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Hemorrhoids: What are they and how pelvic rehab can help

What are hemorrhoids? How do I know if I have them?

Hemorrhoids are swollen blood vessels found internally in the rectum or outside of the anus. These blood vessels cushion the area and protect your anal sphincter and help with closure. Nearly 75% of adults will have hemorrhoids at some point in their lives, often caused by increased pressure in the pelvic region. Causes of this increased pressure may include the weight of your baby during pregnancy, pushing during childbirth, and straining to pass stool. You may also experience hemorrhoids postpartum, as you’re now increasing pelvic pressure by constantly lifting and holding your child. Common symptoms of hemorrhoids may include: blood in your stool, and/or a hard lump and discomfort around your anus. It’s important to check in with your doctor if you’re experiencing any of these symptoms.

Pelvic floor tightness

Maybe you’re already seeking out pelvic floor therapy for vaginismus, dyspareunia, or any other kind of pain with sex. If so, it’s possible that you have a hypertonic pelvic floor. This means that your pelvic floor muscles might hold some overactivity throughout the day. These chronic holding patterns can lead to constipation, which can increase your risk for hemorrhoids. Working with a pelvic floor rehab provider on learning to intentionally relax your pelvic floor can help to decrease some of your habitual patterns, hopefully leading to better stools and decreased hemorrhoid prevalence.

Coordination is key…

Pelvic floor dyssynergia happens when our body unconsciously contracts our pelvic floor when it’s supposed to relax. Ideally during bowel movements, our pelvic floor muscles should lengthen and open, rather than contract. Constantly contracting your pelvic floor muscles while you’re trying to defecate will cause straining and increased pressure on the rectum, possibly leading to hemorrhoids.

Chronic constipation

Chronic constipation impacts 15-20% of the population.¹ Although many people experiencing chronic constipation have pelvic floor involvement, the condition can be caused by a myriad of other factors including not getting enough fiber, movement, and water throughout the day; slow GI motility; chronic stress or trauma; and more. Managing stool consistency through proper evacuation techniques (including using a squatty potty or stool!), diet, exercise, and self-care are some of your best tools in the prevention of hemorrhoids. A pelvic floor therapist can help you parse out and manage some of these factors.

Managing intra-abdominal pressure during defecation

Our entire abdomen is basically a pressure canister that we can use to our benefit or to our detriment. Most of us don’t habitually think about the way we’re passing stool. You may be unconsciously gripping your abdominal muscles and increasing pressure on your pelvic floor. A pelvic floor therapist can teach you methods for reducing this pressure, and for passing stool in a more easeful way.

Hemorrhoids are a nuisance at best, and quite painful at worst. Working with a pelvic floor therapist can help address the underlying causes of your hemorrhoids, focus on management strategies for the present, and preventative treatment for the future.

This article was written by Mirah Sand OTR/L. They are a pelvic floor occupational therapist who is certified Pregnancy and Postpartum Corrective Exercise Specialist, and has received advanced pelvic health training through Herman and Wallace Pelvic Rehabilitation Institute.


“Image used with permission from Pelvic Guru®, LLC”

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