What Causes Hemorrhoids During Pregnancy And When To Worry?

Hemorrhoids during pregnancy mostly occur in the third trimester and affect around 25% to 35% of pregnant women. Hemorrhoids or piles appear as swollen and twisted veins in the lower parts of the rectum and anus. They are characterized by pain, bleeding, and itching. Hemorrhoids may be internal, forming inside the lower intestine, or external, protruding out of the anus (1) (2) (3).

Hemorrhoids may make pregnancy uncomfortable; however, pregnant mothers need not deal with it for long as they can be prevented and treated effectively.

Read this post to know more about the symptoms, causes, and treatment options for hemorrhoids during pregnancy.

What Causes Hemorrhoids During Pregnancy?

Hemorrhoids commonly occur due to external pressure on veins near the rectal and anal areas. The veins contain valves that keep the blood flow going towards the heart. Pressure on the veins can cause blood accumulation, resulting in swelling of the veins (4).

There are several other factors that contribute to the frequency of this condition during pregnancy.

• Hormonal changes in pregnancy are prone to cause sluggish intestinal movements, thus affecting motility. Therefore, constipation is commonly seen in pregnant women. Excessive pressure to get the bowel movement going could lead to hemorrhoids. Hemorrhoids due to constipation may occur as early as the late first trimester of pregnancy.
• As the baby grows inside the womb, the baby’s weight could add extra pressure on the blood vessels in the pelvic area. In these cases, hemorrhoids usually occur during the third trimester when the baby has adequately grown in size, and these hemorrhoids often resolve after childbirth. Some women with no prior complaints may even experience hemorrhoids during labor, which often reduces after childbirth.
• Pregnant women naturally go through hormonal changes. This could slow down the blood flow back to the heart, leading to swelling of smaller veins.
  Standing or sitting for a stretch of time may add to the occurrence of hemorrhoids during pregnancy.
• When expecting mothers gain weight before pregnancy or are overweight before they become pregnant, it could increase the risk of developing hemorrhoids.

What Are The Symptoms Of Hemorrhoids During Pregnancy

External hemorrhoids are characterized by pain and/or itching near the affected area. They sometimes could bleed if wiped or strained. Internal hemorrhoids’ symptoms vary depending on their types.

• First-degree hemorrhoids are marked with bleeding without a prolapse.
• Second-degree hemorrhoids can be seen protruding while defecating or straining.
• Third-degree hemorrhoids are prolapsed hemorrhoids but can be pressed back.
• Fourth-degree hemorrhoids are completely prolapsed hemorrhoids and cannot be put back inside.

In all of the above types of internal hemorrhoids, the passing of blood during defecation is a common symptom (4) (5). Besides these, other common symptoms for both internal and external hemorrhoids include:

• Stool coated with blood
• Blood-stained toilet paper
• A small mass of skin could be seen protruding out of the anus

When Do Hemorrhoids Start During Pregnancy?

Although people can get hemorrhoids anytime during their lifetime, pregnant women are more susceptible to it. They generally occur during the third trimester of pregnancy and could get stretched until after pregnancy due to extra pressure applied during birth (6). In such situations, simple home remedies or suggested treatments can prove effective.

How Are Hemorrhoids During Pregnancy Treated?

There are several types of treatments available depending on the intensity of hemorrhoids and their types. Most hemorrhoids during pregnancy are short-term and can be eased by numerous available home remedies. However, some hemorrhoids could last until after one month of pregnancy and might require a medical approach (3).

Home care for hemorrhoids in pregnancy

One of the most recommended treatments involves a high-fiber diet. This is mostly done to achieve an easy and soft stool to prevent strain or pressure. Drinking sufficient quantities of water to keep the bowel movement going is also highly recommended. Other common home remedies include the following.

• A sitz bath can ease the itching, pain, or irritation and get the blood flow going.

• Ice packs or pads of witch hazel could be used to reduce swelling and also soothe the pain.

• Sitting or standing for long periods of time exerts pressure on the veins. Frequent body movement, such as walking or Kegel exercise, can relieve the pressure.This may also help with constipation (6).

• You may use pregnancy-safe creams or medications for external or internal hemorrhoids as prescribed by your doctor.

• In order to avoid straining during constipation, stool softeners are sometimes prescribed for ease of pressure.

• Change in the sleep position could also help. Sleeping sideways might induce a better blood flow (7).

• You may have natural, fiber-rich, and plant-based laxatives to ease constipation. Psyllium husk is an example of a safe laxative, which is not absorbed in the bloodstream and does not affect the baby. Speak to your doctor to understand which laxatives would be safe for you, depending on your pregnancy trimester.

Surgical treatment

Medical treatments are carried out for internal hemorrhoids, with certain exceptions for external hemorrhoids. Some of the treatments include the following.

• Rubber band ligation: The uncurbed tissue is lifted, and a rubber band is put at the bottom of the tissue via an anoscope. The rubber band blocks the blood flow to the hemorrhoids, and after about five to seven days, the tissue drops along with the band. This treatment consists of several rubber band sessions. The patient may feel faint pain upon completion of the sessions. The doctor may prescribe ibuprofen or acetaminophen.

• Sclerotherapy: A liquid medicine is injected into the hemorrhoidal tissue, causing the blood vessels in it to shrink. Sclerotherapy also involves several sessions for optimum results. This treatment is less complicated and faster than rubber band ligation. It may also be the first choice for patients on certain medications, such as blood thinners.

• Hemorrhoidectomy: It is characterized by excision of the uncurbed tissue. Hemorrhoidectomy may be employed in patients with external hemorrhoids or patients with both external and internal hemorrhoids. In this treatment, the hemorrhoidal tissue is excised surgically, and the post-surgery cut may be closed or kept open.

• Stapled hemorrhoidopexy: In this treatment, the protruding tissue is placed or pushed back into its original place (5). A staple is left to keep the tissue in its correct place. This procedure could be considered in certain cases since it causes less pain than hemorrhoidectomy.

Besides these treatments, doctors may also prescribe topical medications to be administered. These include anti-inflammatory drugs, corticosteroids, and analgesics in different quantities (3).

How To Prevent Hemorrhoids During Pregnancy?

The following practices and measures may help prevent hemorrhoids in most cases (2) (4) (7).

• Include fiber-rich foods to avoid constipation
• Drink sufficient fluids or consider fluids, such as prune juice, which facilitate good bowel movement
• Do not exert excessive strain while passing stool
• Avoid sitting or standing for long stretches to avoid pressure on veins
• Exercise regularly with exercises such as walking and Kegels
• Maintain a healthy weight as per trimester
• Take a warm bath to promote good blood flow
• Avoid tight clothes around the waist since it may restrict blood flow

When To Call Your Doctor?

Hemorrhoids usually resolve on their own without any complications. However, see the doctor if you have bleeding, pain, or prolapse, that is, the hemorrhoid tissue protrudes from the anus. Timely treatment could help prevent the hemorrhoids from progressing to advanced stages, letting you avoid any complications (4).

References

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