F1 and hemorrhoids (I'd value input from the Staff)

Dear forum members, a short and direct question:

what is the impact of GST, in particular of F1, on development and progression of hemorrhoids (no matter of which type)? I suffered from external hemorrhoids in 2011, and lately last week I developed a thrombosis of an external hemorrhoid, which I have to resolve in the next weeks. I will see a specialist (proctologist) in agreement with my house doctor.

I was wondering what could have been the cause of this episode. As a consequence of blood tests and further exams, I gradually switched to a diet with lower daily carbs intake and in this transition I temporarily suffered from diarrhea. However, I know that an increase in abdominal pressure implies dilatation of perianal veins.

What is your opinion on this? It would be extremely helpful if people who are expert in GST give me an unbiased opinion that I can discuss with my doctor, who indicated GST as a potential risk factor especially in its isometric components.

Thanks a lot in advance,

F

Edit: when I mean lower daily carbs, I'm not talking about zero carbs, I'm talking about 220-250g of carbs, of which ~40 from sugars per day, as opposed to 2x which I used to eat before.

I bring this up again. I also would like to use this discussion to come up with a simple and conservative plan for the next weeks.

Please let me know what your opinion is. Thanks a lot.

I recall Pavel talking about some technique for controlling the sphincter or whatever in order to prevent the formation of hemorrhoids, maybe it's worth looking into?

I second that, Ravn. It had something to do with 'power breathing'. Trains the pelvic floor muscles.

Also, dumb question but maybe helpful: Are you getting enough fiber in your diet?

Ravn said:

I recall Pavel talking about some technique for controlling the sphincter or whatever in order to prevent the formation of hemorrhoids, maybe it's worth looking into?

Do you have a link or any particular reference/resource in mind? I quickly searched for it and I found couple of videos and some description on blogs. I will go through it, thanks for the input.

StrongZombie said:

I second that, Ravn. It had something to do with 'power breathing'. Trains the pelvic floor muscles.

 

Also, dumb question but maybe helpful: Are you getting enough fiber in your diet?

Dumb questions do not exist. Yes, definitely. I get 40-45g of fibers/day. Also, I don't drink alcohol/coffee/tea, I don't eat deep fried foods, spices. I walk quite a lot every day, to work and at work and I sit for short periods from time to time, lately preferentially on the floor (unsupported or supported).

I'd like to discuss about the pelvic floor. Are hemorrhoids suggesting a weak pelvic floor? I couldn't find a definitive answer on the web.

Edit: discussion on my diet is public on the GB main forum, here

https://www.gymnasticbodies.com/forum/topic/16837-shaping-a-moderate-gi-diet/

I think it's in "Power to the people" or "The naked warrior".

Ravn said:

I think it's in "Power to the people" or "The naked warrior".

Both.  Naked Warrior in the chapter entitled Power Breathing.  (I just have Kindle edition so no page number available.)  p. 66 in Power to the People.  Neither has much detail, but of the two, there is more discussion of breathing in NW than in PTTP.

Very helpful input. Thanks a lot, I do appreciate your feedback and help.

I looked at the material, it looks like "power breathing" is very similar to the recommended way to breath during DLs and squats at least in powerlifting. However, this way of breathing entails a large increase in intra-abdominal pressure, which in turns has a negative impact on hemorrhoids. The question for me remains: do I have a weak pelvic floor? How would you go about figuring this out?

Edit: in principle, it could also be that the pelvic floor is too strong and that there is an incapacity to relax it under normal conditions.

I don't know what "power-breathing" entails, but you're right that anything that increases intra-abdominal pressure may increase the risk of developing hemorrhoids by increasing the pressure in the veins. I'm not sure there's too much in Foundation that requires holding one's breath and bearing down, but you should definitely avoid doing this when exercising as it will increase the venous pressure in your hemorrhoids.

If there's a situation where you simply can't avoid bearing down like this, you could consider tightening your anal sphincter to "brace" the perianal veins and decrease their transmural pressure (the pressure inside the vein minus the pressure outside the vein) while you're bearing down; it's the transmural pressure that would cause the venous dilatation rather than the absolute pressure. 

-MR said:

I don't know what "power-breathing" entails, but you're right that anything that increases intra-abdominal pressure may increase the risk of developing hemorrhoids by increasing the pressure in the veins. I'm not sure there's too much in Foundation that requires holding one's breath and bearing down, but you should definitely avoid doing this when exercising as it will increase the venous pressure in your hemorrhoids.

 

If there's a situation where you simply can't avoid bearing down like this, you could consider tightening your anal sphincter to "brace" the perianal veins and decrease their transmural pressure (the pressure inside the vein minus the pressure outside the vein) while you're bearing down; it's the transmural pressure that would cause the venous dilatation rather than the absolute pressure. 

Definitely. I found myself bearing down or holding my breath from time to time especially when close to straining. Couple of examples: HBP/PE2, RC/PE3. The point you mention clearly speaks in favor of a strategy whereby progressions are taken much slower than what I used to do so far. That's certainly a point.

I would like to keep this up. What is the position of the staff on this?

The elements of F1 that I believe could contribute to this would be the sPL iM's and SLS PE's and perhaps the hollow and arch work.

I don't recall what Pavel said wrt power breathing, but with your situation, trying to also brace the pelvic floor and anus may very well keep the abdominal pressure created in these elements from causing further issue.

The technique is very simple, 1) tighten your anus muscle and draw it in. 2) To activate the pelvic floor the simplest way to start is just imagine you have to urinate and are 'holding' it. Then do both 1) and 2). Now try to also squeeze the area in between those two, where the perineum is. It will feel a bit odd at first.

all you can do is try and see if it helps. If not we need to scale the offering elements way down and give your body more time to adapt. That is if this is actually the problem, ant not some other factor.

Thanks, I appreciate your contribution and suggestions. Indeed, I've been directed towards this 'pulling in' movement. I tried it with very easy PEs, both static holds and dynamic movements for short holding times/few reps. It's easy to implement but also easy to loose as the set progresses. The elements you indicate - apart from sPL/IMs which I have to say so far, I was at PE3 - were manegeable - are indeed the suspicious ones. 

My plan is to give my body time to recover while maintaining mobiity work only. Then, I will restart F1 from the beginning, taking it easy and taking my time to implement a strict form breathing plus experimenting with this 'pulling in' move. I plan to consider this as part of mastery requirement.

What do you think?

I agree with what Cole Dano suggested. You can in fact strengthen the muscles involved by doing regular sets of the contractions he described, which will make it easier to do them during your workouts. I'd suggest working them two or three times a week after your workouts following Coach's 60 repetition mastery template. If you want more info, you can look up "Kegel" exercises.  

I wanted to mention that this 'pulling in' move must be practiced once fully recovered. I tried it on some easy F1 element this week, e.g. holds for 12s only, couple of reps of PE1s, etc. It seems not so easy to keep it right over time. In addition, it won't help now in the acute phase.

Apparently I still have some weeks to go, as it seems that the clog can take long to resolve, longer than what I expected.

In this period, I think limbering/stretching is the only activity I'm left with. Do you see any issue with that as well? After all, I need something to keep myself active - complete rest won't favor recovery anyway, e.g. by favoring constipation.

I'd be happy to discuss with you further, after having seen a proctologist. One of my worries is that if the specialist is a "tradionalist" he will just discourage me from practising GST. Doctors very often are quite categorical on sports, as they see it only as a "supplement" or facultative activity on top of a healthy life. 

I report the outcome of the medical examinations I did yesterday with a proctologist. 

1. External hemorrhoids with thrombosis.

2. The clog has been evacuated manually (I neglect the details about how pleasant is this maneuver)

3. In 15-20 days - with a treatment based on flavonoids (systemic) and corticosteroids (local), the problem should be resolved. The vein should get back to its normal continence and physiology

4. Since the clog originated in an external vein, as opposed to being a result of prolapse of internal hemorrhoids, is good news

5. Anoscopy indicated an healthy mucose, with small sized second-degree internal hemorrhoids. The doctor told me that are borderline in terms of classification as small and just protruding a little. Hence, they should not to be treated at the moment, also because they are asymptomatic. It is possible that in the future - with aging - these will further progress and require treatments or surgery. To keep the situation under control, a healthy diet, lifestyle, physical activity, ... is required. And I'm certainly in a good position to keep going with this.

I asked the doctor an opinion about GST and swimming. Here's a summary.

1. Swimming is definitely gold for circulation in general. I need to improve my technique then, and to do so I most likely need to attend a class (intermediate level).

2. GST and everything that combines strength, balance, flexibility (i.e. movement) is indicated as long as breathing and intra-abdominal pressure is kept under control.

--This becomes my first priority.

--I need to give my body time to adapt.

--Correct breathing should become part of mastery requirement for me.

Also, I should consider reducing the strength work I do in favor of other underdeveloped components of movement such as balance and flexibility. I want to make the transition smooth, and to this purpose probably using some simplified variation of F1 exercises is the way to go (as suggested by Cole Dano).

--Implementation of Kegel/pelvic floor exercises are fine

This discussion can then be closed, if wished, or kept open to discuss about the original title.

I hope that this report will be helpful for users in the future.