What is the link between hemorrhoids and overactive bladder?

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Both hemorrhoids and overactive bladder (OAB) can occur due to an issue with the pelvic floor muscles. These muscles support and maintain the organs of the pelvis, including the bladder, rectum, and anus. An issue with the pelvic floor could trigger multiple conditions in these areas. In some cases, a person may develop hemorrhoids in addition to OAB.

Pelvic floor dysfunction may be associated with other issues, including:

• Obstructed defecation: This is an inability to evacuate the bowels properly.
• Paradoxical puborectalis contraction (PPC): PPC refers to obstructed defecation associated with the puborectalis muscle of the pelvic floor. In this condition, the muscle does not relax when a person bears down to pass stool.
• Pelvic floor prolapse: This is a condition in which one or more pelvic organs move out of place and slip into the vagina.
• Rectocele: A rectocele is a thinning of the wall between the vagina and rectum, which results in a failure to empty the rectum completely while passing stools. A rectocele weakens the pelvic floor.
• Pudendal neuralgia: This is pain in the pelvic nerves. It may occur following childbirth or without an obvious cause.
• Coccygodynia: Coccygodynia refers to pain in the tailbone.
• Levator ani syndrome: This is an abnormal spasm of the pelvic floor muscles.

A person may also experience OAB or other temporary urinary issues after surgery for severe hemorrhoids.

Hemorrhoids are enlarged veins in or around the anus. There are two types: internal and external.

Internal hemorrhoids form inside the rectum. They are typically painless but may be painful if they become prolapsed and slip outside the anus.

External hemorrhoids form around the opening of the anus. Although covered by sensitive skin, they are typically not painful unless they are very swollen or a blood clot forms inside them.

OAB is a condition in which a person feels a sudden urge to urinate. Urgency incontinence or an unexpected release of urine before reaching the bathroom may accompany OAB.

A person with OAB may wake multiple times throughout the night to urinate. Some people have OAB because of an underlying condition called polyuria, in which their body makes more urine than normal. This condition is often associated with diabetes.

OAB is not the same as stress incontinence, where a person may leak urine during a sneeze or cough.

Possible causes of OAB include:

• aging
• urinary tract infection (UTI)
• overactive bladder muscles
• weak pelvic floor muscles
• improper communication between the brain and bladder
• an underlying health condition, such as multiple sclerosis or stroke
• side effects of certain medications

Below are some of the symptoms associated with hemorrhoids and OAB.

Hemorrhoids

Hemorrhoids may be internal or external:

• Internal hemorrhoids: These form inside the rectum. They are typically painless but may bleed. A person with internal hemorrhoids may notice fresh, bright-red blood on tissue paper when wiping after a bowel movement.
• External hemorrhoids: These form outside the rectum. A person with external hemorrhoids may experience the following symptoms:
  • itching near the anus
  • hard, tender lumps near the anus
  • pain near the anus when sitting down

OAB

The main symptom of OAB is a sudden urge to urinate, which may be accompanied by:

• a small release of urine
• urinating more than eight times during the day
• urinating more than once at night

A person who presents with both hemorrhoids and OAB will likely require separate treatments for the two conditions.

Hemorrhoids

The treatment for hemorrhoids depends on the severity of a person’s condition. Some treatment options are outlined below.

First-line treatments

First-line hemorrhoid treatments include:

• avoiding constipation by keeping hydrated and eating high fiber foods
• treating constipation with stool softeners or a fiber supplement, such as methylcellulose
• avoiding forcing bowel movements
• sitting on the toilet for short periods
• using a sitz bath or sitting in a bath of warm water to alleviate hemorrhoid pain
• applying an over-the-counter hydrocortisone cream or prescription anesthetic cream for local relief
• drinking more water to prevent hard stools

Nonsurgical procedures

If hemorrhoid symptoms persist or worsen despite appropriate first-line treatments, a person should see their doctor. The doctor may recommend one of the following treatment options:

• Rubber band ligation (RBL): This is an outpatient procedure where a healthcare professional places a rubber band around the base of the hemorrhoid to cut off its blood supply. The hemorrhoid should shrivel and fall off within 7 days of the procedure. Treatment success rates can vary.
• Sclerotherapy: This procedure involves injecting a solution into the hemorrhoid. It results in the development of scar tissue, which cuts off the blood supply to the hemorrhoid. Treatment success rates are high. Most people who undergo the procedure do not have a recurrence of hemorrhoids within 6–12 months.
• Infrared photocoagulation: This involves directing infrared light at the hemorrhoid. The heat helps form scar tissue, removing the blood supply and shrinking the hemorrhoid. According to a 2017 study, this method of hemorrhoid removal involved less bleeding, lower pain levels, and better recuperation times than surgical removal of the hemorrhoid.
• Electrocoagulation: This procedure involves directing an electric current into the hemorrhoid. It forms scar tissue, removing the blood supply and enabling the hemorrhoid to shrink. Endoscopic electrocoagulation is a less invasive variation of the procedure. This procedure is quick, and studies have shown that a person can go a year without recurrence.

Surgical procedures

Fewer than 10% of people with symptomatic hemorrhoids require surgery for the condition. Surgical treatment options may take place in a hospital center or an outpatient facility. These options include:

• Hemorrhoidectomy: This treatment involves surgical removal of the hemorrhoid under anesthesia. It may be necessary for a person with large external hemorrhoids or prolapsing internal hemorrhoids that have not responded to treatment. A person may require pain relief in the first week following surgery. Recovery and return to normal activities occurs up to 10 days after surgery.
• Hemorrhoid stapling: A doctor uses a stapling tool to remove hemorrhoid tissue or put a prolapsing hemorrhoid back into the anus. A person will be under anesthesia for the duration of the procedure. Hemorrhoid stapling is associated with fast recovery times and reduced pain, but recurrence is higher. Some hemorrhoids are too big for this type of treatment.

Overactive bladder

A doctor may recommend a range of treatments for OAB.

First-line treatments

First-line treatment for OAB involves behavioral therapy, which aims to change the person’s behavior or environment. These interventions can be combined with other therapies. Examples include:

• changing bathroom habits by training the bladder to go at specific times
• delaying urination for an increasing amount of time
• double voiding, where a person goes to the bathroom two times in quick succession to fully empty the bladder before waiting for a specific time to go again
• pelvic floor exercises to strengthen the pelvic muscles and improve bladder control
• urge control techniques, which may include self-assertion or distraction
• managing fluid or reducing caffeine intake
• avoiding foods that may irritate the bladder
• losing weight

Second-line treatments

Second-line treatments for OAB include:

• Antimuscarinics: These medications block receptors that reduce muscle activity in the bladder wall. They are available as tablets, a liquid, or a transdermal patch. Examples include solifenacin and tolterodine.
• Mirabegron: This medication relaxes the muscles of the bladder wall, allowing the bladder to contain more urine. This helps reduce the frequency of bathroom visits.

Other therapies

If first-line and second-line OAB treatments are ineffective, a doctor may recommend one of the following:

• Neuromodulation therapy: This therapy uses electrical impulses to improve communication between the brain and bladder.
• Botox treatment: This involves injecting Botox into the bladder under local anesthesia to relax the muscles of the bladder wall. The treatment will need repeating.
• Surgery: A person may require surgery to correct OAB. This is a rare treatment option since the surgery carries risks.
• Biofeedback: This therapy involves learning to become more aware of bodily functions.

A person may experience urinary retention after hemorrhoid surgery. This may occur as a result of the following:

• anesthetics, such as an epidural or spinal block
• localized pain relief, which makes it difficult for a person to know when they need to urinate
• irritation of the pelvic nerves
• pain

Symptoms may include:

• pressure or pain in the pelvis
• an urge to urinate, combined with difficulty urinating
• expressing small amounts of urine but feeling that there is more in the bladder

A person’s inability to urinate may lead to a urinary tract infection.

Urinary retention may resolve without further intervention. Severe urinary retention may require immediate attention or treatment by a specialist.

Hemorrhoids are enlarged blood vessels in or around the anus, whereas OAB describes the sudden urge to pass urine. It is possible for a person to experience both conditions simultaneously. This could occur due to pelvic floor dysfunction or following surgery for hemorrhoids.

The two conditions share some common risk factors, but both require different treatments. A person may need to try different treatments depending on the severity of the hemorrhoids and the distress caused by OAB. It is important that a person talks with a doctor about their treatment options and the likelihood of success.