Hemorrhoids during pregnancy

What are hemorrhoids?

Hemorrhoids are swollen blood vessels in and around 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 out through the anus. They're caused by an increase in pressure on the anus and the rectum, the last several inches of your large intestine.

While it's possible to have hemorrhoids without experiencing any symptoms, they can often be itchy, sore, and mildly uncomfortable – or downright painful, especially when you're straining during a bowel movement. In some cases, hemorrhoids cause rectal bleeding or blood in the stool during pregnancy.

It's not uncommon to develop a "thrombosed" hemorrhoid, which is a blood clot that forms inside the hemorrhoid, leading to a large and swollen lump. This type of hemorrhoid can be quite painful and make it hard to walk, sit, or have a bowel movement.

What causes hemorrhoids during pregnancy?

Your growing uterus, constipation during pregnancy, and an increase in the hormone progesterone all make it more likely you'll develop hemorrhoids during pregnancy (as well as varicose veins in the legs and sometimes even in the vulva). And you're not alone – up to half of pregnant women have hemorrhoids while they're pregnant.

Hemorrhoids are especially common in the third trimester, as your expanding 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. As a result, these veins can slow the return of blood from the lower half of your body, which increases the rectal pressure on the veins below your uterus and makes them dilate or swell.

Constipation can also cause or aggravate hemorrhoids because you tend to strain when having a hard bowel movement, and that pushing force encourages the development and growth of hemorrhoids.

During pregnancy, the hormone progesterone relaxes the walls of your veins, which allows them to swell more easily. Progesterone packs a double punch by also contributing to constipation by slowing down your intestinal tract.

Some women get hemorrhoids for the first time while they're pregnant. And if you've had them before, you're unfortunately more likely to have hemorrhoids during pregnancy too.

You may also develop hemorrhoids during labor while you're pushing. 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 prevent postpartum constipation.

How to prevent hemorrhoids during pregnancy

Here are some ways to prevent hemorrhoids while you're pregnant:

• Reduce constipation by eating a high-fiber diet (that includes plenty of whole grains, legumes, fruits, and vegetables), staying well-hydrated by drinking about ten 8-ounce cups of water a day, and getting regular exercise during pregnancy, as long as your healthcare 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; this puts pressure on your rectal area.
• Do Kegel exercises daily. Kegel exercises 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 for long stretches of time. If you're pregnant at work and sitting at a desk all day, get up and move around for a few minutes every hour or so. At home, lie on your 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.

Remedies and treatments for pregnancy hemorrhoids

There are several remedies you can try to get rid of hemorrhoids during pregnancy:

• Use cold. 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.
• Use heat. 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 tub, you can buy a sitz bath, a small basin that you fill with water and position over your toilet so you can sit and submerge your rectal area.
• Alternate cold and hot. Use cold treatments first, then warm, and repeat.
• Keep clean. Clean the affected area gently but thoroughly after each bowel movement. Use soft, unscented toilet tissue, which is less irritating than other varieties. Many women prefer to use unscented wipes rather than toilet tissue. You can also buy wipes moistened with witch hazel specifically for treating hemorrhoids.
• Medicate. Ask your healthcare provider about taking medication for hemorrhoids during pregnancy. They may recommend a topical anesthetic or medicated suppository that's safe to use. Talk to your provider if you need to use these products for more than a week. (Using some of these products for extended periods of time can cause side effects such as skin irritation or thinning.)

Do I need to see a doctor about pregnancy hemorrhoids?

Most of the time, you can find hemorrhoid relief with home remedies or by making sure you're doing what you can to address and avoid constipation issues. Reach out to your healthcare provider if those preventive efforts and home treatments aren't helping, or if you have very painful hemorrhoids during pregnancy or rectal bleeding.

Sharp rectal pain during bowel movements may be a symptom of anal fissures, a less common but routinely seen pregnancy complication. There are effective treatments for anal fissures, but they're different from what you may be doing to treat hemorrhoids. 

It's always a good idea to check in with your healthcare provider before taking any over-the-counter hemorrhoid medications, or any other medications during pregnancy.

In some cases, you may need to see a specialist for treatment to shrink your hemorrhoids. Minor surgery may be necessary, but that's rare, and most healthcare providers will recommend waiting until after you've given birth to discuss surgery options.

Read more:

What to eat when pregnant: The 12 best foods

Frequent urination during pregnancy

Pregnancy symptoms you should never ignore