Hemorrhoids During Pregnancy: Causes, Treatment, Prevention

Hemorrhoids during pregnancy are one of the quite common and most unpleasant problems that expectant mothers have to deal with. Carrying a child is a natural physiological process that should not and cannot be a cause for the onset of illnesses. Nevertheless, the characteristics of the female body and its transformation in a woman expecting a baby can create prerequisites for the development or exacerbate an existing ailment. 

However, hemorrhoids during pregnancy occur in half of women, and after childbirth, more than 80% of young mothers face this condition. It is unacceptable to delay treatment of the disease during pregnancy because the greatest danger is the disease’s tendency to progress. Thrombosis and hemorrhoidal anemia, developing against the background of bleeding from the anus, are far from all the severe complications posed by advanced hemorrhoids.

What is Hemorrhoids

A clear understanding of what hemorrhoids are will allow effective management of the problem during pregnancy. This proctological condition occurs when the hemorrhoidal vessels expand and become inflamed, forming painful lumps on the mucous membrane of the rectal canal and around the anal opening. A complex blood flow system ensures their reduction or enlargement depending on the functioning of the anal sphincter. Inflammation of hemorrhoidal nodes during pregnancy leads to discomfort and causes significant pain, especially during bowel movements. 

There are several forms of the disease:

• external – affecting the vessels under the skin of the anal opening and perineum;
• internal – pathological changes occur in the structure of the rectum located under the mucous membrane of the rectal canal;
• combined – signs of both forms are present.

As a rule, the condition in pregnant women is external.

What other classifications of the condition exist

The disease also occurs in acute and chronic stages. The first option is characterized by severe pain, and the affected area bleeds. Symptoms of acute hemorrhoids indicate that the stage of thrombosis of the hemorrhoidal nodes has begun – it is characterized by inflammation, and in advanced cases – severe bleeding and even necrosis. Usually, the acute form occurs when chronic hemorrhoids are significantly complicated. This form of the disease is dangerous and occurs quite rarely, for example, during childbirth.

The chronic stage of the disease causes mild discomfort for a woman, associated with the prolapse of hemorrhoidal nodes during pregnancy from the anus. It is very important to start treating chronic hemorrhoids on time, despite the absence of pain. This form of the disease often affects the sphincter area. Typically, chronic hemorrhoids during pregnancy develop throughout its duration. There are four stages of its development.

First Stage

All phases of hemorrhoid development during pregnancy differ in symptoms, sensations, and the degree of threat. The first stage is the most manageable, easily addressed with various medications. Its main signs include discomfort in the anal area, minor pain after defecation, sometimes leaving bright blood stains on toilet paper. 

These are the first signs of an impending ailment that you need to respond to in time. It happens that such manifestations do not particularly bother the expectant mother, and she decides to endure them, to wait until it “goes away on its own.” Such a careless attitude towards the problem leads to further progression of the disease, and it may move to the next phase.

Second Stage

At this stage of the pathological progression of hemorrhoids during pregnancy, all symptoms of the first stage intensify, and a troubling persistent itch is added. Sensations change – during bowel movements, pain may significantly increase, but the painful manifestations pass quickly. 

If strong straining occurs during bowel movements, the internal hemorrhoids during pregnancy that have become inflamed may start to protrude from the anal opening. However, at this stage, they can still be easily corrected back on their own. This situation requires immediate consultation with a proctologist, because once hemorrhoids during pregnancy progress to the third stage, the painful symptoms will intensify, and treating the condition will become even more challenging, requiring significantly more time.

Stage Three

If an expectant mother continues to ignore the manifestations of hemorrhoids during pregnancy, pain will become her constant companion and will not go away day or night. In such a situation, it becomes difficult for a pregnant woman to walk, lying down is uncomfortable, and sitting is accompanied by unbearable pain. Hemorrhoid nodules still protrude during pregnancy, but it’s already challenging to push them back in manually, requiring effort. 

The disease at this stage signifies a 100% necessity to visit a proctologist’s office. The specialist will explain how to treat the condition and prescribe treatment that is permissible during pregnancy. The third stage is a direct threat to the child, so continuing to pretend nothing is happening and delaying a visit to the doctor is simply dangerous.

The Final Stage

This phase of hemorrhoids during pregnancy no longer implies medication treatment but requires surgical intervention and removal of nodes on the operating table. Among the many existing techniques during pregnancy, efforts are made to choose the least traumatic ones. In addition, the fourth stage is painful, and constant stress can trigger many ailments. But its main danger lies in the fact that the anus bleeds heavily, and the disease progresses to an acute stage, where thrombosis and necrosis are possible. However, the development of hemorrhoids during pregnancy to the fourth stage is rare. 

Usually, already by the second stage, a pregnant woman is referred to a proctologist who begins to treat her effectively. Moreover, the disease may not progress quickly enough to reach a critical stage during the pregnancy. This, of course, unless the pregnancy occurs when the hemorrhoids were already in the second or third stage.

Why Hemorrhoid Development is Dangerous for Pregnant Women

The development of hemorrhoids during pregnancy, besides causing discomfort and painful sensations, poses many dangers for women in this condition. The internal type of the disease is not frequently associated with the prolapse of hemorrhoidal nodes; however, it can be complicated by bleeding. The enlarged, overstretched veins often burst after defecation. This leads to anemia and affects the development of the fetus due to a lack of oxygen, causing hypoxia. Additionally, when an internal hemorrhoidal node ruptures, a fissure often forms and pain arises. 

Subsequent bowel movements become difficult, increasing the tendency towards constipation. Along with this, the pain provokes a chronic spasm of the anal sphincter muscles. This prevents the anal fissure from healing, as the nutrition of the anal canal mucosa is disrupted. The presence of such a fissure is an independent chronic issue.

What Else This Ailment Can Mean for Expectant Mothers 

With external hemorrhoids during pregnancy, there is the added complication of anal fissures and bleeding, along with the engorgement of external hemorrhoidal nodes. In this scenario, muscle spasm of the sphincter disrupts blood circulation in the nodes. Blood that enters the node through the arteries exits through the veins with great difficulty. This leads to the stretching of the node and causes severe pain. In turn, such a situation results in thrombosis of the hemorrhoidal nodes, greatly intensifying the pain due to inflammation of the surrounding tissues. 

This condition exhausts the pregnant woman, preventing her from sleeping for several days due to pain. It looks intimidating – the nodes swell to the size of a quail’s, and sometimes a chicken’s, egg and stop fitting back into the rectum. Prolonged thrombosis of the hemorrhoidal node leads to tissue necrosis, which is a nutrient medium for microbes. Further symptoms include swelling of the perineum and a rise in temperature.

The Most Common Complications

The most common complication during pregnancy with hemorrhoids is its progression to a chronic form. Doctors recommend surgical intervention if the inflamed nodes continue to trouble the woman 5-6 months after childbirth. In addition to the risk of developing iron deficiency anemia with bleeding hemorrhoidal nodes, they can cause other pathologies. For example, the development of infectious-inflammatory complications. 

Aside from anal fissures, these may include proctitis (inflammation of the rectal mucosa) or paraproctitis (inflammation of the tissue around the rectum). Inflammatory processes caused by infections and mechanical entrapment of nodes, following thrombosis, can lead to gangrene, where urgent surgical intervention becomes necessary. Additionally, nervous and physical exhaustion due to hemorrhoids during pregnancy negatively affects the body’s preparation for childbirth.

Hygienic Procedures

To effectively treat inflamed hemorrhoidal nodes, it is necessary to perform hygiene procedures that help prevent infectious-inflammatory complications of hemorrhoids during pregnancy. For instance, the use of wet wipes or toilet paper is categorically prohibited for internal, and even more so for external nodes. It is necessary to wash with water at room temperature and dry with a damp cloth after defecation. 

The toilet of the anal area is performed using a weak solution of potassium permanganate or decoctions of medicinal herbs. Hygiene procedures for severe pain syndrome are combined with taking warm baths. Warm water procedures are especially useful for internal hemorrhoids as they have an antispasmodic effect. If the nodes are external, baths should be performed with agents containing antiseptic agents to avoid infectious complications.

Causes of the ailment during pregnancy

Hormonal changes in a woman’s body become the preconditions for the occurrence of hemorrhoids during pregnancy. During this period, the level of progesterone, the so-called ‘pregnancy hormone,’ increases in the pregnant woman’s blood serum. The increase in progesterone levels leads to a decrease in the elasticity of the walls of blood vessels. This, in turn, leads to venous stasis in the lower limbs and pelvic organs. 

In addition, during the gestation period, the physiological state of the expectant mother promotes stagnant processes in the pararectal tissue, an increase in intra-abdominal pressure, and a significant enhancement of blood supply to the veins located in the rectum. Among the causes of hemorrhoids during pregnancy are reduced physical activity and the recurrence of a previously existing condition. 

Why else does the disease manifest

In addition to this, factors that can lead to the development of hemorrhoids during pregnancy include:

• The number of births and the woman’s age – before 30, one in five expectant mothers experiences this ailment, and after that, half of them face this problem.
• Hereditary weakness of the venous wall of hemorrhoidal vascular bodies.
• A sharp increase in estrogen levels throughout the pregnancy, weakening the muscle tone of the vascular wall of hemorrhoidal veins.
• Elevated venous pressure in the veins of the legs and hemorrhoidal veins, caused by the pressure of the uterus on the deep pelvic veins and provoking leg varicose veins.
• Due to increased estrogen levels, decreased muscle tone of vessels and smooth muscles of the intestines, a tendency to constipation develops during pregnancy.
• Improper or unbalanced nutrition.
• Venous congestion in the vessels of the anal canal.

Symptoms

Signs of developing hemorrhoids during pregnancy are small nodes outside the anus that are not visible and are located inside the rectum. Discomfort begins to bother the woman as the hemorrhoidal veins enlarge. There is occasional slight itching in the anus area and a feeling of moisture. These manifestations are associated with the secretion of inflammatory fluid from the intestinal tract that irritates the skin around the anal opening. 

There may be other symptoms – scant bloody discharge from the anus related to the act of defecation. In addition, other symptoms of external hemorrhoids include discomfort in the anal area, the presence of blood in the stool, and protrusion of hemorrhoidal nodes under the skin around the anal opening. External hemorrhoids during pregnancy should be treated immediately after the first symptoms appear to increase the chances of avoiding surgical intervention.

Diagnosis

Typically, hemorrhoids during pregnancy are easily diagnosed during an initial examination by a coloproctologist. To make an accurate diagnosis, the specialist interviews the pregnant woman and conducts a manual examination of the anus. To rule out the presence of the internal type of ailment, the woman is additionally assigned instrumental studies – an anoscopy or a sigmoidoscopy. 

The latter type of study involves the introduction of an optical device – a sigmoidoscope – into the anus. With its help, the doctor can examine the inside of the intestine and take material from the mucous membrane for analysis. It is undeniable that if hemorrhoids are diagnosed during pregnancy, local conservative treatment is usually chosen to avoid the potential impact of medication on the developing fetus. 

Prevention

It has become a saying that any ailment is easier to prevent than to cure it later. This is also true for preventing the development of hemorrhoids during pregnancy. To minimize the risk of its occurrence, it’s important to eliminate the causes that lead to this condition in pregnant women both during gestation and after childbirth.

The first cause is vascular, related to impaired blood flow from hemorrhoid nodes during pregnancy. The second is mechanical, associated with the process of childbirth. The development of hemorrhoids after pregnancy is caused by significant stress on the ligaments (Park’s and Tayd’s) and muscles in the perianal area. It is possible to prevent the occurrence of the disease during all periods of pregnancy and childbirth by eliminating these causes – giving up bad habits and increasing physical activity.

What will help prevent the development of the ailment

In addition to avoiding alcohol consumption, smoking, and unhealthy food (fast food), prevention of hemorrhoids during pregnancy can include:

• avoiding heavy lifting;
• including fresh vegetables and fruits in the pregnant woman’s diet, along with foods high in fiber;
• excluding foods that irritate the lining of the rectum from the future mother’s menu – spicy, smoked, salty foods;
• consuming an adequate amount of fluids – 1.5-2 liters of water per day;
• avoiding prolonged sitting;
• adding moderate physical activity to the daily schedule.

However, if the doctor still diagnoses hemorrhoids during pregnancy, simple remedies like diet and exercise can significantly ease the future mother’s condition.

Diet for Pregnant Women with Hemorrhoids

One of the first and main pieces of advice given by proctologists if a woman is diagnosed with hemorrhoids during pregnancy is to urgently eliminate constipation. To achieve this, it’s essential to know which foods a pregnant woman whose hemorrhoids have worsened during pregnancy must immediately exclude from her diet. 

Among them:

• fatty foods;
• all types of legumes;
• alcoholic beverages;
• rich pastries;
• salty, peppery, spicy, and seasoned dishes – like alcohol, they increase the blood supply to the pelvic veins;
• unripe fruits and berries;
• mustard;
• high-calorie dairy products;
• onion;
• black bread.

Conversely, if the hemorrhoidal nodes become inflamed during pregnancy, it is necessary to add stewed and boiled foods to the menu, such as potatoes, beets, broccoli, carrots, cauliflower, prunes, raisins, and sweet dried apricots (only in compote).

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Exercises for the Prevention of Hemorrhoids

To prevent hemorrhoid nodes from becoming inflamed during pregnancy and the condition from exacerbating, it is necessary to perform the following exercises throughout the entire term, starting with these positions:

1. Standing, feet shoulder-width apart, arms extended in front of you. Without lifting your heels off the floor, rotate your torso to the right while moving your right arm as far back as possible – inhale. Return to the initial position on the exhale, rotating to the left. Repeat to each side 5 times.

2. Standing, arms in front with fingers locked together. Move your arms as far back as possible and rotate your torso left and right. Repeat the exercise 5 times on each side.

3. Sitting on the floor, leaning back on your hands. Bend your legs at the knees without lifting your heels off the floor. In the next stage, slowly extend your legs. Repeat 5 times.

Exercises for the First and Second Trimester with Hemorrhoids

To alleviate the condition if hemorrhoids are inflamed during pregnancy, you can perform exercises that are inadmissible in the 3rd trimester but acceptable in the 1st and 2nd trimesters. The first exercise involves sitting with your legs spread as far apart as possible and pressed firmly to the floor. Try not to bend your knees. Bend forward, alternately touching your left and right feet with your hands as far as you can, then straighten up. Repeat the bends 5-7 times. 

The second exercise involves sitting as in the previous one, bending sideways while keeping the opposite hand on your waist. Repeat 5 times on each side. The third exercise requires you to lie on your back, extend your arms along your body. Bend your knees, pulling your legs towards your abdomen, then return to the starting position. It’s recommended to repeat this 7-10 times.

Third Trimester – Exercises for Hemorrhoids

Over time, preventive exercises for hemorrhoids during pregnancy become more difficult due to the growing belly. In the 1st and 2nd trimesters, you can still do this exercise by lying on your right side with your right arm bent at the elbow, resting under your head. At the same time, you need to bend your left leg at the knee and press it to your abdomen, you can help yourself with your left hand. Then do the exercise lying on the other side and repeat 7-10 times for each side.

However, in the 3rd trimester, the allowable exercises for hemorrhoids during pregnancy become as gentle as possible. For example, from a starting position sitting on a chair, extend your right arm to the side. At the same time, lift your left leg, bent at the knee, to the left and forward. While exhaling, try to bring it to the surface of the abdomen from the side, helping yourself with your left hand. Inhale to return to the starting position. Repeat 5 times for each leg.

Treatment Options

Treating diagnosed hemorrhoids during pregnancy without the supervision of a proctologist is strictly prohibited. At home, one can only use the ointments and medications prescribed by the doctor that are guaranteed not to harm the developing fetus. Additionally, it’s important to know that during pregnancy, treatment for hemorrhoids can vary depending on the form and stage of the disease. 

Some women try to combat the ailment without seeking medical help, using folk remedies instead. However, it’s not possible to fully resolve the issue without proper treatment; one can only temporarily relieve the condition of a woman diagnosed with hemorrhoids during pregnancy. Only medical treatment or surgical intervention will be effective.

Medication Treatment

Generally, when choosing treatments for hemorrhoids during pregnancy, the specialist considers whether the woman has an external or internal type of the condition. For the former, ointments are prescribed, while for the latter, suppositories are recommended.

If hemorrhoids during pregnancy have not become severe, the doctor usually prescribes phlebotonic drugs to reduce blood congestion in the hemorrhoid nodes, but with great caution. 

Only the drug Detralex is a phlebotonic that has been scientifically tested for safety during pregnancy. It is prescribed 2-4 times a day, 1-2 tablets each. Other medications such as Troxerutin, Venarus cannot be recommended as they have no confirmed safety for the fetus.

Treatment Medications

While hemorrhoids during pregnancy can be treated with medication, the doctor selects drugs according to their nature and stage. For the acute stage, phlebotonic, analgesic, anti-inflammatory, and hemostatic medications are used, providing both systemic and local effects. Effective treatment is only possible with the combined use of medications from both groups. 

In the last months of pregnancy, NSAIDs and glucocorticoids are contraindicated for both systemic therapy (oral administration) and local application, as well as systemic drugs for treating hemorrhoids during pregnancy. In the last two periods of pregnancy, as well as treatment after childbirth and during lactation, medications can be used with restrictions. This applies to both tablet forms and those applied locally.

Systemic Action Drugs

During conservative treatment of hemorrhoids during pregnancy, systemic medications such as NSAIDs (Diclofenac, Xefocam) are used. The anti-inflammatory effect of such medications is achieved by inhibiting the biosynthesis of prostaglandins, which play an important role in the pathogenesis of inflammation and BS. The decision to use certain systemic medications for treating hemorrhoids during pregnancy is made solely by the proctologist who observes the specific pregnant patient. 

No medications should be taken by the woman without consulting the specialist. Typically, experts prescribe medications to normalize blood circulation and metabolic processes, strengthen the walls of the veins, suppress inflammation, and improve the rheological properties of blood – those that prevent the formation of blood clots, but do not allow bleeding.

Topical medications – suppositories, ointments

A safer choice during pregnancy is to treat hemorrhoids by prescribing medications that have a local effect directly on the hemorrhoidal area and anal fissure. This includes ointments like Hepatrombin G, Troxevasin, Levomekol, Relief, heparin ointment, and sea buckthorn oil suppositories. Local treatment is prescribed to relieve pain and reduce inflammation. 

Among the drugs in this group, specialists particularly highlight Procto-Glyvenol. It contains lidocaine, which reduces pain sensations, alleviates burning and itching, and tribenoside, which reduces inflammation, improves microcirculation, and increases vascular tone. The drug is available in the form of rectal suppositories and cream. In comprehensive treatment using both the cream and suppositories, the main symptoms of the disease – bleeding, pain, itching – decrease by the 7th day. By the 15th day, hemorrhoid symptoms during pregnancy disappear in 92.9–97.6% of cases.

Other Means and Innovations 

Medical science is not standing still in the quest for new methods of treating hemorrhoids during pregnancy. An innovative development that effectively uses a rectal sound wave generator shows promising results. The device consists of a special attachment and a sound wave generator. 

Its principle is based on the fact that when vibrating at a certain frequency in the anal canal, the device accelerates the healing of cracks, reduces swelling, pain, and secondary spasm. A suppository with oil is inserted at its tip into the anal opening. If necessary, this procedure can be performed as many times as required, as it helps to reposition prolapsed internal hemorrhoidal nodes.

Measures to Ease the Condition of Pregnant Women

In addition to medication prescribed by a specialist, certain actions help relieve discomfort from hemorrhoids during pregnancy. These can easily be done at home on one’s own. At the onset of even the mildest symptoms of the condition, it is important to prevent diarrhea and constipation and to avoid straining during bowel movements. 

Additionally, after each bowel movement, it is necessary to thoroughly clean the anus and keep the surrounding skin clean. A woman who develops hemorrhoids during pregnancy should try to sit on soft surfaces. This will help reduce swelling and lower the risk of developing new hemorrhoids.

At the earliest stages, an ice pack can be used.

Surgical treatment methods

Chronic hemorrhoids during pregnancy can exacerbate with bleeding and prolapse of hemorrhoidal nodes. In such a situation, surgical intervention is unavoidable. If a pregnant woman experiences such complications, a minimally invasive method like infrared photocoagulation is used, where the hemorrhoidal nodes during pregnancy are treated with a thermal stream using an infrared beam. 

The removal of a hemorrhoidal node using a special latex ring, known as ligation, is also applied. Sclerotherapy—chemical coagulation of the vessels feeding the nodes—and laser vaporization, where nodes are cauterized with a laser beam, are often used. A proctologist may decide to surgically treat hemorrhoids during pregnancy if the condition is severe and there is a risk of acute infections developing.

Hemorrhoids After Pregnancy 

If a woman’s pregnancy, with a diagnosed condition, successfully ends in childbirth, it does not mean it has disappeared on its own, as many of the provoking causes are no longer present. Moreover, the process of childbirth is associated with additional factors that contribute to the further development of the ailment, its exacerbation, and the emergence of dangerous complications. Treating hemorrhoids after pregnancy has its own features and provides the proctologist more opportunities to apply radical measures. 

Thus, alongside medication treatment, a planned surgical operation can be offered to the mother a few months after the birth, which will rid the woman of the condition. Additionally, the procedure can be combined with breastfeeding and does not require prolonged hospitalization.

Medication Treatment After Pregnancy

The principle of treating hemorrhoids after pregnancy with medication is to ensure that the drugs used, both systemic and local, do not enter breast milk, affect lactation, or pose a risk to the child. This is particularly important when the baby is breastfeeding. Typically, if the condition is in its early stages and is mild, a specialist will prescribe venotonic drugs that improve blood circulation in the veins, as well as laxatives. 

For local application, sea buckthorn rectal suppositories and ointments are used. Natalsid suppository, a medication based on brown seaweed with sodium alginate as the active ingredient, is also prescribed. The composition has hemostatic and anti-inflammatory effects and aids in the healing of mucous membrane damage.

Features of Surgical Methods – Laser Removal

If hemorrhoids after pregnancy could not be treated conservatively, the doctor recommends the woman to resort to surgical treatment methods. Depending on the patient’s history, laser removal of internal and external hemorrhoids may be suggested. This minimally invasive surgical intervention is performed with a CO2 laser. Its essence lies in the simultaneous excision and cauterization of hemorrhoidal nodes with a high-frequency laser beam without causing damage to the tissues surrounding the node in the anal canal. 

This technique is guaranteed to be effective, painless, bloodless, and quick. The procedure takes approximately 15 minutes, with local anesthesia taking 5-10 minutes. The patient can leave the clinic a few hours after the procedure.

Ligation, Laser Sclerotherapy, Desarterization

Hemorrhoids after pregnancy can be treated with latex band ligation. Special equipment is used to apply the rings to the nodules, compressing them, which leads to tissue necrosis due to the cessation of blood circulation in the nodule. Circulation in the local veins stops, leading to tissue necrosis. The nodule falls off within 10-14 days, causing minimal discomfort to the patient. Another advanced technique is laser sclerotherapy of hemorrhoidal nodes. It involves the introduction of a laser fiber into the hemorrhoidal node, causing it to stick together and then fuse. 

A diode laser is usually used during the procedure. Most often, ultrasound detection of the vessels supplying the hemorrhoidal nodes is performed, followed by their ligation. This method is called ‘dearterialization with mucopexy’. The internationally recognized name is Hemorrhoidal Artery Ligation and Recto Anal Repair or HAL and RAR.

Prevention of Hemorrhoids after Childbirth

Preventing illness after the birth of a baby is just as important as during pregnancy. Doctors recommend a balanced and proper diet for prevention, paying special attention to foods rich in dietary fiber – bran, various vegetables, and greens. Limited consumption of fermented dairy products, milk, and pastries will prevent constipation, as bowel motility improves. 

Secondly, to prevent the condition after childbirth, specialists advise drinking plenty of water. The amount of pure water should be 30 ml per 1 kg of body weight. Naturally, juices, teas, and other beverages are not included in this amount. An active lifestyle is essential. It helps with appearance, improves the pelvic floor condition and muscle tone – daily morning exercises, yoga, swimming in the pool, and Pilates contribute to this. A must-have is hygiene of the anal area after defecation with the avoidance of straining.

Reviews

Many women who developed hemorrhoids after pregnancy or during their pregnancy share their experiences and impressions from visiting specialists and the effectiveness of the measures they offer for prevention and treatment of the condition. Most of them found it useful and achieved good results.

For example, a patient named Diana, who is five months pregnant, thanks her proctologist for the prescribed treatment plan, which includes ointments, suppositories, and creams that significantly alleviated the symptoms of the disease. She plans to address the problem thoroughly after the birth of her child. 
Another woman, Maria, whose condition worsened after childbirth, shares her impressions of the sclerotherapy surgery she underwent to treat her hemorrhoids. The condition existed before, and after childbirth, complications arose that required surgical intervention.