The Essentials to Build Your Lady’s Rectal Care Pantry
How to soothe your unwanted hemorrhoids while waiting for the doctor!
TL;DR: We are all born with internal hemorrhoids that can flare up, causing peri-rectal microbial imbalance and ITCHING. Preparation H is not feminine. Choose the right stuff for your pantry so your rectum can have a better day. 😃 🍑
Us ladies, they say, enjoy shopping, particularly online, for items like shoes and skincare products. Yet, shopping can sometimes be an unpleasant disruption, especially when it involves rectal care products. The traditional over-the-counter product aisles can be overwhelming. What should you choose for your beautiful bum?
Both the mainstream and natural supplement companies can leave you perplexed and wary of worsening the situation.
So, let's discuss a common complaint from my decade in private practice as a gastroenterologist: flaring internal hemorrhoids causing soreness and itching.
📣 There are facts, tips on lifestyle factors, and a focus on over-the-counter products that can help.
This guide serves as a helpful primer while you navigate the medical system; while you wait and wait to see a gastroenterologist or colorectal specialist, or PLEASE ANYONE for a diagnosis and treatment plan.
Hemorrhoids are often seen as a men’s problem, as evidenced by the color schemes on products like Preparation H. But this perception is misguided. In fact, women more often seek health advice for rectal issues such as hemorrhoids compared to men.1,2 The rectum is central to childbirth, affected by hormonal changes, and thus, women have every right to be part of the conversation on hemorrhoids.
Did you know…
Internal hemorrhoids can flare during the luteal phase of the menstrual cycle.
Activities like weightlifting, which is great for bone health, can exacerbate hemorrhoids due to increased pelvic blood flow with squatting.
Pregnancy, childbirth, and postpartum recovery emphasize the importance of rectal care.3
Furthermore, prolonged sitting on the toilet, such as while scrolling on devices, a common habit for millennials and Generation Z, has been known for a long time to be associated with higher rates of symptomatic hemorrhoids4-6 (check out @thestomachdoc or @doctorsethimd; gastroenterologists highlighting this on Tik Tok – so true guys). Hence, the advent of using a stool or squatty potty to help improve one’s defecation posture to reduce the time sitting on the toilet.7 (This may be worth adding to your pantry as well.)
Back advocating for the land down under…
Back to the normalizing of our lovely rectums and the internal anatomy of our rectum. We all have internal hemorrhoids. We are born with them. One of the most absurd things I have read is from one of our most prestigious journals: “One in 3 Americans have hemorrhoids on screening colonoscopy”.2,8 Are doctors just not looking?! We all have internal hemorrhoids! They are anatomically normal areas of vascular and smooth tissue that help us hold our bowels (aka maintain continence). When those annoying, uncomfortable symptoms sneak up, this normal anatomical feature becomes a medical concern.
The etiology of why these normal vascular smooth muscle structures become annoying, throbbing, sore, and mucous-producing is ‘speculative’ with a paucity of research—quite a disservice if you ask me. However, we do know that disturbances in the microbes in the peri-rectal area lead to soreness and itching.9 Altering the local flora through scratching or fecal mucous can lead to inflammation and fungal overgrowth.
This isn't an active infection but an altered microbial state requiring treatment.
So, what are the essentials for rectal care shopping?
Preparation H products vary widely and generally include phenylephrine, a vasoconstrictive medication, and may not address the root cause of the problem. FYI, there is no evidence from well-designed studies to support using any over-the-counter preparations.2 Thus, below is a curated list of OTC options with pure active and minimal inactive ingredients, which from my experience can start improving your rectal discomfort and itching. These over-the-counter options can provide temporary relief until you receive a proper examination, diagnosis, and/or prescription medication.
The Lady’s Rectal Care Pantry
Epsom Salts, Unscented
Known as magnesium sulfate, this compound has anti-inflammatory properties and can help soothe flares when used in sitz baths. Aim for unscented varieties to avoid irritation. Aim for baths a few times a day during a flare.
Zinc Oxide Paste 40%:
A barrier cream, such as Boudreaux's Butt Paste, can address peri-rectal soreness and itching. Apply a pea-sized amount post-toileting and before bed, being mindful that it may be messy on clothing, but with proper cleaning, it won’t stain.
Witch Hazel 100% Ointment
Derived from the Hamamelis virginiana shrub, this ointment helps shrink swollen tissue and balance the microbial ecosystem. Use similarly to zinc oxide.
Hydrocortisone 1% Cream
This is an over-the-counter steroid that can reduce inflammation. Apply a pea-sized amount peri-rectally post-toileting and before bed.
Hydrocortisone 1% cream + Clotrimazole 1 % cream
Look for clotrimazole in the vaginal cream aisle. A blend of the hydrocortisone anti-inflammatory and the clotrimazole antifungal creams can be a makeshift treatment for peri-rectal itching. Mix in a 1:1 ratio and apply as needed. Apply a pea-sized amount peri-rectally, post-toileting and before bed.
With these products, your rectal care pantry is ready to address immediate needs. Sitz baths and these topical treatments should improve comfort in a few days.
📣 These products can be used on the same day, but it’s best to apply only one product at a time. Remember, this doesn't replace professional medical advice, but it can help while you wait for an appointment.
Heading to D.C!
In the next blog, we'll summarize the upcoming Gut Microbiota for Health Summit!
Aren’t you ready for your medical doctor to really know about digestive and rectal wellness? It's time for the medical field to enhance our understanding of the gut microbiota’s role in digestive and rectal health. Stay tuned for insights from global experts amidst the spring cherry blossoms in Washington D.C, my perspective to be posted April 16th.
End dictation.
Your lady MD,
Emily
Facts
Women were more likely to report hemorrhoids compared to men.1
Hemorrhoids are the third most common outpatient gastrointestinal diagnosis. Visits for hemorrhoids were more frequent than for colon cancer, diverticular disease, irritable bowel syndrome, or inflammatory bowel disease.8
Tips
Drink plenty of water, continue exercise, but adjust your workout for 1-2 weeks when you are not sitting on a bike or putting undue pressure on your rectum (such as with squats).
Again, drink plenty of water while increasing dietary fiber to up to 25-30 grams/day, a topic unto itself.
During a flare, wear wicking underwear that you don’t mind getting messy with the witch hazel and/or zinc oxide products.
References
1. LeClere FB, Moss AJ, Everhart JE, Roth HP. Prevalence of major digestive disorders and bowel symptoms, 1989. Adv Data. Mar 24 1992;(212):1-15.
2. Sandler RS, Peery AF. Rethinking What We Know About Hemorrhoids. Clin Gastroenterol Hepatol. Jan 2019;17(1):8-15. doi:10.1016/j.cgh.2018.03.020
3. Zielinski R, Searing K, Deibel M. Gastrointestinal Distress in Pregnancy: Prevalence, Assessment, and Treatment of 5 Common Minor Discomforts. The Journal of Perinatal & Neonatal Nursing. 2015;29(1):23-31. doi:10.1097/jpn.0000000000000078
4. Davis BR, Lee-Kong SA, Migaly J, Feingold DL, Steele SR. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. Dis Colon Rectum. Mar 2018;61(3):284-292. doi:10.1097/DCR.0000000000001030
5. Garg P, Singh P. Adequate dietary fiber supplement and TONE can help avoid surgery in most patients with advanced hemorrhoids. Minerva Gastroenterol Dietol. Jun 2017;63(2):92-96. doi:10.23736/S1121-421X.17.02364-9
6. Johannsson HO, Graf W, Pahlman L. Bowel habits in hemorrhoid patients and normal subjects. Am J Gastroenterol. Feb 2005;100(2):401-6. doi:10.1111/j.1572-0241.2005.40195.x
7. Modi RM, Hinton A, Pinkhas D, et al. Implementation of a Defecation Posture Modification Device: Impact on Bowel Movement Patterns in Healthy Subjects. J Clin Gastroenterol. Mar 2019;53(3):216-219. doi:10.1097/MCG.0000000000001143
8. Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part II: lower gastrointestinal diseases. Gastroenterology. Mar 2009;136(3):741-54. doi:10.1053/j.gastro.2009.01.015
9. Palumbo VD, Tutino R, Messina M, et al. Altered Gut Microbic Flora and Haemorrhoids: Could They Have a Possible Relationship? J Clin Med. Mar 12 2023;12(6)doi:10.3390/jcm12062198