Hemorrhoids are blood vessels which surround the anus and rectum. Everyone has these blood vessels which provide a cushion during bowel movements. When swollen, inflamed, or irritated, hemorrhoids may be painful, bleed, itch, discharge, swell, and cause these symptoms during receptive anal sex. (I promise I’ll get some images and graphics up here soon!)
Causes
Hemorrhoids typically become symptomatic due to abdominal pressure forcing excessive blood into these blood vessels, causing them to swell and become inflamed. Prevention focuses on avoiding this excessive abdominal pressure which typically occurs during bowel movements but can occur during other activities.
Avoiding constipation and straining with bowel movements is essential to hemorrhoid prevention. This typically includes limiting the time spent on the toilet, increasing dietary fiber, use of fiber supplements, increased hydration, and avoiding constipating foods. Fiber options are explored other content here.
Straining during exercise is a less common cause of hemorrhoidal flares and typically occurs when
• a person attempts to lift more weight than they are capable
• they don’t support their core/abdomen, and
• breathing exercises are not employed consistently throughout exercises.
These situations are common toward the end of a workout session when tired, less focused, and proper techniques are ignored.
Pregnancy is another common cause of hemorrhoids which can be particularly difficult to treat due to limitations on medical interventions and medications during pregnancy. I will explore best practices in pregnancy in future content.
Anal Sex and Hemorrhoids
Straining during receptive anal sex is uncommon and typically occurs when someone is uncomfortable (physically or emotionally). I think of straining during sex as a physical manifestation of your anus saying “get outta here!” ie when a partner is more well-endowed than we’re accustomed to, when it is uncomfortable due to other causes, when we don’t feel emotionally safe or comfortable, or poor positioning which adds pressure.
Hemorrhoids can also occur when something is rapidly expelled or pushed out of the rectum. Meaning that cleaning out your anus before sex may cause hemorrhoidal swelling whether with an enema, douche, or the biggest offender of all- the shower hose attachment. Hemorrhoidal swelling caused by cleaning may occur immediately, but it more commonly will occur after cleaning, sometimes after sex, sometimes after a bowel movement after sex, and sometimes after a few bowel movements.
Acutely inflamed hemorrhoids will make receptive anal sex uncomfortable and can cause bleeding during or after. The key is preventing hemorrhoids from getting inflamed and proactively treating them when they are. If hemorrhoids are impacting your sex life, I recommend discussing with a healthcare professional as well considering the following:
• Is cleaning out prior to sex worsening your hemorrhoids?
• Are your bowel movements optimized with adequate fiber and hydration?
• Are you spending too much time on the toilet?
• Are you straining during exercise or other activities?
• Is there actually something else causing your symptoms?
It is very common for people to assume that any rectal symptoms (like discomfort or bleeding) are caused by hemorrhoids, but this is not always the case. If these symptoms are occurring, it is important to see a qualified healthcare provider as there are many other causes of these symptoms and some can be serious.
Often hemorrhoids will have both internal and external aspects or may be mixed, meaning that they act as both internal and external hemorrhoids exhibiting symptoms of both. It is best to consult a healthcare provider to evaluate, but conservative prevention as above remains important in the prevention and management of internal, external, and mixed hemorrhoids.
Internal Hemorrhoids
Internal hemorrhoids are one of the most common causes of rectal bleeding, typically with both receptive anal intercourse and bowel movements. Internal hemorrhoids mostly exist under the thin lining of the rectum and any swelling or inflammation will cause them to bleed easily. With some exception, that bleeding is typically painless and typically bright red. There can also be a clear discharge from internal hemorrhoids which causes irritation or itch on the skin especially at the anal opening.
External Hemorrhoids
External hemorrhoids occur under the skin of the anus and while they are typically external, often occur at the opening of the anus or even superficially within the anus. They appear as a swelling which is usually in a focal or specific location (rather than circumferential or all the way around).
The blood within external hemorrhoids can clot or become hardened. While blood clots in other parts of the body can cause significant health issues (ie a heart attack or stroke), clotted external hemorrhoids do not travel to other parts of the body to cause these issues. They stay in place which means that they may persist for weeks or even months before entirely resolving. These clotted or thrombosed hemorrhoids are typically only painful for a few days, but the physical lesion may persist. Surgery can be appropriate for painful, new thrombosed hemorrhoids or when they recur. Like a balloon, the hemorrhoidal vessels exhibit elasticity and will revert back to normal over time, but sometimes that elasticity is stretched too far or for too long and the hemorrhoid will recur over and over in the same place. In these cases surgery is the only definitive treatment. It is important to evaluate your specific situation with a qualified healthcare professional to determine the best treatment options.
RectalRockstar 