Hemorrhoids and pregnancy: All the questions answered

Hemorrhoids, in essence expanded veins found either on the interior or exterior of the lower rectum, are perhaps a more commonplace condition than many of us would like to believe, with some recent evidence showing that the odds of experiencing this disease at one time in our lives may be as close to the flip of a coin.^[1]

If straining during everyday bowel movements can be one of the main reasons for hemorrhoids developing, then perhaps it should come as little surprise that the incredible physical demands of pregnancy and childbirth often give rise to hemorrhoids. In fact, pregnancy creates such great intra-abdominal pressure that hemorrhoids are estimated to occur in up to 35% of women.^[2]

In 2005, a study was carried out in Serbia and Montenegro due to concerns over complications from untreated hemorrhoids which discovered that, during the women’s second or third pregnancy, the number suffering from hemorrhoids rose to a staggering 85%.^[3]

In this article, we explain the main causes and symptoms of hemorrhoids during pregnancy, and how to treat and prevent them.

What causes hemorrhoids during pregnancy?

As with hemorrhoids which occur outside of pregnancy, symptoms may vary – largely dependent on which of the 2 types (internal or external) has formed. The most noticeable, uncomfortable, and painful symptoms of hemorrhoids during pregnancy are, however, usually experienced with external hemorrhoids and include:

• Itching, aching, and discomfort
• Inflammation or swelling
• A burning sensation around the anus
• Dyschezia (difficult bowel movements)
• Bleeding (of a bright red color)

Symptoms during pregnancy are most expected to occur, or first be noticed, during the third trimester. They can also develop directly after childbirth and are especially associated with vaginal deliveries.^[4] In the majority of these instances, the hemorrhoids may clear up within a matter of weeks.

Although it is not yet completely understood exactly what makes hemorrhoids form during pregnancy, there are many studies which point toward several potential causes.

Other than simply the added abdominal pressure exerted on the nearby rectal veins by the extending uterus, the likelihood of hemorrhoids occurring can increase due to a combination of factors which include:

• Hormonal changes and elevated blood pressure combined – which can lead to the widening of the veins themselves
• Constipation – which is known to aggravate hemorrhoids and can result in flare-ups.⁴

As more studies emerge, the numerous cases of constipation such as dyschezia are so high – reportedly affecting up to nearly half of pregnant women^[5] – that this condition, together with a late or traumatic delivery, are being classed as 2 major independent risk factors strongly associated with hemorrhoids.^[6]

It has also been noted that the risks of hemorrhoids occurring “directly correlates with the number of pregnancies and deliveries”,⁴ with the same study stating that the process of childbirth itself raises the risk of having hemorrhoids by nearly 8 times.

How to treat hemorrhoids during pregnancy

There are a variety of recommended methods for the treatment of hemorrhoids which can alleviate discomfort, reduce symptoms, and shorten the healing process. These range from simple lifestyle changes and things you can do at home, to reputable and trusted creams and oral medications that your doctor can recommend, based on the details of your individual case. However, in many instances and as a precautionary measure, it is preferable to avoid the use of medications during pregnancy, unless prescribed by your doctor.

As such, home remedies are a good option associated with specific treatment for pregnant women suffering from hemorrhoids. Some common tips that can help alleviate hemorrhoid pain during pregnancy include:

• Soaking in a sitz bath. A warm bath that only covers hips and buttocks^[7]
• Drinking lots of fluids which can fight constipation and therefore help reduce the discomfort of hemorrhoids ⁹
• Avoiding patting the area, instead gently rub it and opt for moist toilet paper or wet wipes^[8]
• Using soft pads with witch hazel applied to the anal area^[9]

Ask your doctor for specific treatments that are considered safe to use during pregnancy^[10]

Check out this article for more information on the  4 hemorrhoid signs that tell you it’s time to go to the doctor.

How to prevent hemorrhoids during pregnancy with lifestyle changes

As we have seen, hemorrhoids during pregnancy are very common especially as the pregnancy comes to term. There are, however, some tips and lifestyle changes that are recommended to put into action from the early stages of pregnancy in order to prevent suffering from hemorrhoids.

• Exercising and keeping active, and avoiding sitting for long periods of time which can increase the pressure on the veins in the anus and worsen hemorrhoidal discomfort¹⁰
• Eating a diet with enough fiber, either through fruits, vegetables, whole grains and oats, or with fiber supplements. Check what diet to eat when you have hemorrhoids  ^[11]
• Performing Kegel exercises lying on the left-hand sid Since these specifically target the muscles in the pelvic area, Kegel exercises can help in the prevention of hemorrhoids.^[12] To perform Kegel exercises, make sure that your bladder is completely empty and tighten your pelvic floor muscles for 5 seconds. Relax the muscles for another 5 seconds and repeat the cycle 5 to 10 times^[13]

Modifying dietary habits, to include more fruits and vegetables, together with keeping active, can significantly reduce the risk of hemorrhoids during and after pregnancy.^[14] You can read more about other tips and advice on treatment and prevention of hemorrhoids.

How to heal hemorrhoids after pregnancy

40% Of pregnant women and women in postpartum, will suffer from hemorrhoids or anal fissures.16 For women that have already given birth, hemorrhoids typically happen within the first 1 to 2 days afterwards, due to:

• Perianal diseases during childbirth
• Instrumental delivery
• Straining duration of more than 20 mins
• More than 3,800 g (8.3 lbs.) of weight of the newborn⁴

By continuing with the recommended dietary and lifestyle changes mentioned above, it should help with the healing of hemorrhoids after pregnancy, however, it is always recommended to consult your doctor as they might prescribe adequate pain relief, oral, and topical flavonoid preparations according to each specific case.^[15]

Find out more information about  how long hemorrhoids last, and make sure to follow up with your doctor to avoid developing chronic hemorrhoidal disease