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What Are Piles?

Updated on January 17, 2018
tobusiness profile image

Jo has been an ITU nurse at the London North West NHS Trust for 14 years. She obtained her RN at University College London Hospital.

"Piles" refers to the condition known as hemorrhoids...the word Pile is derived from the Latin word "Pila" which means "ball"
"Piles" refers to the condition known as hemorrhoids...the word Pile is derived from the Latin word "Pila" which means "ball"
Don't be embarrassed by Piles seek doctors advice
Don't be embarrassed by Piles seek doctors advice | Source
Piles makes it painful to seat down, try a surgical ring cushion
Piles makes it painful to seat down, try a surgical ring cushion | Source
Internal and External Piles
Internal and External Piles
Prevent piles, eat more fruits and veg
Prevent piles, eat more fruits and veg

Tips to help prevent Piles

prevent Piles

  • Eat more wholemeal or multi-grain bread instead of white loaf
  • Try brown rice and wholemeal pasta
  • Cut down on on animal fat, sugary and processed or refined foods
  • Add nuts and seeds to breakfast cereals and sprinkle on your salads
  • Eat five portions of fresh fruit and vegetables per day
  • Eat more pulses such as baked beans, lentils, beans, kidney beans and chickpeas
  • Drink water regularly to stay hydrated
  • Take regular exercise
  • Try to avoid medication that causes constipation, such as painkillers containing codeine
  • Reduce alcohol intake, alcohol causes dehydration and can harden the stool to cause constipation

Piles, No Joke

Do You Have Piles?

I received a call from an old friend recently, she was rather distressed and needed advice on a delicate matter.

My friend was obviously embarrassed; she found it difficult to explain the exact cause of her predicament. She used words like 'down below, '....' know.. in' then finally she explained, ending with; 'well it's cancer, isn't it? '

She had piles, however; she did not, at that time know it. She went to the toilet and was horrified to find that there was evidence of fresh blood from her back passage (anus) after passing stool.

My friend immediately thought the worst; it must be cancer. My friend was surprised to learn that the most obvious and most common cause of rectal bleeding is 'piles,' also known as hemorrhoid or haemorrhoids.

Piles are often the butt of many jokes, (pardon the pun), or well-meaning advice like,“don't sit on cold cement." However, if you are the individual suffering from piles, it is not a joking matter. This condition can be the source of much embarrassment and stress as people imagine the worst case scenario.

I asked my friend a few pertinent questions, and soon I was able to reassure her. I explained that she should contact her doctor for an appointment to confirm the problem and to rule out potentially serious conditions. However; chances are, she may be suffering from a small crack or tear in the anus or quite possible bleeding piles.

After her trip to the doctor, I received another call from my very relieved friend, informing me that she was indeed suffering from piles.

What are Piles or Haemorrhoids

Haemorrhoids, also known as piles comes from the Greek word haimorrhois, meaning “ liable to discharge blood." These are abnormal swelling of tissue containing veins and tiny arteries within the lining of the anus and lower rectum.

These vessels can become dilated and engorged with an excess of blood, rather like varicose veins. The engorged vessels and surrounding tissue can develop into small swellings, known as haemorrhoids or piles.

It is estimated that 50% of people in the UK and around 10.4 million people in the US suffers from piles. 50% of us will develop piles by the age of 50, there are 1 million new cases of piles each year in the US, but only a small proportion will seek treatment.

The reason we get piles is not exactly clear, In some cases it occurs for no apparent reason, but the general consensus is that the condition occurs when there is an increased intra-abdominal pressure exerting force in and around the anus, resulting in the formation of piles.

In many cases, piles are mild, and often, without symptoms. However; in severe cases symptoms can include:

  • Bleeding of bright red blood after passing stool

  • Itching around the anus

  • Mucous discharge after passing stool,

  • Inflammation and soreness around the anus

  • Feeling like the bowels remains full and still need to be emptied

Types of Piles or Haemorrhoids

There are two types of piles, internal and external

  • Internal piles often remain along the anal wall with no obvious symptoms; people with internal piles are normally unaware of their presence unless it breaks through the anal wall. When this occurs, the swelling needs to be pushed back after passing stool, also known as protruded or prolapsed haemorrhoids or piles. Internal piles are not usually painful but can be associated with other conditions such as fissure.

    Fissure is a tear in the lining of the anal canal which can be further extended when stool is passed during a bowel movement; it can be painful, bleeds and itches.

  • External; this type of piles consists of small soft pads along the opening of the anus, normally the same colour as the skin. When external haemorrhoids form a blood clot, it can appear blue, accompanied by severe pain, itching, and inflammation.

Piles can become strangulated and bulge outside of the anus; the anal muscles tighten around the pile causing it to become hard and painful.

Perianal haematoma is associated with external blood clots under the skin

Thrombosed external haemorrhoid, is a hard lump consisting of blood clots that develop around the anus and can be painful

How do you get Piles? Cause and Symptoms

Certain factors are thought to increase the chances of developing piles; they include:

  • Chronic Constipation, passing large hard stool can cause straining that increases the pressure in and around the anus to form piles.

  • Pregnancy and childbirth, piles, are a common occurrence in pregnancy, this is probably due to the pressure of the baby lying above the rectum and anus. Hormonal changes during pregnancy can also affect the veins in the anus to cause piles

  • Age, the tissue lining the anus, can become less supportive with age, increasing the risk of piles

  • Hereditary, some people may inherit a weakness in the wall of the anal region

  • Chronic Diarrhea

  • Prolonged sitting or standing

  • Heavy lifting

  • Obesity

How to prevent Piles

The best management of piles is prevention, ways to avoid piles includes:

  1. Diet, a high fibre diet with plenty of fruits, vegetables and grain, will increase bulk and soften the stool to reduce straining

  2. Hydration, drink more fluids

  3. Fibre consider taking fibre supplements, but remember to drink 8-10 glasses of water while taking them, or they can cause constipation.

  4. Exercise can help reduce pressure on the veins caused by long periods of standing or sitting; it can also help to reduce weight and obesity.

  5. Go to the toilet as soon as you feel the urge, holding back causes the stool to become drier and harder to pass.

  6. Don't sit on the toilet for too long, doing so will increase the pressure on the anus and can exacerbate the problem.

Treatment for Piles

A mild condition can be relieved by good management as mentioned above, the condition will quite often settle down after a few days without treatment, however; treatment is available to relieve the symptoms in more severe cases, and to remove or shrink piles where necessary.

  • Creams, ointments and suppositories are available over the counter from various pharmacies. They can be used to relieve the symptoms of swelling and inflammation, but should only be used for five to seven days at a time; any longer can cause irritation of the sensitive skin around the anus.
  • Painkillers such as paracetamol and local anaesthetics can help to relieve pain
  • Laxatives may be recommended the doctor for relieving constipation, can also help to form bulk in stool
  • Banding is a procedure that can be used to treat second and third-degree haemorrhoids (piles). This procedure involves the placing of a tight elastic band around the base of the piles to effectively cut off the blood supply. Piles should fall off within seven days of having the procedure.
  • Injection ( sclerotherapy) this is often used for internal piles as an alternative to banding. A chemical solution is injected into blood vessels in the anus to deaden the sensory nerve endings, relieve pain and harden to form scar tissue. The piles should reduce in size and shrivel up in about four to six weeks.
  • Infrared coagulation can also be used in the treatment of piles.'
  • Haemorrhoidectomy Surgery is sometime necessary to treat large internal piles or those that are graded three or four
  • Cold compress may be used when piles are extended outside of the anal canal, can help to relieve swelling
  • Avoid; foods that may worsen the condition such as nuts, coffee, alcohol and spicy foods
  • Use wet wipes or moist toilet paper after passing stool.
  • Use Epsom Salt in warm water, sit for approximately 15 min at a time can help to relieve symptoms and reduce the inflammation
  • Clean anal area by gently cleansing with warm water, soap may aggravate the condition.
  • Prolapsed piles may be pushed back very gently into the anal canal
  • Surgical rings or donut cushion and pillows can help to relieve pressure and maintain comfort

Care should be taken when using over the counter medication containing vasoconstrictors in people with the following condition:

  • Diabetes

  • Heart disease

  • High blood pressure

  • Thyroid problem

  • Difficulties passing urine

  • Taking anti-depressant medications

Always get advice from your primary health provider, and read all instruction before taking medication.

Home remedies for piles include:

  • Apple Cider Vinegar; this is apparently one of the most popular natural treatments for piles, soak a cotton ball with apple cider vinegar and apply to the piles. Repeat this process until the inflammation and symptoms are gone. Alternatively; half a cup of apple cider vinegar can also be added to a sitz bath.

  • Rutin; is a health-promoting compound, which has been credited with properties that strengthen blood vessels. Rutin is found in buckwheat, oranges, grapefruits, asparagus lemons, and cranberries, to name but a few. Rutin is often used to treat piles and can be taken as s supplements.

  • Coconut oil; can be applied to haemorrhoids or piles, then rinse and repeat. This will help to relieve the symptoms of piles which should disappear within a few days.

  • Witch Hazel; this is one of the oldest known natural remedies for piles. Use by soaking a cotton ball with witch hazel and apply to the affected area.

  • Aloe Vera; just apply to the affected area to relieve symptoms

  • Sitz bath; soak the area a few times per day in warm water for 10-15 min to relieve symptoms

  • Squat, Don't sit; the conventional position we assume when using the toilet may be one of the reasons why piles are so common in developed countries. In many of the less developed parts of the globe, squatting is the preferred position when using the loo. Sitting down while having a bowel movement put excess strain on the rectum, squatting, on the other hand, helps to straighten the rectum and relaxes the puborectalis muscle.

In conclusion, don't die of embarrassment; if you find blood in you stool, contact your doctor, do not assume the worst...a trip to the doctors can put your mind at ease. If the problem proves to be something more serious, the earlier the intervention, the better.

Piles are little more than a nuisance, but if ignored it can be painful, needing more invasive management, prevention is always better that cure, and squatting better than sitting.

Oncologists have observed that 80% of colon cancers occurs in the caecum and sigmoid colon, the areas that are not fully emptied when we use the sitting position to empty the bowel. This causes residual fecal matter to stagnate, and this may well be the reason colon cancer is the second leading cause of deaths in developed countries.

In cultures where squatting on the loo is the norm, such as Asia and Africa, colon cancer is very rare. However, I believe that a less refined diet, high in grain fresh fruits and vegetables may have something to do with the statistics. The old way of our ancestors, 'squatting' may yet prove to be the healthier position, and people in the US and Europe are beginning to warm to the idea, as new products begin to emerge in the marketplace to facilitate squatting.

Some Over the Counter Treatment for piles

(click column header to sort results)
Product Names  
Preparation-H ointment
mineral oil
shark liver oil
Anusol ointment/ suppositories
Zinc oxide
balsam peru
benzyl benzoate
Preparation-H suppositories
cocoa butter
shark liver oil
Xylocaine ointment
local anaesthetics
Daflon / Cyclo-3 Fort oral tablets

Reduce the strain by squatting

Do you have Piles ? If yes

See results
Use squatty stool to prevent piles
Use squatty stool to prevent piles


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    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Hi Crafty, many thanks for taking a look at this, at best piles are very uncomfortable to live with, at worst it can be very painful, needing surgical intervention. It doesn't help when some people insists of having a laugh when you are the one suffering from the embarrassing condition that dare not say its name. :) And your are correct, it is also common in pregnant women, this is due to the increased intra-abdominal pressure. Thanks again for the visit and comment, always appreciated and my best to you.


    • CraftytotheCore profile image

      CraftytotheCore 4 years ago

      I never knew there was so much to know about this. I know that they are very common during pregnancy and childbirth. It's very interesting.

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      To squat or not to squat....I haven't yet made it to China, however; I'm learning how to squat :). The Chinese are of course, very astute people with a wealth of knowledge, if it's good enough for them... Thank you for stopping by, very much appreciated.

    • kulewriter profile image

      Ronald Joseph Kule 4 years ago from Florida

      Anyone who has visited the Great Wall in china, knows, if they visited the bathrooms there, that squatting is definitely the norm in China.

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Hi Paul, many thanks for this insightful and valuable comment!...It is always better to get medical advice sooner rather than later. You've really been through the wars, by the sound of it. I do hope you're feeling much better now. take care and my very best to you.

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Hello Moonlake, a pleasure to see you!...yes, there are many baby-boomers out there and just as many conditions like Piles, affecting the age group. Thank you so much for the visit, comment, vote and share.

      Have a wonderful day and my best to you.

    • Paul Kuehn profile image

      Paul Richard Kuehn 4 years ago from Udorn City, Thailand


      This is a very interesting and useful hub. I had hemorrhoids since I was about 18, and finally at the age of 65 they got so bad that I had to have a hemorrhoidectomy. I probably should have had the operation 10-15 years earlier but thought I could control the internal piles with things like Preparation H. They finally got so bad and bulged out of my anus and were so painful that I was forced to have the operation. My advice is that if you need an operation, get it when you are younger and don't wait as long as I did. Before I had the operation, I checked on the Internet and found that the normal recovery time was 2-4 weeks. This time is probably for younger people. It took me 6 months from the time of the operation to get back to normal with no more pain. The first week after the operation was awful. My bodily functions were all screwed up and at times there was no differentiation between urination, defecation, and passing gas! Due to the pain in bowel movements, I developed a bad case of constipation and had to go to the hospital for an enema. According to the doctor, heredity, diet, and cleanliness of the anal cavity play a big part in preventing piles. Voted up and sharing with followers.

    • moonlake profile image

      moonlake 4 years ago from America

      Well its seems there are many people interested in this subject. Very good hub and full of information. I'm old I knew what piles meant. Voted up and shared.

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Shanmarie, just for you we'll use hemorrhoids :). The word piles comes from the Latin word 'Pila' meaning 'ball' which refers to anal swelling. Piles or hemorrhoids, what's in a name....:)

      Thank you for reading this, much appreciated and my best to you.

    • shanmarie profile image

      shanmarie 4 years ago

      Very interesting and useful, of course. I'd never heard them called piles before.

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Hi Bac2basics, so nice to see you!....many thanks for taking a look at this, much appreciated. You are right, a sore bum is no joking matter :). Many of the OTC preparations do contain phenylephrine which is a common vasoconstrictor, it works well for the piles by tightening the blood vessels and shrinking the tissues. However; not so good if you have high blood pressure or heart problems, it's always a good idea to discuss your individual situation with your doctor or indeed the pharmacist. Your neighbour is correct, Iodine is also a natural cure for piles, 20 drops can be mixed with an oil such as olive oil, apply directly on the affected area daily, but it can cause burning and stinging. Thank you once again for the visit and helpful comment, have a lovely day and my best to you.


    • bac2basics profile image

      Anne 4 years ago from Spain

      Hi Tobusiness.

      Well you really got to the bottom of things with this hub. Pun most definitely intended. Seriously though, when Piles really kick off they can make you feel miserable as well as in pain. I´m very pleased I read this because I have high blood pressure which is controlled with medication and had a niggling suspicion that OTC creams could cause problems but after saying that the misery of a burning bum out weighed my fears. I shall ask the pharmacist next time I need some pile cream to recommend one that doesn´t contain vasoconstrictors, or give the apple cider vinegar a go. Just as a matter of interest my Spanish neighbour say´s that iodine also works well, but I didn´t give it a fair trial to find out, maybe I should.

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      LadyLLD, thank you for stopping by!... Your visit and comment are much appreciated, so glad you found this hepful.

      My best to you.

    • LadyLLD profile image

      LadyLLD 4 years ago

      I've always wondered what piles were myself. Good Hub, quite comprehensive.

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Jonnycomelately, you are spot on!...we need to be able to discuss these things without fear of embarrassment.

      Thank you so much for taking the time. I will certainly take a look at the links. Hope you're having a great day and my very best to you.

    • jonnycomelately profile image

      Alan 4 years ago from Tasmania

      It really is beneficial for people to be discussing this subject, because it is so often a no-no, as though we humans are so far removed from animals that we refuse to talk about "doing it." Yet how can we come to know better practices if we are not able to discuss it?

      "tobusiness," I hope your willingness to write a hub about it will allow so many others to share their opinions without the threat of being ridiculed. It's such a useful path to better health.

      I would recommend these two Website links, which I found helpful, interesting and perhaps a bit of fun as well.

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Hi Joelle, lovely to see you!... Thanks for the visit and wonderful comment, always appreciated. Piles can be very painful and many people find it uncomfortable to discuss openly, but it can be easily managed and treated. Once it is diagnosed, other causes of bleeding can be ruled out.

      Take care now, and my best as always.

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Mary, thank you again, you are very kind.

      Take care now.

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Hi Eddy, always a pleasure to to see you, thanks for stopping by, much appreciated.

      I hope you're having a great weekend.

    • kidscrafts profile image

      kidscrafts 4 years ago from Ottawa, Canada

      Excellent article about a delicate subject! Very well done and illustrated!

      I always like your medical hubs; always well done!

      I love your sentence..... "Piles are often the butt of many jokes" ... a good one :-)

      Thanks for sharing this useful info!

      Have a great Sunday!

    • mary615 profile image

      Mary Hyatt 4 years ago from Florida

      Just wanted to come back and thank you for letting me know about your first photo. Having been in the medical profession, I just did not recognize what your photo depicted. I understand now. Thanks.

      I know this condition is quite common and I'm sure very painful. You wrote a very good article on the subject.

      Hope you have a wonderful day today.

    • Eiddwen profile image

      Eiddwen 4 years ago from Wales

      Very interesting, well presented and so very useful too tobu.

      Voted up.


    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Imkarn, sorry about the end of my previous comment, just got off night and I'm losing the battle to stay awake, so I'm off. Take care, and best wishes to you.

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Jonnycomelately, you may well be, but I see you are not the new kid in town:). Thank you so much for the visit and wonderful comment, much appreciated.

      Squatting seems to be the way to go, assuming the researchers have got it right.

      Take care and my best to you.


    • jonnycomelately profile image

      Alan 4 years ago from Tasmania

      Excellent attention to detail and a very worthy Hub for helping the community.

      The squat position is certainly better for your health.

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Rajan, thank you for everything. I very much appreciate your support and yes, squatting does looks like to way to the future, well...we'll see.

      Have a great weekend.

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Hi Mary, thank you for the visit and comment... well now; HP didn't like the wonderful medical images of real piles which I had provided. The photo you alluded to, was the closest I got to piles emerging, since I did not wish to use the proverbial bunch of grapes; I thought that the seed pod was a pretty good likeness and that it will suffice, sorry but it's the best I could come up with, I hope I didn't confuse you too much :). My best to you.

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Imkarn, you are guaranteed to get me laughing my socks off. You are pretty special. Good luck with the appointment. My best to you. I'll have to write the other two commenta

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Pamela, a pleasure to see you!...many thanks for taking a look at this.

      Yes, drinking sufficient quantities of water is always a good thing. Take care and enjoy the weekend,

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Hi LaDena, lovely to see you!...Thanks for stopping by and for the insightful comment. You obviously did the right thing by getting to the doctor quickly, it helps if your doctor also happens to be a good sensitive female. Take care, and my best to you.

    • rajan jolly profile image

      Rajan Singh Jolly 4 years ago from From Mumbai, presently in Jalandhar,INDIA.

      Squatting is indeed serious business! Lol Very good information and comprehensive.

      Voted up, useful and interesting. Sharing this too.

    • mary615 profile image

      Mary Hyatt 4 years ago from Florida

      What in the world does your first photo depict?? I have looked and looked and I just don't get it....sorry.

      Interesting and informative. I voted it so.

    • ImKarn23 profile image

      Karen Silverman 4 years ago

      OY! Could we talk! LOL..

      This was definitely taking a 'BACK DOOR' approach to a great hub! (and no - i would NOT sh** you about it)

      i have been there - and am still doing dat...childbirth was a bitch - i mean a hemmorhoid!

      i actually have an appointment with a Dr - a male as there apparently isn't ONE female who does of thing - in the whole backass city!


      great job! (sorry bout all the punnies - i get like that around poopie)

      sharing on..

    • Pamela99 profile image

      Pamela Oglesby 4 years ago from United States

      You really covered this topic very thoroughly. I think drinking plenty of water and eating the way you suggest would help prevent this misery for many people. I did not know squatting was better than sitting either. Voted up and useful.

    • justateacher profile image

      LaDena Campbell 4 years ago from Somewhere Over The Rainbow - Near Oz...

      Great information on an embarrassing issue. Been there, done that and thought the same as your friend, initially. I went to the doctor immediately, though, and she made things better.

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Good morning Faith, I hope all is well with you and the family....thank you for the great comment as always.

      Many of us will experience this very painful condition, we must start talking about it instead of suffering in silence.

      I'm off to tame the jungle outside and enjoy the sunshine while it last, so have a great weekend and my very best to you.

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Vellur, always a pleasure...thank you for the visit and comment, I hope you're having a great weekend.

      My best to you.

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Hi Martin, thanks for the visit and comment, much appreciated.

      My best to you.

    • Mhatter99 profile image

      Martin Kloess 4 years ago from San Francisco

      Interesting information. Thank you for your effort.

    • Faith Reaper profile image

      Faith Reaper 4 years ago from southern USA

      Very good hub here, full of useful information, and I hope I never have to experience such! You are a good friend.

      Voted up ++

      Blessings, Faith Reaper

    • Vellur profile image

      Nithya Venkat 4 years ago from Dubai

      Piles can be real painful as I gather from your article. Very well explained, useful and informative. Thank you for sharing this, voted up.

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Hi Rose, nice to see you!...Thank you for reading this...I was also surprise about the toilet position, but squatting is certainly a more natural way to do the business :). Even the little toddlers squats.

      We sit because it looks more dignified, its probably time to rethink.

      My best to you, have a lovely weekend.

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Hello Kashmir, thank you for stopping is a very delicate subject indeed, but we must begin to talk about it and not suffer in silence.

      It's good to see you, have a good weekend and my best to you.

    • tobusiness profile image

      Jo Alexis-Hagues 4 years ago from Bedfordshire, U.K

      Hi Frank, you can still read while you're on the throne, just squat not sit :).

      You're right...tooo much information. Thank you for taking a look, always appreciated.

      My best to you.

    • Frank Atanacio profile image

      Frank Atanacio 4 years ago from Shelton

      well in part good news for your friend.. butt.. bad news for the backside.. a very good hub.. hmm maybe im gonna squat instead of sit.. but I enjoy reading on that old ceramic throne.. LOL I know too much information.. thanks for this wonderful useful no butt hub..:)

    • kashmir56 profile image

      Thomas Silvia 4 years ago from Massachusetts

      Hi my friend well done at helping your friend and writing this article, you gave her and use good sound advice and information on a very delicate subject .

      Vote up and more !!!

    • rose-the planner profile image

      rose-the planner 4 years ago from Toronto, Ontario-Canada

      Wow......this was very informative and you handled a delicate subject for many, so well. It's interesting that squatting as opposed to sitting is preferential in avoiding long term problems. I know this practice is common in many countries, so I guess they have it right. Another, excellent and insightful article! Thank you for sharing. (Voted Up )