By Howard LeWine, M.D.
Q: I have hemorrhoids. Can running or exercise make hemorrhoids worse or cause them not to heal? Also what do you suggest if they become painful?
A: Symptoms of hemorrhoids may sometimes be brought on by activity. Vigorous exercise, such as heavy weight lifting, or any activity that causes exertion, straining or bearing down can cause hemorrhoids to swell.
So, exercise may make symptoms worse temporarily, but the hemorrhoids will not permanently worsen. There is no reason to avoid exercise because of hemorrhoids, unless it causes symptoms that you find unacceptable.
Hemorrhoids are lumps of tissue in the anus. These lumps contain enlarged blood vessels. Hemorrhoids may be inside the anal canal (“internal hemorrhoids”), where they primarily cause sporadic bleeding, usually when having a bowel movement.
Hemorrhoids may also lie outside the anal canal (“external hemorrhoids”), where they primarily cause swelling and sometimes discomfort. These symptoms may occur sporadically. Many people have both internal and external hemorrhoids.
Sometimes blood vessels in external hemorrhoids may clot (undergo “thrombosis”). This causes the sudden appearance of a firm painful lump (1/2 to 1 inch) at the anal opening. The hemorrhoid thrombosis usually goes away with time.
Hemorrhoids are not dangerous, so treatment is almost always optional. Minor symptoms can be relieved with home treatment. The most important treatment is a eating plenty of fiber, taking fiber powder and staying well hydrated. This keeps the stools soft.
Also, soaking in warm water three times a day can help if there is swelling, inflammation or discomfort. Ointments, creams, and suppositories are less important.
Hemorrhoids don’t actually “heal.” They just have ups and downs in terms of the symptoms they cause. Nevertheless, if you see rectal bleeding, visit your doctor. This is to determine if the bleeding is only from hemorrhoids and not from something more serious.
If hemorrhoid symptoms are persistent and bothersome despite home treatment, you may consider surgery to remove them or office treatment with rubber band ligation. With rubber band ligation, a rubber band is slipped around the base of the hemorrhoid to cut off its circulation. Once it has been deprived of its vital blood supply, the banded hemorrhoid withers and falls off.
(Howard LeWine, M.D. is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)