of course, but you don’t want to necessarily be eating large amounts of fatty red meat, you know, burgers and sausages, lots of butter, coconut oil, even, you know, just high fat foods.
We also want to balance it out. Two things to be aware of there in terms of diet.
Key nutrients for a diet to prevent haemorrhoids
Now in terms of some actual nutrients to include and things that you should add, which is what I always like to think about and focus on. Flavonoids has come out as a possible treatment for haemorrhoids.
Flavonoids for piles
Flavonoids are antioxidants that are naturally occurring in a lot of dark coloured fruits and vegetables. Blackberries, cherries, raspberries, but as well as beetroot, kale, spinach, sweet potatoes. These are really helpful. Flavonoids have also been shown to be very helpful for venous health, so that’s the health of your veins. Your cardiovascular system. When anyone’s thinking about like reducing your cholesterol levels, trying to reduce inflammation and reactive oxygen species, so that’s like the free radicals we want to get control of, by fighting them off with antioxidants.
It’s another reason why flavonoids and generally antioxidant rich foods are brilliant for our health. If you’re eating a lot of foods that have got those in naturally, you are also likely to be getting some good vitamin C and vitamin C is very important for making collagen.
Collagen production for haemorrhoids
Collagen is helping to hold all our skin and tendons and bones and all our connective tissues. And it does start to decline as we’re aging. To make collagen we need vitamin C, we need sufficient protein, we need zinc. Thinking about things that allow our body to help repair these connective tissues and strengthen that wall of the rectum. The anus, to make sure that it is as strong as it can be.
That’s another reason why lots of fruits and vegetables is a good idea. But, I found a little study that showed that out of 1, 514 patients, people who took flavonoids had a reduced risk of bleeding of 67%, 65 percent less pain, and 35 percent less itching. They also had a much better rate of reoccurrence, so they had a 47 percent less chance of getting haemorrhoids back again once they’d gone.
And I think that’s quite a strong reason to try and include some of those foods in our diet. If you’re not tempted by the reasons of having a high fibre diet, then maybe thinking about it from the flavonoid perspective. What can you add that’s those brightly coloured, fresh fruits like citrus, spinach. All of those things I just mentioned, they’re really great for your immune system. But also for creating the right ingredients so that we can help our collagen production.
Protein
Then also I mentioned protein, you’re going to need good quality protein at every meal because that’s part of the building blocks of repair. It’s also for things like digestive enzymes and you know just the whole body system, not just thinking about structure, but protein is very important for lots of things.
Something else you might consider would be some bulking agents to reduce straining on the toilet and they may help to add a bit of, um, bulk to your stool. So this could be things like psyllium husk, partially hydrolyzed guar gum or PHGG or even slippery elm. So these are things you can add like a supplement that may help you with passing stool and just creating a healthy environment by adding bits of fibre to your diet.
Topical treatments for piles
The other thing you can think about is topical treatments. So if you’re really bothered by haemorrhoids, you know, there are lots of things that have got Pain killers in, like local anaesthetics, corticosteroids and anti inflammatory drugs, just to help you with the symptom relief.
So do speak to a pharmacist about that to see what might be suitable for you.
Another sort of soothing thing you can do is what’s sometimes called a little sitz bath, so it’s either a special kind of, it’s like a small bowl that you put over the toilet that you can sit on and just kind of bathe your bum in some small amount of warm water. You could also just sit in a little bowl or you could run yourself a very shallow bath or maybe you have a bidet. Those kind of things are helpful just because they’re very soothing. You may also want to put something in it that is like Epsom salts. Or something that is just generally going to clean the area without having to touch it, that can be very sore if they’re external and they’re very uncomfortable.
So again, you can speak to your pharmacist about what is suitable to put in a little bath like that, but some people will find that very helpful, and particularly women after childbirth are sometimes advised to wash in this way after, things are very sore. I hope that has given you a few ideas of things to try in terms of changing the way that you go to the toilet, how you’re sitting, your movement throughout the week, a couple of things about your diet, and a few nutrients to focus on.
Work with me – IBS nutritionist
And if you have any questions about this episode or about any of things I’ve talked about, then please feel free to give me an email. It’s in the show notes. You can just email me It’s info@goodnessme-nutrition.Com. If you have a topic you would like me to speak about in a future episode, then please do get in touch.
I love hearing from people with their requests and I nearly always am able to accommodate the requests for research and Investigation.
So thank you very much to anyone who sent questions in. And if you’re looking for someone to work with for your IBS, then just know that I have a three month program called the Gut Reset Program. Over three months I work with you really closely. We start off with weekly calls and we have a lot of time talking together about your specific conditions. The things you need help with. I can help you find a diet that helps to reduce your unpredictable gut symptoms. Reduce the bloating, and get back to enjoying food again.
Helping you with your IBS diet
It’s always one of my big priorities is to get people eating a diet that’s broader than they’re eating now. And to reduce some of the fear around food. Because as well as your symptoms that are really difficult with IBS, there’s also those two things which can take away a lot of the joy of eating. That’s a key focus for when you’re working with me.
There’s a Link in the show notes to book a free call where we can have a chat about what you’re looking for help with.
Thank you very much for listening to this episode of the Inside Knowledge. Better digestion for everyone.