Postpartum hemorrhoids

What are hemorrhoids?

Hemorrhoids are swollen veins in your rectum – the very bottom of your large intestine. When these blood vessels swell up, you'll feel a soft, or sometimes hard, lump inside your rectum or around your anus. Hemorrhoids can be as small as a pea or as large as a grape. They can itch or hurt. Sometimes they cause rectal bleeding, especially when you have a bowel movement.

Hemorrhoids are common during pregnancy and in the postpartum period. Usually, hemorrhoids that developed during your pregnancy will go away on their own after you give birth, especially if you're careful to avoid constipation (with some simple tips mentioned below).

Sometimes hemorrhoids after pregnancy don't go away. About 40 percent of women have hemorrhoids or small tears in their anus called fissures after they deliver.

If postpartum hemorrhoids don't shrink on their own, there are a few things you can do to treat them.

Why are hemorrhoids so common after birth?

Pregnancy makes you more likely to get hemorrhoids (and swollen veins in other parts of your body, like your legs) for a few reasons.

One is that your growing uterus puts pressure on a large vein called the inferior vena cava that carries blood from your legs back up to your heart. That pressure slows blood flow from the lower half of your body. It's kind of like a backed-up garden hose. Pressure from the slowed blood presses on veins around your rectum and makes them swell up.

At the same time, a rise in the hormone progesterone relaxes the walls of your veins, making it easier for them to swell. Progesterone also contributes to constipation by slowing the movement of digested food through your gastrointestinal tract (your stomach and intestines). When your stool moves more slowly, more water is pulled out of your stool, making it hard.

Constipation (another common complaint during pregnancy) can cause hemorrhoids or make them worse. When you're trying to push out a hard bowel movement, you strain. Straining leads to hemorrhoids. And speaking of pushing, the intense pushing you did during labor can also contribute to hemorrhoids after birth.

How are postpartum hemorrhoids treated?

For temporary pain relief, you can take acetaminophen (Tylenol) or ibuprofen (Advil, Motrin IB), even if you're breastfeeding. Just be careful not to take more than the dose recommended on the package. Since aspirin is linked to Reye's syndrome in children, it may be best to avoid it while you're breastfeeding.

After each bowel movement, gently clean your bottom using the plastic squirt bottle (peri bottle) the hospital gave you. Or you might use wipes premoistened with witch hazel that are made just for people with hemorrhoids. You can also take a shower after a bowel movement, use a bidet if you have one, or take a shallow bath to clean the area.

After using the bathroom, wipe or pat dry with soft, unscented toilet tissue. It's less irritating than other varieties.

You'll find many hemorrhoid creams, ointments, pads, and suppositories on drugstore and supermarket shelves. It's safest to check with your doctor before trying one on your own. And keep in mind that most of these products are meant to be used for a week or less. Using them for too long might make your hemorrhoids even worse.

If you had an episiotomy or a tear in or around your rectum, it's especially important not to put anything – including suppositories – in there until you get the okay from your doctor.

Are there any natural remedies for hemorrhoids after birth?

Soaking your bottom in a sitz bath can feel soothing when you have hemorrhoids. You can sit in a few inches of warm water in your tub, or use a sitz bath – a small plastic basin that you fill with water and place over your toilet.

If you didn't get a sitz bath when you left the hospital, you can buy one at any drugstore. Try soaking in it a few times a day for 10 to 15 minutes, two to three times a day.

Another way to get soothing relief is to hold an ice pack (with a soft covering) to the area a few times a day. Ice may bring down swelling and discomfort. Cold compresses soaked in witch hazel can also feel soothing.

You might alternate cold and warm treatments. Start with an ice pack, and then sit in a warm sitz bath.

Can I prevent postpartum hemorrhoids?

Yes. One way to prevent hemorrhoids is to avoid the constipation that causes them. Here are a few tips to help keep you regular:

• Eat a high-fiber diet with plenty of fruits, vegetables, whole grains, and beans. Add fiber into your diet slowly if it makes you gassy.
• Drink plenty of water (six to eight glasses a day), if your urine is dark yellow, that's usually an indication that you need to drink more. 
• Aim for 150 minutes of aerobic exercise a week. It helps you sleep, relieves stress, and boosts your energy level so you can keep up with your active baby! Even if you only have time for a short, quick walk, that counts as exercise. Always check with your provide before exercising postpartum, though.
• If you're constipated, ask your doctor whether you should try a fiber supplement or stool softener like a laxative to make it easier to go.

Go as soon as you feel the urge to use the bathroom. Waiting can make stool drier and harder to pass. Also, try not to strain.

Another way to treat constipation is with daily Kegel exercises. These exercises strengthen not only the muscles that help you pee, but also the muscles around your rectum.

Try to avoid sitting or standing for long stretches of time to reduce the pressure on veins in your rectum. Lie down when you're nursing, reading, or watching TV.

When to see your healthcare provider about postpartum hemorrhoids

These home care tips should make your hemorrhoids shrink. If you've tried them for more than a week and your symptoms haven't improved, call your doctor.

Hemorrhoids can be an embarrassing topic to talk about, even with your doctor. But getting treatment will end your discomfort and help you avoid hemorrhoid complications like anemia, a blood clot, or an infection.

Call your provider sooner if you notice:

• Bleeding from the rectum
• Pain in your rectum
• A hemorrhoid has become hard and painful

If the hemorrhoids don't go away or they bother you, your provider has treatments for them. One uses rubber bands to cut off the hemorrhoid's blood supply. Others get rid of hemorrhoids with an electrical current or heat. Rarely, eliminating hemorrhoids requires minor surgery.