Meet Yanko: haemorrhoids, birth, and what actually helps

A Bulgarian friend of ours refuses to say the word haemorrhoids. She calls them Yanko — a plain male first name, the sort of neighbour who turns up uninvited, stays too long, sits in the worst possible chair, and eventually leaves without explaining himself. Once you have heard it you cannot unhear it. Half of the discomfort of this subject is the vocabulary, and Yanko fixes that in one word.

So: Yanko. Let us talk about him properly, because roughly one in three pregnancies ends with him at the door, and almost nobody mentions it in advance.

What Yanko actually is

Everyone has haemorrhoidal tissue. It is not a disease you catch. Inside the anal canal there are three cushions of blood vessels, connective tissue and smooth muscle that help seal the canal and give you fine control — the difference between gas and everything else. They are supposed to be there.

The trouble starts when those cushions engorge, slip downward, or lose their anchoring tissue. Then you get the familiar cast:

• Internal — above the dentate line, poorly supplied with pain nerves. Usually painless, usually announced by bright red blood on the paper.
• External — below the line, in skin that has an excellent sense of pain. This is the one that ruins sitting.
• Thrombosed external — a clot forms inside one. Sudden, hard, purple, genuinely painful for two to three days, then improves. Peak misery is early; if you are past day four you are on the way down.

Why birth invites him in

Pregnancy is close to a designed experiment for producing haemorrhoids, and each factor stacks on the last.

Blood volume rises by about forty per cent. Everything venous is fuller than usual.

The uterus presses on the inferior vena cava and the pelvic veins. Return flow from below slows. Pressure backs up into exactly those cushions.

Progesterone relaxes smooth muscle — helpful for a growing uterus, unhelpful for vein walls and for the bowel, which slows down. Slow bowel plus iron supplementation equals harder stool.

Then there is the second stage of labour. Prolonged, breath-held pushing against a closed glottis produces some of the highest intra-abdominal pressures the human body ever generates, repeatedly, for minutes to hours. Instrumental birth and a long pushing stage both raise the odds further.

None of this is a failure on your part. It is plumbing under load.

The good news is genuinely good: most postpartum haemorrhoids settle within weeks as blood volume normalises, the uterus involutes and the bowel wakes up. You are managing a temporary condition, not signing a lifetime lease.

The unglamorous foundation

No cream outperforms the basics. Get these right first, because the entire problem is mechanical.

Stool consistency is the whole game. Soft, formed, passed without effort. Fibre — around 25 to 30 g a day, from oats, pulses, fruit, psyllium husk if food alone is not enough — plus enough water that the fibre can do its job. Fibre without fluid makes things worse, not better.

Do not strain, and do not sit. The toilet is not a reading room. Two or three minutes. If nothing is happening, stand up and come back. Sitting on the seat with the sphincter relaxed and nothing to do is itself a mild, sustained prolapsing force.

Change the angle. Feet on a low stool, knees above hips, lean forward. This straightens the anorectal angle and cuts the effort required. A cheap wooden step is the most effective purchase in this article.

Do not delay the urge. Wait, and water is reabsorbed, and the stool hardens, and you are back to straining.

Warm sitz baths. Ten minutes in plain warm water, two or three times a day, especially after a bowel movement. This relaxes the internal sphincter spasm that drives much of the pain. No salt needed, no additives, no fragrance. Pat dry — do not rub.

Move. Walking helps venous return and bowel transit both. Lying on your left side takes pressure off the vena cava when you need relief.

Wipe less. Water on a soft cloth, or a rinse in the shower, beats dry paper. Perfumed wipes are a common cause of the contact dermatitis that people mistake for worsening haemorrhoids.

Eucalyptus cream

Among the plant remedies, eucalyptus is the one we keep hearing about from people who actually use it, and the reasoning holds up.

Eucalyptus oil is dominated by 1,8-cineole (eucalyptol), which has documented anti-inflammatory and mild local anaesthetic and vasoconstrictive properties. On inflamed perianal skin the practical effect is cooling, a reduction in the itch–scratch loop, and a genuine easing of the burning that makes the area impossible to ignore. It is symptomatic relief rather than cure — it does not shrink a prolapsed cushion — but symptomatic relief at three in the morning is not nothing.

How to use it well: always a properly formulated cream or a dilution, never neat essential oil on mucosa. Thin layer, clean dry skin, after a sitz bath. External use only — do not push it inside. Patch test on the forearm first if your skin is reactive.

Where we are careful: eucalyptus should not be applied to or near the face of infants and young children, and inhaled cineole can cause breathing difficulties in babies. On your own perianal skin that risk does not arise — but keep the tube away from small hands, and wash yours before you pick anyone up. If you are breastfeeding, there is no issue with perianal application; the concern is only ever about direct contact with the baby.

Witch hazel on a cool compress does a similar astringent job and is the classic alternative. Aloe vera gel, plain and unperfumed, is the gentlest option for raw skin.

The Dutch cure: Curanol

Live in the Netherlands long enough and someone will eventually say the word Curanol in the tone reserved for family secrets. It is sold in every drogist, has been for decades, and comes in two forms that are meant to be used together.

Curanol zalf — the ointment. Applied externally, and with the supplied applicator internally, several times a day and after each bowel movement. This is the fast-acting half: it soothes, protects the skin surface, and eases the itch and burning while the tissue calms down.

Curanol tabletten — the tablets, taken orally. The interesting part of the Dutch protocol is that the treatment is not purely topical. The oral course is aimed at the vessels themselves rather than the skin over them, which is the same logic behind the flavonoid preparations prescribed elsewhere in Europe — diosmin and hesperidin, which have reasonable trial evidence for reducing bleeding and the duration of an acute episode.

How the Dutch actually use it: both together, consistently, for the full course rather than one hopeful application. Ointment for the surface, tablets for the vessels, and the boring mechanical basics underneath both. Read the leaflet, and — this matters — ask the pharmacist before starting the tablets if you are pregnant or breastfeeding. The ointment is the more conservative choice in that period. A Dutch apotheek will give you a straight answer in thirty seconds and will not make it strange.

When Yanko needs a professional

Send him to someone qualified if:

• Bleeding is heavy, dark, mixed into the stool rather than on its surface, or continues beyond a week or two.
• There is fever, spreading redness, or discharge.
• Pain is severe and rising past day three or four rather than easing.
• A lump appears that you cannot push back, or one that was reducible and no longer is.
• Any bleeding at all after the age of about forty without a clear cause. Haemorrhoids are common; so is assuming that bleeding is haemorrhoids when it is not.
• It has been eight weeks postpartum and nothing has improved.

A thrombosed external haemorrhoid seen within about seventy-two hours can be drained in a few minutes in a clinic, with immediate relief. After that window the body usually resolves it faster than a scalpel would.

The part nobody says out loud

The reason this subject stays hidden is embarrassment, and embarrassment costs people weeks of unnecessary pain and, occasionally, a missed diagnosis. Midwives, GPs and pharmacists deal with Yanko constantly. He is one of the most ordinary things that happens to a body that has just done something extraordinary.

Name him something silly. Buy the step stool. Keep the cream in the drawer. He leaves.

This is a researched guide, not a substitute for a consultation with your midwife, GP or pharmacist — particularly during pregnancy and breastfeeding.