Haemorrhoids: A pain in the butt.

Today was a great day - my little friend that joined me as soon as the first post chemo colossal colonic emptying happened, has finally gone! It’s been a literal pain in my ass.

Haemorrhoids are far more common that people may realise around 1 in 20 people will get them in their life time (I reckon it’s probably higher than this, people just don’t want their piles to be common knowledge). The majority of people will have had a little bit of blood on the tissue when they wipe after having done a poop. This is usually due to “internal” haemorrhoids that have been brushed against by said poop as it’s come out which has caused them to bleed a bit.

What are haemorrhoids (or piles)?

I like to think of them as varicose veins in your bowel. They’re big, juicy blood vessels and if a particularly big or hard poo goes by, they bleed a bit. Sometimes they can pop out of your bum and you end up with a grape, cherry or sometimes even bigger lump outside your bottom. These “external” piles are the ones that are painful.

Click here for more information.

Why do they occur with chemotherapy?

This is likely due to a number of factors.

Chemo can do ANYTHING to your bowels;
If it’s causing constipation and you’re straining - this could be adding to it.
If it’s causing diarrhoea - this could be adding to it.
Some drugs (particularly anti sickness) can cause constipation and again if you’re straining - this could be adding to it.
Chemo can affect your blood and reduce the number of platelets you have - these are important in making blood clots and stopping you from bleeding, if you have a low number of platelets it means you’re more likely to bleed - so if your platelets are low, a normally non threatening poop might just be enough to cause a bleed!
Your bowel can become irritated and inflamed because of chemo, this can increase the blood supply to the bowel and so would make it bleed more easily.

What can you do?

Keep your poop soft, straining can increase the likelihood of you getting them and will prevent them from getting any better.
Lactulose is a great gentle medication that can help keep your poop soft (see other post here).
Any form of straining can worsen them, so avoid any heavy lifting or straining if you can.
Using haemorrhoid creams or suppositories (tablets that you put up your bum) regularly for a week. Anusol is the commonly used one but you can get cheaper unbranded creams/tablets.
If your haemorrhoids are particularly itchy, choose a cream or suppository that contains hydrocortisone (HC - which is a mild steroid) as this will help settle the itch.
Drink plenty of water.
Try and increase your fibre intake to keep your stools soft.
Take paracetamol if they’re very painful.
Avoid excessive wiping - use damp toilet tissue or a flannel if needed.
Use ice/frozen peas wrapped in a towel/flannel to help with swelling and pain if needed.