Hemorrhoids are a very common malady which can be traced back to ancient times. Upon contemplation, one has probably not asked the following questions: are Hemorrhoids Holy? are hemorrhoids a divine manifestation than can help us on our lifelong struggle to connect us with G-d? Can this disease remind of our connection to G-d and the ultimate coming of the Moshiach? After reading this article one may conclude with the answer — maybe.
Currently, half of the population will suffer from hemorrhoids at one point in their lifetime. Thus, it would be interesting to note how far back this diagnosis is documented in the Torah literature. In this way we may better understand the holy origins of this surgical disease.
The contemporary Hebrew word for hemorrhoids is “T’chorim“(טחורים) . There is some debate if Tchorim are hemorrhoids or bubonic plague. However, I prefer to explore the assumption that today we are dealing with the same ancient illness which is referred to as T`Chorim or hemorrhoids.
The first mention of hemorrhoids is found in the Chumash, Parshas Ki Savo, where there is a list of rewards and severe punishments based on the Jewish people’s behavior:
והיה אם שמוע תשמע בקול ה’ אלקיך לשמר לעשות את כל מצותיו אשר אנכי מצוך היום, ונתנך ה’ אלקיך עליון על כל גויי הארץ: ובאו עלך כל הברכות האלה והשיגך כי תשמע בקול ה’ אלקיך: ברוך אתה בעיר וברוך אתה בשדה:…והיה אם לא תשמע בקול ה’ אלקיך לשמר לעשות את כל מצותיו וחקתיו אשר אנכי מצוך היום, ובאו עליך כל הקללות האלה והשיגוך:… יַכְּכָה ה` בִּשְׁחִין מִצְרַיִם, ובעפלים (וּבַטְּחֹרִים קרי), וּבַגָּרָב , וּבֶחָרֶס אֲשֶׁר לֹא תוּכַל לְהֵרָפֵא:
It shall be that if you listen to the voice of Hashem, your God, to keep, to perform all of His commandments that I command you this day, then Hashem, your G-d, will make you supreme over all the nations of the earth. All these blessings will come upon you and take effect, if you listen to the voice of Hashem your G-d: Blessed shall you be in the city and blessed shall you be in the field… But it will be that if you do not listen to the voice of Hashem, your G-d, to observe faithfully all His commandments and laws which I command you this day, all these curses shall come upon you and take effect:… Hashem will strike you with the boils of Egypt, with hemorrhoids, with wet boils and dry boils, of which you cannot be cured. (Devarim 28:1-27)
In the above verses the Jewish People are being admonished by G-d that if they stray from observing the commandments, they will be inflicted with punishments. It seems that one of the most severe punishments G-d will inflict is called: hemorrhoids. The actual word for hemorrhoids is a ” Ksiv/Kri כתיב/קרי ” , written one way and read another. The written word used is “Bapolimבעפלים ” but the read version is “Batchorim בטחורים “. Why not write hemorrhoids as Tchorim טחורים? What are Apolim עפולים? One answer is found in the Talmud. The Torah, to maintain purity, at times will chose to write a cleaner word such as “Apolim”:
תלמוד בבלי, מסכת מגילה דף כה עמוד ב
תנו רבנן: כל המקראות הכתובין בתורה לגנאי, קוראין אותן לשבח. כגון: “ישגלנה, ישכבנה”; בעפולים, בטחורים“…
The Rabbis taught in a Baraisa: All verses that are written in the Torah indelicately, when recited for the congregation are read delicately. For example: for yishgalena we read yishkavena; for bapolim we read batchorim… (Talmud Bavli Megillah 28b)
Rashi explains that both words refer to the anus, but בטחורים is less explicit. Therefore, when the Torah writes the word “Apolim”, we know that it means “Tchorim” (hemorrhoids).
In the English language we have a similar custom. Instead of using the vulgar term “ass” it is more socially acceptable to prefer to use the word “buttocks”. Interestingly the same page in Talmud Megillah shares with us a Hebrew word used for referring to the “buttocks”, as “shes”:
תלמוד בבלי, מסכת מגילה דף כה עמוד ב
אמר רב הונא בר משמיה דרב אחא בריה דרב איקא: שרי ליה לבר ישראל למימר ליהץ לעובד כוכבים שקליה לעבודת כוכבים ואנחיה בשין תיו
Rav Huna bar Manoach said in the name of Rav Acha son of Rav Ika: It is permitted for a Jew to tell an idolater to “take this idol and place it in his shin tav.” (Talmud Bavli Megillah 28b)
כן ינהג מלך אשור את שבי מצרים ואת גלות כוש נערים וזקנים ערום ויחף, וחשופי
שת ערות מצרים.
So will the king of Assyria lead away the captivity of Egypt and the exile of Cush – young and old – unclothed and barefoot, with exposed buttocks, the nakedness of Egypt. (Yishaya 20:4)
Thus we are given a rabbinically permissible way on how to curse an idolater. This sounds very similar to a commonly used curse in American culture popularized in a country music song. “Take This Job and Shove It” is a 1977 country music song written by David Coe and popularized by Johnny Paycheck. When it came out it was number one on the country music charts for two weeks. The song also inspired a 1981 film of the same name.
The next mention of hemorrhoids can be found in the Prophets נביאים, in the book of Shmuel. The Holy Ark (Aron Hakodesh) was taken out from the Mishkan in Shiloh and carried to battle against the Plishtim near Even Haezer. The Jews lost the battle and the Aron Hakodesh was captured by the Plishtim. This Aron belonged in the Kodesh Kodashim of the Mishkan, not the battlefield. There was arguably another Aron made of wood (no gold inlay/overlay) made by Moshe Rabeinu for the broken luchos (tablets with The 10 Statements). Some argue that this wooden “Aron Lamilchama” was designated for the battlefield. Nonetheless, the Plishtim were punished by G-d for taking the Aron Hakodesh with an infliction of hemorrhoids:
שמואל א ה:א-י”ב
וּפְלִשְׁתִּים לָקְחוּ אֵת אֲרוֹן הָאֱלֹקים וַיְבִאֻהוּ מֵאֶבֶן הָעֵזֶר אַשְׁדּוֹדָה: ויִּקְחוּ פְלִשְׁתִּים אֶת אֲרוֹן הָאֱלֹקים וַיָּבִאוּ אֹתוֹ בֵּית דָּגוֹן וַיַּצִּיגוּ אֹתוֹ אֵצֶל דָּגוֹן: וַיַּשְׁכִּמוּ אַשְׁדּוֹדִים מִמָּחֳרָת וְהִנֵּה דָגוֹן נֹפֵל לְפָנָיו אַרְצָה לִפְנֵי אֲרוֹן ה’ וַיִּקְחוּ אֶת דָּגוֹן וַיָּשִׁבוּ אֹתוֹ לִמְקוֹמוֹ: וַיַּשְׁכִּמוּ בַבֹּקֶר מִמָּחֳרָת וְהִנֵּה דָגוֹן נֹפֵל לְפָנָיו אַרְצָה לִפְנֵי אֲרוֹן ה’ וְרֹאשׁ דָּגוֹן וּשְׁתֵּי כַּפּוֹת יָדָיו כְּרֻתוֹת אֶל הַמִּפְתָּן רַק דָּגוֹן נִשְׁאַר עָלָיו: עַל כֵּן לֹא יִדְרְכוּ כֹהֲנֵי דָגוֹן וְכָל הַבָּאִים בֵּית דָּגוֹן עַל מִפְתַּן דָּגוֹן בְּאַשְׁדּוֹד עַד הַיּוֹם הַזֶּה: וַתִּכְבַּד יַד הֹ` אֶל הָאַשְׁדּוֹדִים וַיְשִׁמֵּם וַיַּךְ אֹתָם בעפלים (קרי בַּטְּחֹרִים( אֶת אַשְׁדּוֹד וְאֶת גְּבוּלֶיהָ: וַיִּרְאוּ אַנְשֵׁי אַשְׁדּוֹד כִּי כֵן וְאָמְרוּ לֹא יֵשֵׁב אֲרוֹן אֱלֹקי יִשְׂרָאֵל עִמָּנוּ כִּי קָשְׁתָה יָדוֹ עָלֵינוּ וְעַל דָּגוֹן אֱלֹקינוּ: וַיִּשְׁלְחוּ וַיַּאַסְפוּ אֶת כָּל סַרְנֵי פְלִשְׁתִּים אֲלֵיהֶם וַיֹּאמְרוּ מַה נַּעֲשֶֹה לַאֲרוֹן אֱלֹקי יִשְׂרָאֵל וַיֹּאמְרוּ גַּת יִסֹּב אֲרוֹן אֱלֹקי יִשְׂרָאֵל וַיַּסֵּבּוּ אֶת אֲרוֹן אֱלֹקי יִשְׂרָאֵל: וַיְהִי אַחֲרֵי הֵסַבּוּ אֹתוֹ וַתְּהִי יַד הֹ` בָּעִיר מְהוּמָה גְּדוֹלָה מְאֹד וַיַּךְ אֶת אַנְשֵׁי הָעִיר מִקָּטֹן וְעַד גָּדוֹל וַיִּשָּׂתְרוּ לָהֶם עפלים (קרי טְחֹרִים): וַיְשַׁלְּחוּ אֶת אֲרוֹן הָאֱלֹקים עֶקְרוֹן וַיְהִי כְּבוֹא אֲרוֹן הָאֱלֹקים עֶקְרוֹן וַיִּזְעֲקוּ הָעֶקְרֹנִים לֵאמֹר הֵסַבּוּ אֵלַי אֶת אֲרוֹן אֱלֹהקי יִשְׂרָאֵל לַהֲמִיתֵנִי וְאֶת עַמִּי: וַיַּאַסְפוּ אֶת כָּל סַרְנֵי פְלִשְׁתִּים וַיֹּאמְרוּ שַׁלְּחוּ אֶת אֲרוֹן אֱלֹקי יִשְׂרָאֵל וְיָשֹׁב לִמְקוֹמוֹ וְלֹא יָמִית אֹתִי וְאֶת עַמִּי כִּי הָיְתָה מְהוּמַת מָוֶת בְּכָל הָעִיר כָּבְדָה מְאֹד יַד הָאֱלֹקים שָׁם: וְהָאֲנָשִׁים אֲשֶׁר לֹא מֵתוּ הֻכּוּ בעפלים (קרי בַּטְּחֹרִים) וַתַּעַל שַׁוְעַת הָעִיר הַשָּׁמָיִם.
And the Plishtim took the Aron of Hashem and they brought it from Even Hazer to Ashdod. And the Plishtim took the Ark of God and brought it to the house of Dagon, and set it up beside Dagon. And the people of Ashdod arose early in the morning and behold, Dagon was falling face downward to the ground before the Ark of Hashem and they took Dagon and returned it to his place. And they arose early the next morning, and behold, Dagon fell face down on the ground, before the Ark of the Hashem, and Dagon’s head and the two palms of his hands were cut off, and lying) on the threshold; only Dagon’s body remained intact. Therefore, the priests of Dagon and all those who come to the house of Dagon, do not tread upon the threshold of Dagon in Ashdod until this day.
The hand of Hashem then became heavy upon the Ashdodites, and He devastated them; He struck them with hemorrhoids, Ashdod and its borders.
And the people of Ashdod saw that it was so, and they said, “Let not the Ark of the G-d of Israel dwell with us, for His hand is severe upon us and upon Dagon, our god. And they sent and gathered all the lords of the Plishtim unto them, and they said, “What shall we do to the Ark of the G-d of Israel? “And they said, “Let the Ark of the G-d of Israel be brought around to Gat,” and (thereupon), they transferred the Ark of the G-d of Israel.
And it was, after they had brought it around, that the hand of Hashem was upon the city (with) a great panic, and He smote the people of the city, both young and old, and hemorrhoids broke out in their hidden parts. And they sent away the Ark of G-d to Ekron, and it was that when the Ark of G-d came to Ekron, that the Ekronites cried out, saying, “They have brought around the Ark of the G-d of Israel to me to kill me and my people.
And they sent and gathered all the lords of the Plishtim, and they said, “Send away the Ark of the G-d of Israel, and let it return to its place, so that it will not kill me and my people,” for there was a panic of death in the entire city; the hand of G-d was very heavy there a panic of death. And the people who did not die, were smitten with hemorrhoids, and the cry of the city ascended to heaven. (Shmuel 1 5:1-12)
The Aron Hakodesh was in Plishti custody for seven months. They then wanted to get rid of the Aron and return it to the Jews because of the hemorrhoid affliction. Their priests told them to return the Aron with the proper gifts in order to be healed from their hemorrhoids.
שמואל א ו: ד-ה
ויאמרו מה האשם אשר נשיב לו ויאמרו מספר סרני פלשתים חמשה עפלי (טחרי קרי) זהב וחמשה עכברי זהב כי מגפה אחת לכלם ולסרניכם: ועשיתם צלמי עפליכם (טחרכם קרי) וצלמי עכבריכם המשחיתים את הארץ ונתתם לאלקי ישראל כבוד אולי יקל את ידו מעליכם ומעל אלקיכם ומעל ארצכם:
So they said, “What is the guilt-offering that we should send back to Him?” They answered, “According to the number of Plishti governors — five golden images of hemorrhoids (Afley/Tchori) and five golden mice; for the same plague is upon all of you and upon your governors. Make your images of hemorrhoids (Afleichem/Tchoreichem) and your images of mice which are demolishing the country, and give them as homage to the G-d of Israel; perhaps He will alleviate His hand from upon you and your gods and your land. (Shmuel 1, 6:4-5)
The Radak explains that a specific affliction of hemorrhoids was meted out on the Plishtim. When the Plishtim would relieve themselves mice would bite the bleeding hemorrhroids. Therefore, the Plishtim sent golden mice as presents to G-d, since they recognized that these mice were sent by G-d and not by chance. This was prophesized by the Spies in the time of Moshe, who criticized the land of Israel as “a land that devours its inhabitants ארץ אכלת יושביה” (Bamidbar 13:32). Parenthetically, by the incident of the spies it states that the “Nefilim נפלים” were in the land. The work Nefilim is very similar to the word for hemorrhoids “Afeylim. עפלים ” Maybe there is another connection here between these two stories?
In the aftermath of the Spies bad mouthing the Land of Israel and discouraging Aliyah, the Jewish people were told they would die in the desert and not merit moving to Israel. At this point a group of Jewish people attempted to go up to (ויעפלו) the Land of Israel, without permission, and they were subsequently all killed for this defiance of G-d:
במדבר יד: מד-מה
ויעפלו לעלות אל ראש ההר, וארון ברית ה’ ומשה לא משו מקרב המחנה: וירד העמלקי והכנעני הישב בהר ההוא, ויכום ויכתום עד החרמה.
But they defiantly ascended to the mountaintop, while the Aron of Hashem’s covenant and Moshe did not move from the midst of the camp. The Amaleki and the Canaani who dwelled on that mountain descended; they struck them and pounded them until Chorma. (Bamidbar 14: 44-45)
Rashi explains the word עפל as voracity, intransigence, and ferocity, all words intimating harshness. Whereas the Midrash Tanchuma translates the word as אופל with an ”א ” being related to darkness. Maybe a reference to the place where the “sun don’t shine.”
The Abarbanel further illustrates that the mice would pull on the rectums of the Plishtim and prolapse their intestines (Meam Loez). Grade 4 hemorrhoids are by definition internal hemorrhoids that are prolapsed externally and are thus very painful.
The Plishtim, an ancient and extinct nation, returned the Aron Hakodesh with presents of five golden hemorrhoids. (This ancient people should not to be confused with the current Palestinians; interestingly, the word Palestinian פלשתי can be traced to the root word פלש which means “to divide,” or “invader”). These “gifts” were accepted by the Jewish people as Holy and were later placed in the Holy of Holies of the Beis Hamikdash. This box of golden mice and hemorrhoids was given a place of honor next to the Aron Hakodesh and even hidden away with it, prior to the destruction of the Temple (Yoma 52b). The Aruch Laner (Minchas Ani, Parshas Korach) suggests that this was meant to implicitly refute the argument that the non-Jews won’t respect us if we study Torah rather than the sciences. Here we see, to the contrary, that the Plishtim respected the Torah so much as to send along a gift when they returned it! This serves as a lesson for all time to all of us to be sincere to the Jewish religion, and disregard what that non-Jews may think of our commitment to the Torah.
Another point, is that this was the first time in history that an entire non-Jewish people recognized G-d’s power and tried to appease Him. This deserves to be highlighted, as indeed the verse does, listing each of the five major Plishti cities and its “golden hemorrhoid” separately and in a festive tone (Daas Sofrim 6:17). These gifts, therefore, deserved to be placed in the Kodesh Hakodashim; since this was the first step in the long process towards the time in the future, when all of the peoples of the world will achieve the realization, with the coming of Moshiach, that Hashem is the one and only true G-d.
The Talmud in Tractate Nedarim gives an answer to a common question. Why do people now a days get hemorrhoids? The answer given by Rav Shmuel is that hemorrhoids are caused by anger.
Rabbi Shmuel bar Nachmeini taught: Whoever gets angry becomes controlled by all forms of Gehinnom. Moreover, he becomes prone to hemorrhoids. Rabbah bar Rav Huna taught: Whoever gets angry indicates that the Shechina (Divine presence) is unimportant to him. Rabbi Yirmiya of Difti says: He forgets his Torah learning and becomes foolish. Rav Nachman bar Yitzchak says: He demonstrates that his sins are more numerous than his merits. (Talmud Bavli Nedarim 22a)
Talmud Kesubos states the currently accepted medical etiology of hemorrhoids which comes from prolonged sitting:
Sitting too long causes hemorrhoids. (Talmud Bavli Kesubos 111a)
Another explanation for hemorrhoids is found in Talmud Berachos:
Has it not been taught? Ten things bring on hemorrhoids:
- Eating the leaves of reeds
- Eating the leaves of vines
- Eating the sprouts of vines
- Eating the rough parts of the flesh of an animal
- Eating the backbone of a fish
- Eating salted fish not sufficiently cooked
- Drinking wine lees
- Wiping oneself with lime
- Wiping with potters’ clay
- Wiping with pebbles which have been used by another.
- Some add, to strain oneself unduly in a privy! – There is no contradiction: one statement refers to one who stays long and strains himself, the other to one who stays long without straining himself. (Talmud Bavli 55a)
The above is similarly quoted in Talmud Shabbos:
Yannai said: If there is a fixed place for the privy, [one may carry in] a handful [of stones]; if not, [only] the size of the leg of a small spice mortar [is permitted]. R. Sheshes said: If there is evidence upon it, it is permitted.
An objection is raised: Ten things lead to hemorrhoids in a man, and these are they: [i] eating the leaves of reeds; [ii] the leaves of vines; [iii] sprouts of grapevine;[iv] the rough flesh of an animal without salt; [v] the spine of a fish; [vi] a salted fish insufficiently cooked; [vii] drinking the lees of wine; [viii] wiping oneself with lime, [ix] with clay. [x] [and] with a chip which one’s neighbor has [already] used thus. And some say, Suspending oneself in a privy too. – There is no difficulty; the one refers to a damp [stone]; the other to a dry one.
Alternatively, here the reference is to the same side [of the stone]; there, to the other side. Another alternative: the one refers to his own; the other, to his neighbor’s.
Abaye asked R. Yoseph: What if rain fell on it and it [the stain] was washed away? If the mark thereof is perceptible, he replied, it is permitted. (Talmud Bavli Shabbos 81a)
We are taught in Gemara Shabbos not to wipe the anal area with sharp clay.
Yohanan said: One must not cleanse oneself with a shard on the Sabbath. What is the reason? Shall we say on account of danger? Then on weekdays too [let it be forbidden]? Again if it is on account of witchcraft: it may not [be done] even on weekdays too? Again, if it is on account of the tearing out of hair, – but surely that is unintentional? (Talmud Bavli Shabbos 81b)
The Gemara in Shabbos gives additional practical advice and also refers to hemorrhoids as the “three teeth”.
Huna said to his son Rabbah: What is the reason that you are not frequently sitting as a disciple before Rav Chisda, whose teachings are sharp? Rabbah replied to him: For what should I go him more often? For whenever I do go to him to study, he sits me down before him and tells me about mundane matters, rather than words of Tora! For instance , he said to me: One who enters a latrine to relieve himself should not sit down forcefully, nor should he strain himself overly to eliminate; for the rectum is supported by 3 teeth, and therefore these practices must be avoided, lest the teeth of the rectum become dislocated and the person come to be endangered. Rav Huna said to his son: He (Rav Chisda) is dealing with issues that impact the very lives of people, and you say that he speaks of mundane matters!? If he discusses matters of such importance certainly you should go to him and study! (Talmud Bavli Shabbos 82a)
Interestingly, the most commonly found anatomic variation is to have three external hemorrhoids. One is located in the left lateral position and the other two in the right anterior and lateral positions. Another possibility is that the Gemara is not referring to the external hemorrhoids but rather to the three external sphincter muscles. Using modern technology, MRI imaging of the anal sphincters, shows a deep external sphincter, a superficial external sphincter and a subcutaneous external sphincter. Dr. Corman’s Textbook of Colorectal Surgery states:
The External Anal Sphincter (EAS) was initially described as encompassing 3 divisions: subcutaneous, superficial and deep…The EAS is, in fact, more likely to be one muscle unit…The Internal Anal Sphincter (IAS) represents the distal condensation of the circular muscle layer of the rectum. (Colon & Rectal Surgery, 5th Edition, Marvin L. Corman, 2005. Pg. 11-13)
The same Gemara continues onto the debate of whether one is allowed to wipe oneself with stones or pottery:
If one had before him a stone and a pottery shard, Rav Huna said: He should wipe himself with the stone, and he should not wipe himself with the shard. But Rav Chisda said: He should wipe himself with the shard, and he should not wipe himself with the stone…when the Baraisa states that a shard is preferable to a stone, it refers to the broken-off rims of utensils, which are smooth and pose no danger in use. Stones, however are still preferable to sharp-edged shards.
If one had before him a stone and grass…one said: he should wipe himself with the stone but not with the grass; while the other ruled: He must cleanse himself with the grass, not with the stone. An objection is raised: If one cleanses himself with inflammable material, his lower teeth [hemorrhoids?] will be torn away? – There is no difficulty: the one refers to wet [grass]; the other to dry [grass]. (Talmud Bavli Shabbos 82a)
Once again it is not clear whether the Gemara is concerned about tearing the external hemorrhoids or the anal sphincter mechanism. The Gemara seems to imply that that hemorrhoids protect or defend the rectum.
Close to the current Israeli city of Beit Shemesh a famous defender of Israel is buried, his name was Shimshon. He is so named because he was to be G-d’s shield for the Jews of his day. Shimshon is called by the name of G-d, as it is stated, for a shemesh and a shield is G-d שמש ומגן (Tehilim 84:12). So what does Beit Shemesh have to do with hemorrhoids?
Currently I live in Ramat Beit Shemesh, very close to the location where the afflicted Plishtim returned the Aron Hakodesh to the Jewish nation with the golden hemorrhoid gifts. When one hikes in any of the surrounding hills there is a plethora of stones and thousands of shards of ancient pottery readily available. Thus, if one needs to relieve oneself in the field there are two easily accessible options to cleanse oneself with ברוך אתה בעיר וברוך אתה”) (“בשדה. Which one do we chose to use? It seems that using stones to wipe is the correct choice.
The Gemara Kesubos gives practical medical advice on how to prevent hemorrhoids:
Dates when eaten in the morning and evening, they are good for a person; when eaten in the afternoon, they are bad for a person; when eaten at noon, there is nothing like them, and they nullify three things:
- Bad thoughts (worry)
- Intestinal sickness and
- Hemorrhoids (Talmud Bavli Kesubos 10b)
A medical treatment for hemorrhoids is described in Gemara Gittin:
For hemorrhoids ( (רושחתא – לרש”י תחתוניות: Bring acacia, aloe, quicksilver, litharge(silver scum), a phyllon (fragrant flower) locket and dove (or chicken) excrement, wrap them in rags of flax cloth during the summer, and in rags of cotton during the winter, and place them [on the hemorrhoids]. (Talmud Bavli Gittin 69b)
We have a mitzvah to visit the sick based upon the verse “You shall love your fellow as yourself” (Vayikra 19:18). However, there is an exception to visiting the sick:
One does not visit a sick person who has contracted bordam (בורדם) and one does not even mention its name. (Talmud Bavli Nedarim 41b)
The Gemara explains that bordam is a disease which causes a person to gush blood. This may be bleeding hemorrhoids. It is a condition the Gemara says not to even mention in polite speech (Ran). Another explanation is that the person suffering this disease is embarrassed to hear someone speak its name (Rosh).
With this background, we can now appreciate some of the practical Jewish Laws relevant to this subject found in the Shulchan Aruch. We can start with the first volume of Jewish Law, which discusses the treatment of hemorrhoids on Shabbos:
Sabbath laws are set aside for any injury caused by metal, a rectal boil, a furuncle or for a patient with a very high temperature with chills. (Orach Chaim 328:7)
Based on this the sefer Nishmat Avraham states:
a sufferer from hemorrhoids may take medication on the Shabbos to prevent constipation, since this is not treatment but prevents further injury to hemorrhoids. If one has painful hemorrhoids one may soak in a basin of warm water heated prior to Shabbos. Suppositories may be inserted (Shaylos v`teshuvos Tzitz Eliezer). A patient with hemorrhoids that bleed after defecation should wash with water rather than use toilet paper.
The Shulchan Aruch also discusses the laws of prayer by one who suffers from hemorrhoids:
If one has feces on the area of his anus he may not recite the Shema according to all opinions, even if the area is covered and even if the feces can only be seen when he sits but not when he stands. (Orach Chaim 76:5)
One who has hemorrhoids and a constant odorous discharge, may not recite the Shema (Mishna Berura 16, Radbaz). This must be discussing a severe case of hemorrhoids which may cause a bad odor, such as grade 4 ischemic hemorrhoids. Instead of prayer, this patient needs an urgent operation (hemorrhoidectomy).
In Halachos of Refuah on Shabbos, (Rabbi Yisroel Pinchos Bodner 2008) states:
It is estimated that about half of the population will suffer from hemorrhoids at some time in their lives. On Shabbos treatment depends on the degree of suffering of the patient. If it is just a mild ailment (מיחוש) where hemorrhoids are uncomfortable but not incapacitating, medication usage is limited. In this case one may not use medicated creams. However, if incapacitated (חולה שאין בו סכנה) to the point that the pain/discomfort incapacitates him, he may use medicated creams or insert suppositories as needed. One should be careful not to smear or rub the cream on. One may sit in a warm bathtub if the water was heated before Shabbos. (Halachos of Refuah on Shabbos. pg. 230-231)
We have seen quoted previously from the Talmud, that it is forbidden to wipe oneself with a pottery shard on the Shabbos (שבת פא:) due to the danger of cutting the “teeth of the rectum”. However, there is an additional reason quoted in the same Gemara that is forbidden to wipe with pottery:
…for this concern applies even during the week as well…rather it is forbidden on account of the possibility that an enemy will find the used shard and use it to harm him through witchcraft (a shard on which one leaves bodily wastes can be used by one versed in witchcraft to harm that person). (Talmud Bavli Shabbos 81b)
Based upon this Gemara the Shulchan Aruch (Orach Chaim 3:11) rules that:
One should not wipe himself with earthenware because of the danger of witchcraft. One should not wipe himself with dry grass, since if one wipes himself with an article which is susceptible to fire his hemorrhoids will drop out. One should not wipe himself with a pebble with which his fellow wiped himself, because this causes a person to have hemorrhoids.
According to the Rama:
Nowadays, when our lavatories are not in the field, it has become the practice to wipe oneself with earthen ware (that is smooth) and it has likewise become the practice to wipe oneself with an article which is susceptible to fire and no harm is incurred (dry grass cuts the flesh). One may follow the maxim, “Go out and see what is the public practice.
The Shulchan Aruch canonizes into Jewish Law that:
…it is forbidden to wipe oneself with a piece of earthenware even on a weekday, because there is a danger that one may cut the teeth of the rectum (hemorrhoids). (Ohr Hachaim 312:4)
Similarly the laws of Shabbos are clarified on whether one is allowed to use a pebble or pottery to wipe:
If one has both a pebble and a smooth earthenware handle (which because it is smooth, it is not dangerous) available on the Shabbos, he should wipe himself with the earthenware handle…and is not muktzeh, whereas the pebble is. If one has both a pebble and grass available, he should wipe himself with the grass if it is moist. However, one should not wipe himself with dry grass, because it is sharp and cuts one’s flesh. (Ohr HaChayim 312:5)
Thus, in the end, the study of hemorrhoids begins in the Chumash continues in the Navi and onto the Talmud and practical Halacha. Through the study of hemorrhoids we have learned about anatomy, medicine and how not to upset G-d. We have learned from the suffering of others who angered G-d in the Land of Israel that this is not wise. However, out of the suffering we have seen that one can connect with G-d and connect with the land of Israel, as the Talmud teaches:
Whomever the Holy One, Blessed is He, desires, He crushes with afflictions, as it is stated (Yishaya 53:10) “And the one whom Hashem desires He crushed with sickness…Rabbi Shimon Bar Yochai said: The Holy One Blessed is He, gave three good gifts to the Jewish people, and he gave them only through suffering. They are: Torah, the land of Israel, and the World to Come. (Berachos 5a)
However, most important, by keeping and studying the halachos relevant to hemorrhoids, we can also get closer to the Shechina of G-d himself, since “The Holy One, Blessed is He, has nothing in His world but for the four amos of Halacha” (Berachos 8a).
Arie E. Pelta MD is a full time practicing surgeon in Israel.
He can be contacted at firstname.lastname@example.org