Hemorrhoids are swollen blood vessels in the rectal area. They typically range in size from as small as a pea to as large as a grape, and they can develop inside the rectum or protrude through the anus.
Hemorrhoids can be itchy and mildly uncomfortable – or downright painful. Sometimes they even cause rectal bleeding, especially when you have a bowel movement.
Pregnancy and vaginal delivery predisposes women to develop hemorrhoids because of hormonal changes and increased intra-abdominal pressure. It has been estimated that 25% to 35% of pregnant women are affected by this condition. In certain populations, up to 85% of pregnancies are affected by hemorrhoids in the third trimester.
Hemorrhoids occur when the external hemorrhoidal veins become varicose (enlarged and swollen), which causes itching, burning, painful swellings at the anus, dyschezia (painful bowel movements), and bleeding. Pain with bowel movements and bleeding are often the first signs of hemorrhoids. It is important to note, however, that hemorrhoids are not the only cause of rectal bleeding, and the physician should properly confirm the diagnosis before initiating any treatment. Hemorrhoids should be treated to prevent more serious complications, including inflammation, thrombosis, and prolapse.
Treatment Hemorrhoids During Pregnancy
Most forms of the condition can be successfully treated by increasing fibre content in the diet, administering stool softeners, increasing liquid intake, anti-hemorrhoidal analgesics, and training in toilet habits. However, most evidence of the efficacy of therapeutic alternatives for hemorrhoids is gained from studies performed in non-pregnant patients.
A recent systematic review of both published and unpublished randomized controlled trials, which included the enrolment of more than 350 patients, showed that laxatives in the form of fibre had a beneficial effect in the treatment of symptomatic hemorrhoids. Decreased straining during bowel movements shrinks internal hemorrhoidal veins, resulting in a reduction of symptoms. Bathing with warm water (40°C to 50°C for 10 min) usually relieves anorectal pain. Suppositories and ointments that contain local anesthetics, mild astringents, or steroids are available.
More aggressive therapies, such as sclerotherapy, cryotherapy, or surgery, are reserved for patients who have persistent symptoms after 1 month of conservative therapy. Some recent studies have shown the effectiveness of botulinum toxin injections as a treatment for chronic anal fissure and hemorrhoids. Because of its mechanism of action, however, botulinum toxin is contraindicated during pregnancy and lactation.
Although most pregnant women experience improvement or complete resolution of their symptoms with the conservative measures mentioned above, some women will need medications. Oral treatment with ruto-sides, hidrosmine, Centella asiatica, disodium flavodate, French maritime pine bark extract, or grape seed extract can decrease capillary fragility and reduce symptoms improving the microcirculation in venous insufficiency. However, evidence of their safety in pregnancy is not yet conclusive.
Topical medications with analgesics and anti-inflammatory effects provide short-term local relief from discomfort, pain, and bleeding. Because of the small doses and limited systemic absorption, they can be used by pregnant women; however, the safety of any of them in pregnancy has not been properly documented.
Most topical preparations for hemorrhoids have been used in Canada for more than 25 years. They often contain anesthetics, corticosteroids, and anti-inflammatory agents in varying proportions. Most of these products help to maintain personal hygiene and alleviate symptoms. However, there are no prospective randomized trials that suggest topical preparations reduce bleeding or prolapse in nonpregnant patients.
At present, there are no reproductive safety data available for any of the compounds commonly used for hemorrhoids. Hemorrhoids in pregnancy should be treated by increasing fibre content in the diet, administering stool softeners, increasing liquid intake, and training in toilet habits. It is expected that these conservative measures can alleviate symptoms in most patients. If required, patients should receive topical treatment. For many women, most symptoms will resolve spontaneously soon after giving birth, and only few cases will require a surgical evaluation during pregnancy or after delivering.
Hemorrhoids During Pregnancy: Causes And Prevention
Unfortunately, hemorrhoids during pregnancy are common. Hemorrhoids are varicose (swollen) veins of the rectum and are usually painful. They most often appear during the third trimester.
What causes hemorrhoids when you are pregnant?
Hemorrhoids are related to constipation. Constipation combined with increased pressure on the rectum and perineum is the primary reason that women experience these. Prolonged standing may also be a factor contributing to hemorrhoids.
What can you do to treat hemorrhoids when you are pregnant?
The good news is that the problem usually improves after the baby is born. In the meantime, there are a number of things you can do to treat hemorrhoids.
The following may help relieve hemorrhoids:
- Place baking soda (wet or dry) on the area to reduce itching
- Take a warm bath with baking soda in the water
- Use witch hazel to reduce swelling or bleeding
- Avoid sitting for long periods
- Use Tucks Medicated Pads
What can you do to prevent hemorrhoids during pregnancy?
The best thing to do to prevent hemorrhoids during pregnancy is to avoid getting constipated. If you are constipated, avoid straining during bowel movements.
Try the following to prevent constipation:
- Eat a high fiber diet
- Drink plenty of fluids
- Drink prune juice
- Do not delay going to the bathroom
- Eat plenty of fruits and vegetables
- Know what foods you need to avoid while pregnant
ALWAYS check with your health care provider before taking any medication for hemorrhoids.
About Pregnancy and Hemorrhoids
Why are hemorrhoids more common during pregnancy?
Pregnancy makes you more prone to hemorrhoids (as well as to varicose veins in the legs and sometimes even in the vulva) for several reasons. Your growing uterus puts pressure on the pelvic veins and the inferior vena cava, a large vein on the right side of the body that receives blood from the lower limbs. This can slow the return of blood from the lower half of your body, which increases the pressure on the veins below your uterus and causes them to dilate or swell.
Constipation (another common problem during pregnancy) can also cause or aggravate hemorrhoids because you tend to strain when having a hard bowel movement, and straining leads to hemorrhoids.
In addition, an increase in the hormone progesterone during pregnancy relaxes the walls of your veins, allowing them to swell more easily. Progesterone also contributes to constipation by slowing down your intestinal tract.
Hemorrhoids are particularly common in the third trimester. Some women get them for the first time while they’re pregnant. And if you’ve had them before pregnancy, you’re more likely to have them again now. They may also develop while you’re pushing during the second stage of labor.
It’s not uncommon to develop a “thrombosed” hemorrhoid, which is a blood clot that forms inside the hemorrhoid, leading to an especially large and swollen lump. This type of hemorrhoid can be quite painful and makes it hard to walk, sit, or have a bowel movement.
Discomfort or bleeding from hemorrhoids is also a common complaint during the early postpartum period. In most cases, however, hemorrhoids that developed during pregnancy go away soon after you give birth, especially if you’re careful to avoid constipation.
How can I avoid getting hemorrhoids?
Here are some ways to prevent (and treat) hemorrhoids:
- First and foremost, take steps to avoid becoming constipated: Eat a high-fiber diet (plenty of whole grains, beans, fruits, and vegetables), drink plenty of water (about 10 8-ounce cups a day), and get regular exercise (as long as your provider says it’s okay). If you’re already constipated, ask your healthcare provider about taking a fiber supplement or using a stool softener.
- Don’t wait when you feel the urge to have a bowel movement, and try not to strain.
- Don’t sit on the toilet longer than necessary because this puts pressure on your rectal area.
- Do Kegel exercises daily. Kegels increase circulation in the rectal area and strengthen the muscles around the anus, reducing the chance of hemorrhoids. They also strengthen and tone the muscles around the vagina and urethra, which can help your body recover after you give birth.
- Don’t sit or stand for long stretches of time. If your job involves sitting at a desk, get up and move around for a few minutes every hour or so. At home, lie on your left side when sleeping, reading, or watching TV to take the pressure off your rectal veins and increase blood return from the lower half of your body.
What else can I do for hemorrhoid relief?
- Cold therapy may reduce swelling and discomfort. Apply an ice pack (with a soft covering) to the affected area several times a day. Some women also find cold compresses saturated with witch hazel soothing.
- Soak your bottom in a tub of warm water for 10 to 15 minutes a few times each day. If you don’t have a bathtub, you can buy a sitz bath at the drugstore. (This is a small plastic basin that you fill with water and position over your toilet so you can sit down and submerge your rectal area.)
- Try alternating cold and warm treatments.
- Gently but thoroughly clean the affected area after each bowel movement. Use soft, unscented toilet tissue, which is less irritating than other varieties.
- Many women find it more comfortable to use pre-moistened, unscented wipes rather than toilet tissue. You can also buy wipes moistened with witch hazel, specifically for treating hemorrhoids.
- Ask your healthcare provider to recommend a topical anesthetic or medicated suppository that’s safe to use during pregnancy. There are many hemorrhoid relief products on the market, but consult your provider before trying one. And keep in mind that most of these products should be used for no more than a week. (Using a medication for longer than recommended can cause side effects such as skin irritation or thinning.)
When should I call my healthcare provider?
Consult your provider if preventive efforts and home treatments don’t help, or if you have severe pain or rectal bleeding.
In some cases, you may need to see a specialist for treatment to shrink your hemorrhoids. Rarely, minor surgery is necessary.