Hemorrhoid Troubles for Long-Distance Cyclists: Causes, Prevention, and In-Season Management Strategies

Prevalence of Hemorrhoids

Hemorrhoids refer to varicose veins and swelling around the anus. The prevalence among the general adult population is about 4-5%, but surveys of long-distance cyclists show 20-30% experience symptoms to varying degrees. Internal hemorrhoids are located above the dentate line, are painless but prone to bleeding; external hemorrhoids are located below the dentate line and cause noticeable pain.

Why Cyclists Are a High-Risk Group

1. Direct Pressure from the Saddle

Sitting on the saddle for extended periods (4+ hours) puts body weight pressure on the perineum, compressing pelvic venous return and causing congestion in the anal blood vessels.

2. Pre-Race Nervous Diarrhea

Poor sleep the night before a race, dietary changes, and elevated adrenaline cause 30-40% of cyclists to experience diarrhea. Repeated friction from bowel movements worsens hemorrhoids.

3. Holding in Bowel Movements During Races

In events over 100 km, many riders hold in bowel movements for 3-5 hours. Stool that remains in the rectum too long hardens, and subsequent straining during elimination causes venous dilation.

4. Dehydration Effects from Nutrition Products

Energy gels, caffeine, and sports drinks without adequate water intake cause intestinal dehydration and hardening of stool.

5. Repeated Valsalva Maneuvers

Naturally holding your breath (Valsalva) when exerting power on climbs raises intra-abdominal pressure, repeatedly pushing against the anal veins—a cumulative effect similar to “straining during constipated bowel movements.”

5 Steps for Prevention

1. High-Fiber Diet

Daily fiber intake target: 30 g (the Taiwanese adult average is only 15 g):

• Breakfast: 50 g oatmeal + 1 apple = 12 g fiber
• Lunch: 1 bowl of brown rice + 200 g cabbage = 8 g fiber
• Dinner: purple rice + wood ear mushrooms + broccoli = 10 g fiber

2. Adequate Hydration

35 ml/kg of body weight on training days (about 2.5 L for a 70 kg rider), plus 1 L more on training days. The number one cause of constipation is not lack of fiber—it’s lack of water.

3. Regular Bowel Habits

Sit on the toilet for 5-10 minutes at a fixed time each day (recommended after waking up or after breakfast) to train the bowel reflex. Do not hold in bowel movements.

4. Change Position on the Saddle

During long rides, every 30 minutes:

• Stand and pedal for 30 seconds to relieve pressure on the perineum
• Shift your weight side to side to distribute pressure points
• Avoid staying in a forward-leaning position (the drops concentrate pressure even more)

5. Saddle and Shorts

• Saddle: Choose one with a “perineal pressure relief channel” design (such as Specialized Power Mimic, Selle SMP)
• Shorts: 3D contoured chamois + premium Lycra (high-density foam for pressure relief)
• Petroleum jelly or dedicated chamois cream (such as Chamois Butt’r)

Managing Acute Flare-Ups

Symptom Grading

Pre-Race Management

If Grade I-II symptoms occur within 2 weeks before an A-priority race:

1. Anti-inflammatory ointment: containing hydrocortisone 1% (such as Anusol) short-term for 5-7 days
2. Warm sitz baths: 10 minutes morning and evening, water temperature 37-40°C
3. Avoid spicy food and alcohol: to reduce vasodilation
4. Add an extra layer on the saddle on race day: thin foam pad or silicone pad
5. Have a bowel movement 30 minutes before the race: to avoid holding it in during the race

In-Race Response

Bleeding mid-way through a long-distance event:

• Stop at an aid station and wipe clean
• Replenish with 500 ml of water + 1 salt tablet
• Apply petroleum jelly to the saddle area to prevent friction
• Reduce intensity in the latter half and increase time standing while pedaling

When to Seek Medical Attention

Warning signs requiring immediate medical attention:

• Continuous bleeding > 3 days with heavy volume
• Severe pain making it impossible to sit
• Hemorrhoids that cannot be pushed back
• Stool turning black (suspected gastrointestinal bleeding)

Do not assume all anal bleeding is hemorrhoids—those over 40 with prolonged bleeding should undergo a colonoscopy to rule out colorectal cancer.

Conclusion

Hemorrhoids are a problem cyclists are “too embarrassed to mention” but is actually very common. Daily 5-step prevention, proactive management 2 weeks before a race, and knowing how to respond during a race will ensure that this awkward little issue doesn’t ruin your entire experience at your next 100 km+ event.

Related Reading

• Saddle Sores: The Hidden Annoyance for Cyclists and a Complete Prevention and Treatment Guide
• Gut Training for Cyclists: Reducing Gastrointestinal Issues in Long-Distance Riding
• Gastrointestinal Issues in Long-Distance Riding: Causes and Solutions for Digestive Discomfort
• Gut Management for Long Rides: Preventing and Handling Digestive Problems While Cycling