Hemorrhoids During Pregnancy

Hemorrhoids affect more than half of pregnant women, typically toward the end of the second trimester and into the third trimester.   Though not harmful to mom or baby, they can be very uncomfortable.

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Hemorrhoids are a normal part of the anal canal. Most women who experience hemorrhoid issues do so for the first time during a pregnancy. The discomfort of engorged pregnancy hemorrhoids usually resolves during the weeks and months after the pregnancy has completed. However for some moms the symptoms of hemorrhoid engorgement can become chronic or recurrent.

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Symptoms of Pregnancy Hemorrhoids

Symptoms include heaviness, discomfort, swelling, anal itching, painless bleeding with bowel movements, tissue prolapse.  Anal fissures are another common problem for new or expectant moms.  If the bowel movement is sharply painful (a tearing sensation) please see our advice on managing an Anal Fissure.

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Causes of Hemorrhoids during Pregnancy

The hemorrhoids of pregnancy arise through several causes. Due to pressure from the enlarging heavy uterus and increased blood flow in the pelvic area, hemorrhoid veins in the anorectal wall may swell and bulge. Pregnancy hormones may cause the walls of hemorrhoid veins to relax, contributing to the ease of swelling. Constipation during pregnancy leads to increased straining during bowel movements. The time of vaginal delivery with the increased pelvic pressure exerted by mom and child is particularly hazardous to hemorrhoid vessels. Post-partum constipation and hard stools are risks of breast-feeding moms (another common time for painful anal fissures).

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Seeking Relief

During the later stages of pregnancy, efforts to relieve the pressure on the pelvic floor may aid in managing hemorrhoid symptoms. Lying, or sleeping on your side (perhaps left side more so than right) may improve blood flow through the anorectal area.  Avoid  pressure on the pelvic floor from prolonged standing or sitting. Changing your body position will aid in pelvic floor blood flow.

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Avoid constipation. Drink water. Eat fruits and vegetables.

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   - If this is not enough speak with your obstetrician or family doctor or midwife about adding a stool softener (colace or generic) to your diet. 

   - The gentle laxative Miralax (and generic) has been used safely during pregnancy, but should be approved by your doctor. 

   - When using supplemental fiber (e.g. Metamucil) start with a low dose and ramp up slowly over several days to the recommended dose, or until you are experiencing the regularity you seek. 

   - Daily exercise, such as a walk, can also aid in digestion and promote regularity.

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Some options for directly treating the inflamed tissues include:

• Soaking the affected area in warm water for 10 to 20 minutes several times a day.

• Check with your doctor about which over-the-counter hemorrhoid creams and ointments are safe to use. Steroid creams and topical Lidocaine preparations can be safe when used in moderation, but should be approved by your doctor before use. Calmoseptine is a product we have recommended with success. Thinly applied onto the hemorrhoids and anal skin, it creates a moisture barrier, anti-itch and soothing menthol experience.

• Use of unscented soft toilet paper, and/or moist towelettes.

• Keep the area dry and clean to avoid irritation.

• Apply cold compresses for 10 minutes at a time up to four times a day.​ This may be especially helpful following a bowel movement when the hemorrhoid tissues may be  re-inflamed.

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Surgery

Most hemorrhoids of pregnancy are successfully managed without need for surgical intervention. Situations that are worsening in the post-partum time may benefit from office evaluation.  We often see new moms who actually have an ANAL FISSURE, (intense sharp pain with bowel movements, or sharp throbbing pain beginning shortly after leaving the bathroom) which benefits from a different and specific therapy plan.

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