What and Why? 

Constipation produces faeces that are too dry and too small to slip easily along the last thirty centimetres of your bowel, especially once chronic colitis has stiffened its kinks. Overdistension weakens the grip of your bowel muscles, despite stimulation from medicines. If you hope to move your bowel at all, you are going to have to push.

In health, all the propulsion your faeces need comes from the bowel itself. A wave of contraction presses from behind and the bowel in front relaxes out of the way. But that is not all. The propulsive wave needs to get a grip on something, like a roller-skater trying to move a heavy bin. The only anchor available is the relaxed bowel in front of the faeces you are trying to move, and pulling on that draws it back over your faeces, as if peeling the bowel skin off them. That not only gets the tunnel your faeces must pass through wide open and out of their way, but leaves stale blood free to flow away from your bowel, back towards your heart and lungs. Nothing in this process can possibly cause congestion.

Straining alters these forces radically. Propulsion now comes from your diaphragm and the sheets of muscle round your belly, which press inwards on everything they contain. If your bottom is relaxed it cannot resist this pressure from within, and anything nearby pouts out. That includes all the flesh surrounding your anus and the last part of your bowel as well as any faeces inside them. Sustained high pressure also traps blood in your legs and lower bowel by blocking the main vein that drains them; blood even tends to flow in the wrong direction. So engorgement and congestion of the flesh round your anus is added to the stretching and scraping they get. Irritation from accumulating faeces perpetuates the congestion between bowel actions, so your bottom gets no rest. Piles are the long-term structural results and may take only twenty years to form.

What can I do?

Advice to maintain and maximise your health

1. Posture: The English pedestal toilet is appallingly designed, going by the posture it requires. To act your bowel well you need to squat, your knees apart and thighs firmly against your belly, with your back well arched. That lines up your bowel, giving faeces a straight run out.

2. Don’t delay: Always act when pangs tell you your bowel is willing and never postpone it. Adopt a good posture, relax your bottom thoroughly, and breathe deeply with your diaphragm, holding your breath in briefly but not straining. This massages and energizes your bowel, reinforcing and harmonizing its action. It is quickly unloaded, easing and satisfying the whole of you.

3. Ease pain and discomfort: Piles get painful when blood clots in them; otherwise they are sore and irritable. Grease them with Vaseline or anaesthetizing ointment before your bowel opens and sooth them afterwards with a generous flow of cold water. A bidet is ideal but a short hose adapted to your cold bath tap works just as well. Really acute discomfort responds to ice; sit gently on a cube for several minutes, letting it melt into the shape of your anal cleavage. Afterwards pat yourself dry, and apply Calendula or Hamamelis Ointment to soothe soreness and irritation. Arnica Ointment is better for aching pain but avoid using it on any scratches or fissuring.

4. If you are obviously constipated, sort that out. Curing this is vital to reducing your piles and getting defecation comfortable again.

5. Never get out of a hot bath without chilling your bottom thoroughly as if it had just acted. Give those tissues no excuse to stay bloated and relaxed; it undermines all your other efforts.

6. Several ointments and suppositories available from your doctor are fine, but try to keep off any containing cortisone or other steroids, or antiseptics.

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