By Alan Bragman, D.C.
Without a doubt one of the most unpleasant maladies associated with riding a bike is hemorrhoids. This is a condition where the veins around the anus or lower rectum become painful, swollen, inflamed and may itch or bleed.
Before providing a more detailed explanation of hemorrhoids, including classification and treatment options, Here’s the good news:
Contrary to what most people think, riding a bicycle is not directly related to causing hemorrhoids. Cycling is indirectly linked to hemorrhoids, as it can be a contributing factor to further aggravating or causing additional deterioration in existing hemorrhoids.
Obviously, sitting on a bike seat for a prolonged period of time with painful, inflamed hemorrhoids is neither comfortable nor conducive to resolving the situation. When sitting on a bike seat, blood flow to the anal region is greatly reduced, and there is friction between the saddle and the hemorrhoid. Cycling itself does not cause hemorrhoids to develop in an otherwise healthy anus, but it certainly can aggravate an existing condition.
Hemorrhoids in Detail
If these veins are located inside the anal canal, they are classified as internal hemorrhoids. Near the opening, they are external hemorrhoids.
External hemorrhoids are varicosities of the veins draining the inferior rectal vessels, which are branches of the pudendal artery. External hemorrhoids are prone to developing blood clots. This is classified as a thrombosed hemorrhoid.
Internal hemorrhoids are varicosities of the veins draining the territory of the superior rectal arteries. Because this area lacks pain receptors, internal hemorrhoids are usually not painful unless they become thrombosed or necrotic.
Internal hemorrhoids, if untreated, can lead to prolapsed or strangulated hemorrhoids. Prolapsed hemorrhoids are severely distended and are actually pushed outside of the anus. If the anal sphincter goes into spasm, the prolapsed hemorrhoid may have its blood supply cut off and become strangulated.
Internal hemorrhoids are graded by the degree of prolapse:
Grade I: No Prolapse
Grade II: Prolapse upon defecation but spontaneously reduce.
Grade III: Prolapse upon defecation and must be manually reduced.
Grade IV: Prolapsed and cannot be manually reduced.
About 75% of the population suffers from hemorrhoids at some point in their life, with the 45- to 65-year-old population being the most commonly afflicted. The primary causes of hemorrhoids are constipation, straining on the stool, excessive sitting, pregnancy, being overweight, lack of exercise, a sedentary lifestyle and a poor, low fiber diet.
Fortunately most cases of hemorrhoids resolve within a few days, and only rarely do they require additional treatment. Home treatment includes over-the-counter creams, ointments, suppositories, or pads, which contain witch hazel or hydrocortisone. Other home remedies that offer some relief are using an ice pack over the area for 15-20 minutes or soaking in a warm bath for a similar amount of time.
For painful or bleeding external hemorrhoids, a doctor may make an incision to drain and remove the blood clots.
One treatment option for internal hemorrhoids is Rubber Band Ligation. This involves placing one or two tiny rubber bands around the base of the hemorrhoid to cut off the circulation. The hemorrhoid will wither and fall off within a week and this is very effective in most cases. Another treatment option is an injection or Sclerotherapy. This is where a chemical solution such as Phenol is injected directly into the hemorrhoid tissue to shrink it.
At times, coagulation techniques utilizing lasers, infrared light or heat are used in an attempt to shrink the hemorrhoids. Generally, coagulation and Sclerotherapy are less effective then banding.
If all else fails, surgery may be the last resort, as it may have secondary complications such as infection, urinary retention, bleeding and anal strictures. A hemorrhoidectomy is reserved for severe and persistent hemorrhoids that fail to respond to more conservative measures. This involves surgical excision of the hemorrhoids, and it is a very painful procedure with a lengthy recovery period.
If even that fails, there is a church located in Murtosa, Portugal, that has a statue of a local saint from the 13th century that is thought to have the power to cure this unpleasant malady. In addition to curing hemorrhoids, Saint Goncalo was also thought to have the power to cure acne and help women find husbands.
Alan Bragman is a chiropractor living in Atlanta, Georgia. He is a former Cat 3 cyclist and nationally ranked inline speed skater. He was on the medical advisory board at Bicycling magazine for 10 years and has written for other sports publications. He is the author of 11 books and articles in the RBR Bookstore.
I was researching this for a friend … Great piece, thx!
Nick Maync says
Detailed article, but does not seem to address how one is to bicycle correctly with prolapsed hemorroids while undergoing slow, but apparently successful treatment. Is the saddle of consequence? 30 minutes cycling at a time appropriate? Any offsetting exercises to compensate for cycling?
Dr., Is the last paragraph a joke? Cause if it’s real I want to book my ticket to Portugal right away. Saint Goncalo, here I come : )
Thomas Jameson says
It’s good to know that hemorrhoidectomies should be a last resort for hemorrhoid removal. My wife has been telling me about some pain that she’s been having, and I think it could be due to a hemorrhoid. I’ll pass this information along to her so that she can look further into all of her options for dealing with her hemorrhoid.
Peter v says
So should we never ride our bikes again or change the saddle, do short rides, this article just leaves you hanging NOT A LOT OF HELP.
There are many “split” bike seats to help keep the sore area from being compressed and further damaged. Search Amazon for “bike seat split” to see many options. Some are completely split like the Hobson or Selle, Others are just hollowed out/open where needed. I bought a hollowed out super soft memory foam version from Walmart for about $20 (Bell memory foam cruiser).
I suffered alone in complete denial & embarrassment for far too long, and if I had only allowed myself to be vulnerable, maybe I could have started the conversation that would have helped myself and others immeasurably! Glad to see this post!
I suffered for a decade. I’d be at least bleeding after every sitting (even just from eating anything that causes inflammation), would need to manually reduce, and found no relief with every OTC remedy. It completely derailed my biking, and scarred my psyche – my confidence and sense of self-worth hit an all time low. i’d become reluctant to go anywhere longer than I could hope to get back to the privacy of my own bathroom when i needed. I was eating high fiber, drinking excessive water, using wipes, creams, suppositories, to no avail. I finally had no choice but to opt for surgery, and had a stapled hemorrhoidectomy. That was another horrifying experience, so i’ll spare you the details, but i’m happy to say i’m much better off today and back on the saddle!
fwiw, I never found much useful 1st hand reference online – even on dedicated forums, the engagement is poor and people don’t come back to post-mortem or share there experience down the road. that’s why it was such a pleasant surprise to see this discussion here! If you’re looking for an active community to learn & share, this one helped me a lot – https://rhoidrage.select.id/kmnn – you need to cancel the hemorrhoids, not the healthy habits and certainly not bike riding!
Dr. RH says
Thanks for your candid comment. I can relate. I just had banding procedure two days ago. It could be worse but not enjoying the recovery. I’ve had stage 3 internal hemorrhoids for a few years. The issue started noticeably 13 years ago while in graduate school…. days and nights sitting. Ironically med school. I’ve eaten a healthy diet my whole adult like and competitive cyclist the last 6 years. Can agree cycling didn’t make them worse. Like others finding this article, I’m curious how long discomfort lasts after banding. And not looking forward to the follow up. Race season is eminent… planning to get on my trainer tomorrow.