Obesity and Hemorrhoids: Are They Related?
Obesity can be measured using the body mass index (BMI) which is defined as the ratio of body weight to height. A person is obese if their BMI is larger than 30 kg/m2. (1)
Haemorrhoids are naturally occurring vascular structures in the anal canal and help control stool and flatulence release or retention. If these muscles weaken, they can become pathological when they swell up and become inflamed; eading to bleeding, bloody stool, itching and pain. (2) This is the condition known as hemorrhoids, or in some older language, piles.
Johanson found that 10 million people in the United States have suffered from hemorrhoids in recent years, which raises the prevalence rate to 4.4%. In both males and females, the prevalence rate becomes higher between the ages of 45 – 65 years, with the prevalence decreasing after the age of 65. (3)
There is currently much debate as to whether obesity causes hemorrhoids, but in any case it is possible to find a correlation between the two. They are co-morbid diseases according to a few studies, which reported that an obese patient will most likely also have hemorrhoids. (4) (5)
Circulatory system problems that link obesity and hemorrhoids
When a person is obese their excess body weight puts unwanted and unexpected strain on their circulatory system. Peripheral venous stasis, or venous insufficiency occurs when the veins have trouble returning deoxygenated blood back to the lungs and heart, for oxygenation. The veins are constricted by the extra body weight preventing efficient blood flow full of oxygen. This deoxygenated blood then accumulates in the pelvic region, clogging and filling up the vascular structures in the anus, which can cause them to become inflamed and protrude from the anus. This is the cause of external hemorrhoids, which can bleed, be itchy and come with a burning sensation. (6)
Nature or nurture?
Obesity and can be hereditary, as children of overweight parents are prone to weight problems. The same is also true for hemorrhoids. On the other hand families often share and teach their children diet and lifestyle choices which can also affect hemorrhoid development. (7)
Under an obese state the body has to carry an excessive surplus of body-fat. This places significant pressure on the pelvic area; the bones and the muscles. A lack of exercise common in many obese people also contributes to the weakening of muscle tone. This pressure, with age, can cause the muscles to weaken and balloon out or bulge. Once the muscles have lost their tightness they never fully go back. (8)
A larger abdominal cavity has been shown to have an adverse effect on the passing of stools. More pressure is needed to expel feces, therefore there is a higher risk of hemorrhoids developing. Excess weight on the pelvic muscles and the extra exertion it takes to pass stools may also be a contributing factor, as a study showed examining the higher prevalence of hemorrhoids during pregnancy. (9)
Hand in hand with obesity a poor diet is often found as well. A healthy diet includes fiber- high foods (the skeleton of plants), which can cause the stool to soften, making it easier to pass from the body. Fiber-high foods act almost like a scrubbing brush inside the intestines, cleaning the bowels as they pass through. (10) The harder the stool and the more exertion and effort it takes to pass, can increase the likelihood that the muscles weaken, causing hemorrhoids. Fiber-high foods include fruits, vegetables and grains. (11)
A sedentary lifestyle may also cause hemorrhoids and is often correlated with obesity. Professions where extensive sitting is required can put excess pressure on the pelvic region. Also, the fatigue associated with carrying around the excess weight leads to a more inactive lifestyle that is often associated with obesity. (12)
The lack of exercise is also a major contributing factor to both obesity and hemorrhoids. Exercising the muscles makes them able to take more strain and this is true also for the anus muscles. Pilates is one form of exercise where you can learn how to use the stomach muscles like any other muscle of the body, making it easier to pass stool, and to strengthen the pelvic area. In learning these Pilates exercises pressure is relieved from the anus muscles. It can be possible to practice contracting the anus and learning how to push stool out without putting extra pressure on the anus.
Sitting and bouncing on a fitness ball is an effective method to counter act sitting for hours on a chair, as it not only strengthens the pelvic muscles, helping to fight hemorrhoids, but also helps posture, as well as strengthening the back, gluteus and thigh muscles. (13)
Poor posture also puts pressure on the rectal veins, and if it is co-morbid with obesity. The pelvic muscles have to carry too much weight around, thus being weakened, leading to hemorrhoid outbreak. There is a case to be made also about bad posture on the toilet. Sitting opens up the anus and relaxes the pelvic muscles in an unnatural way, allowing the hemorrhoids to sag out to the relaxed anus sphincter. If a small stool is placed before the toilet bowl, and the legs are bent at the knees and raised, the body is in more of a squatting position, which can help the easier expulsion of stool, using gravity and insuring that the colon is straight in line with the sphincter. (14)
Lose the weight!
Hemorrhoids are a natural part of the human anatomy, they have three parts:
1. The lining, which are either mucosa or anoderm.
2. The stroma (anal tissue), which encases the blood vessels, smooth muscles, and the supporting connective tissue.
3. The anchoring connective tissue system, which attaches the hemorrhoids to the anus sphincter and the surrounding large muscles.
These muscles deteriorate with age, with lack of exercise, with increased pressure from obesity, and with increased effort needed to pass hard stool. (15) (16)
Exercise these muscles as if you were lifting weights. Prevention before cure!