From the Guidelines
Hemorrhoids hurt when sitting, even on cushions, because pressure on the swollen, inflamed blood vessels in the anal area causes pain regardless of surface softness. This is due to the compression of sensitive tissues against the pelvic bones, which cushions may not fully eliminate 1. The anal cushions, which consist of connective tissue surrounding direct arteriovenous communications, contribute to the bulk of the hemorrhoidal cushions and play a crucial role in ensuring complete closure of the anal canal 1. When these cushions become enlarged and prolapsed, they can lead to symptoms such as bleeding, protrusion, itching, and pain 1.
To manage hemorrhoid symptoms, several treatment options are available. Over-the-counter treatments like hydrocortisone creams (0.5-1%, apply up to 4 times daily for 1 week), witch hazel pads, or oral pain relievers such as acetaminophen (up to 3000mg daily) or ibuprofen (up to 1200mg daily) can provide relief 1. Additionally, warm sitz baths for 15 minutes, 2-3 times daily can reduce inflammation. A donut-shaped cushion specifically designed for hemorrhoids may also help by redistributing pressure away from the anal area.
Some key factors to consider in managing hemorrhoids include:
- Staying hydrated
- Consuming fiber (25-30g daily)
- Taking brief walking breaks when sitting for long periods
- Avoiding straining at stool
- Controlling diarrhea with fiber, anti-motility agents, and specific treatment of any underlying cause 1.
If pain persists beyond a week or worsens, medical evaluation is necessary as more severe hemorrhoids may require prescription treatments or procedures 1.
From the Research
Hemorrhoid Pain When Sitting
Hemorrhoids can be painful when sitting, even on a cushion, due to several factors:
- Increased pressure on the anal canal and hemorrhoidal cushions when sitting, which can cause discomfort and pain 2
- Weakening and dilatation of the hemorrhoidal cushions due to prolonged sitting time, contributing to the development of hemorrhoids 2
- High anal canal pressures in patients with hemorrhoids, which can be related to an increased vascular pressure in the anal cushions 3
Factors Contributing to Hemorrhoid Pain
Several factors can contribute to hemorrhoid pain when sitting:
- Increased intra-abdominal pressure, which can cause the hemorrhoidal cushions to become engorged and painful 4, 5
- Constipation and straining during bowel movements, which can increase pressure on the anal canal and hemorrhoidal cushions 4, 5
- Poor toilet habits, such as spending a long time on the toilet, which can contribute to the weakening and dilatation of the hemorrhoidal cushions 2
Relationship Between Hemorrhoid Grade and Toilet Habits
Research suggests that there is a linear association between the time spent on the toilet and the degree of hemorrhoids, with longer sitting times contributing to the development of more severe hemorrhoids 2