Hemorrhoids during pregnancy: causes, treatment, prevention

Hemorrhoids during pregnancy are one of the most frequent and most unpleasant problems that expectant mothers have to face. Bearing a child is a natural physiological process that should not and cannot be the cause for the occurrence of diseases. Nevertheless, the features of the female body and its transformation in a woman expecting a baby can become a prerequisite for the development or exacerbate an existing ailment.

However, hemorrhoids during pregnancy manifest themselves in half of women, and after delivery, more than 80% of young mothers face this disease. It is unacceptable to postpone the treatment of the disease during the period of bearing the baby, because the greatest danger is the property of the disease to progress. Thrombosis and hemorrhoidal anemia that develops against the background of bleeding from the anus are not all serious complications that threaten advanced hemorrhoids.

What is hemorrhoids

Effectively solve the problem of hemorrhoids during pregnancy will allow a clear idea of what this disease is. A proctological ailment manifests itself when hemorrhoidal vessels dilate and become inflamed, forming painful nodes on the mucous membrane of the rectal canal and around the anus. A complex blood flow system ensures their decrease or increase, depending on the functioning of the sphincter. Inflammation of hemorrhoids nodes during pregnancy leads to discomfort and causes significant pain, especially during defecation. 

There are several forms of the disease:

• external – damage to the vessels under the skin of the anus and perineum;
• internal – in the structure of the rectum, located under the mucous membrane of the rectal canal, pathological changes occur,
• combined – there are signs of both forms.

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

What other classification of the disease exists

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

The chronic stage of the disease gives a woman mild discomfort associated with the loss of hemorrhoids during pregnancy from the anus. It is very important to start treating chronic hemorrhoids in time despite the absence of pain. This form of the disease often affects the sphincter zone. As a rule, chronic hemorrhoids during pregnancy develop throughout its continuation. There are four stages of its development.

First stage

All phases of the development of hemorrhoids during pregnancy are different in symptoms, sensations and degree of impending danger. The first stage is the easiest, it is easy to cope with it, stopping various medications. Its main signs are discomfort in the anus, a slight pain after the act of defecation, sometimes leaving bright blood traces on toilet paper.

These are the first signals of an impending ailment that need to be responded to in time. It happens that such manifestations practically do not bother the expectant mother, and she decides to be patient, to wait until it “passes by itself”. Such a frivolous attitude to the problem entails further progression of the disease, and it can go into the next phase.

The second stage

At this stage of the pathological progression of hemorrhoids during pregnancy, all the symptoms of the first stage increase, a disturbing obsessive itch is added to them. Sensations change – during defecation, the pain can increase significantly, but the painful manifestations pass quickly.

If strong attempts are made during defecation, the internal nodes of hemorrhoids during pregnancy, which have become inflamed, begin to climb out of the anus. However, so far they can be easily adjusted back on their own. This state of affairs requires an immediate visit to the proctologist, since when hemorrhoids pass into the third phase during pregnancy, the painful symptoms will intensify, and it will become even more difficult to treat the ailment over time and much more time is required for this.

Stade three

If the expectant mother continues to ignore the manifestations of hemorrhoids during pregnancy, the pain will become her constant companion and it will not be possible to get rid of it either day or night. With this development of the situation, it becomes difficult for a woman in the position to walk, lie down is uncomfortable, and sitting is accompanied by unbearable pain. Hemorrhoids nodes during pregnancy still come out, but it is already difficult to adjust them back on their own, effort is required. 

The disease in this stage is one hundred percent necessary to visit the proctologist’s office. The specialist will tell you how to treat the disease, and prescribe the treatment that is permissible during pregnancy. The third stage is a direct threat to the child, so continuing to pretend that nothing is happening, and postponing a trip to the doctor is simply dangerous.

Last stage

This phase of hemorrhoids during pregnancy no longer involves drug treatment, but requires surgical intervention and removal of nodes on the operating table. Among the many existing techniques during pregnancy, they try to choose the most atraumatic. In addition, the fourth stage is painful, constant stress can provoke many ailments. But its main danger is that the anus bleeds heavily, and the disease goes into the acute stage, where thrombosis and necrosis are possible. However, the development of hemorrhoids during pregnancy until the fourth stage is rare. 

Usually, already on the second pregnant woman, she goes to the proctologist, who begins to treat her effectively. In addition, the disease may not progress so quickly and not have time to develop to a critical stage during gestation. Unless, of course, pregnancy occurred when hemorrhoids were in the second or third stage.

Why is dangerous the development of hemorrhoids in pregnant women

The development of hemorrhoids during pregnancy, in addition to discomfort and pain, is fraught with many dangers for women in this position. The internal variety of the disease is not associated with frequent prolapse of hemorrhoids, but can be complicated by bleeding. Dilated overstretched veins often burst after defecation. This leads to anemia and affects the development of the fetus, due to lack of oxygen, causing hypoxia. In addition, when the internal hemorrhoidal node ruptures, a crack often forms and pain occurs. 

Subsequent bowel movements are difficult, which increases the tendency to constipation. Along with this, the pain provokes a chronic spasm of the muscles of the sphincter. This does not allow the fissure to heal, since the nutrition of the mucous membrane of the canal is impaired. The presence of such a crack is an independent chronic problem.

What else is fraught with illness for expectant mothers

In the presence of external hemorrhoids during pregnancy, the fissure and bleeding are supplemented with infringement of the external hemorrhoids that have fallen out. In this case, against the background of muscle spasm of the sphincter, blood circulation in the nodes is disturbed. Blood entering the node through the arteries leaves it through the veins with great difficulty. This leads to stretching of the node and causes severe pain. In turn, this situation leads to thrombosis of hemorrhoids, and this is a multiple, order of magnitude increase in pain due to inflammation of the surrounding tissues. 

This situation exhausts the pregnant woman, not allowing her to fall asleep due to pain for several days. Everything looks frightening – the nodes swell to the size of a quail and sometimes a chicken egg and cease to be adjusted into the rectum. Prolonged thrombosis of the hemorrhoidal node leads to tissue necrosis – a nutrient medium for microbes. This is followed by swelling of the perineum and a rise in temperature.

Most frequent complications

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

In addition to fissures, it can be proctitis (inflammation of the mucous membrane of the rectum) or paraproctitis (inflammation of the fiber near the rectum). Inflammatory processes caused by infections and mechanical infringement of the nodes, following thrombosis, can lead to gangrene, when urgent surgical intervention is indispensable. Also, nervous and physical exhaustion during hemorrhoids during pregnancy negatively affects the preparation of the body for childbirth.

Hygienic manipulation

To effectively treat inflamed hemorrhoids, it is necessary to carry out hygienic procedures that will help prevent infectious and inflammatory complications of hemorrhoids during pregnancy. So, it is strictly forbidden to use sanitary napkins or toilet paper with internal, and even more so with external nodes. It is necessary to wash with water at room temperature and wipe with wet rags after defecation.

The toilet of the area is carried out using a weak solution of potassium permanganate or decoctions of medicinal herbs. Hygienic 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 made with agents containing antiseptics, in order to avoid infectious complications.

Cause of the disease during pregnancy

Hormonal changes in the body of a woman become prerequisites for the occurrence of hemorrhoids during pregnancy. During this period, the level of progesterone in the serum of a pregnant woman increases – the so-called “pregnancy hormone”. An increase in the amount of progesterone leads to a decrease in the elasticity of the walls of blood vessels. And this, in turn, leads to venous stagnation in the lower extremities and pelvic organs.

In addition, during the period of gestation of the fetus, the physiological state of the expectant mother contributes to stagnant processes in the parametric fiber, an increase in intra-abdominal pressure, a significant increase in the blood supply to the veins located in the rectum. Among the causes of hemorrhoids during pregnancy are a decrease in physical activity, a relapse of a pre-existing disease.

Why else is the disease manifested

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

• The number of births and the age of a woman – up to 30 years, the disease appears in every fifth future mother, and after that half of them face this problem.
• Hereditary weakness of the venous wall of hemorrhoidal vascular bodies.
• A sharp increase in the level of estrogen during the gestation period, weakening the muscle tone of the vascular wall of hemorrhoidal veins.
• Increased venous pressure in the veins of the legs and hemorrhoidal veins, caused by the pressure of the uterus on the deep veins of the pelvis and provoking varicose veins of the legs.
• Due to the increased level of estrogen, a decrease in muscle tone of blood vessels and smooth muscles of the intestine – the development of a tendency to constipation during the period of bearing a child.
• Improper or unbalanced nutrition.
• Venous congestion in the vessels of the canal.

Symptoms

Signs of incipient hemorrhoids during pregnancy are small nodes outside the anus, which are not visible and are located inside the rectum. Discomfort begins to bother a woman as hemorrhoidal veins increase. Periodically there is a slight itching in the anus and a feeling of moisture. Such manifestations are associated with the release of inflammatory fluid from the intestinal tract, which irritates the skin around the anus.

There may be other symptoms – scanty bloody discharge from the anus associated with the act of defecation. In addition, other symptoms of external hemorrhoids are discomfort in the area, the presence of blood in the feces, under the skin in the anus area of the protrusion of hemorrhoids. External hemorrhoids should be treated immediately after the first symptoms appear – this will increase the chances of doing without surgery.

Diagnostics

As a rule, hemorrhoids during pregnancy are easily determined during the initial examination by a coloproctologist. To make the correct diagnosis, the specialist interviews the pregnant woman, applies a manual examination of the anus. In order to exclude the presence of an internal variety of the disease, the woman is additionally prescribed hardware studies – anoscopy or sigmoidoscopy.

The last type of study involves the introduction into the anus of an optical apparatus – a sigmoidoscopy. With its help, the doctor can examine the inside of the intestine and take material from the mucous membrane for analysis. There is no doubt that if hemorrhoids are diagnosed during pregnancy, local conservative treatment is usually chosen, which excludes the likelihood of the effect of medications on the developing fetus.

Prophylaxis

It has already become an aphorism of the expression that it is easier to prevent any ailment than to treat it later. It is also true in relation to the prevention of the development of hemorrhoids during pregnancy. To minimize the risk of its occurrence, it is necessary to exclude as much as possible the causes of the formation of this ailment in pregnant women both during gestation and the occurrence of the disease after the birth of a child.

The first reason is vascular, associated with a violation of the outflow of blood from hemorrhoids nodes during pregnancy. The second is mechanical, which is associated with the process of childbirth. Large loads on the ligaments (Parks and Tides) and muscles in the perianal region lead to the development of hemorrhoids after pregnancy. It is possible to prevent the onset of the disease during all periods of gestation and delivery if you eliminate these causes – forget about bad habits and increase physical activity.

What will help prevent the development of the disease

In addition to the exclusion of alcohol intake, tobacco smoking, the use of junk food (fast food), the prevention of hemorrhoids during pregnancy can be:

• inadmissibility of lifting weights;
• inclusion in the diet of a pregnant woman of fresh vegetables and fruits, foods high in fiber;
• exclusion from the menu of the expectant mother of foods that irritate the mucous membrane of the rectum – spicy, smoked, salty;
• the use of a sufficient amount of liquid – 1.5-2 liters of water per day;
• the inadmissibility of prolonged sitting;
• adding moderate physical activity to the daily routine.

But if the doctor still diagnosed hemorrhoids during pregnancy, simple means such as diet and exercise can significantly alleviate the condition of the expectant mother.

Diet for pregnant women with hemorrhoids

One of the very first and main tips that proctologists give if a woman is diagnosed with hemorrhoids during pregnancy is to urgently get rid of constipation. To achieve this, you need to know which products a pregnant woman who has exacerbated hemorrhoids during pregnancy will have to be urgently excluded from her diet.

These include:

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

And, on the contrary, if hemorrhoids are inflamed during pregnancy, it is necessary to add to the menu stewed, boiled foods, such as potatoes, beets, broccoli, carrots, cauliflower, prunes, raisins, sweet dried apricots (only in compote).

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Adventions for the prevention of hemorrhoids

In order not to allow the nodes of hemorrhoids during pregnancy to become inflamed, and the ailment itself to worsen, throughout the entire period of bearing the baby, it is necessary to do the following exercises in the initial positions:

1. Standing, legs shoulder width apart, arms extended in front of you. Without taking the feet off the floor, a right turn of the body is performed with the right arm pulled back as much as possible – inhale. Return to the starting position on exhalation, performing a turn to the left. Repeated in each of the sides 5 times.

2. Standing, hands in front of you with your fingers interlocked in the lock. Pulling your hands back as much as possible, perform body turns left and right. Repeat the exercise 5 times in each direction.

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

Performations for the first and second trimester for hemorrhoids

It will be possible to alleviate the condition if the nodes of hemorrhoids are inflamed during pregnancy by doing exercises that are unacceptable in the 3rd trimester, but are acceptable in the 1st trimester and the 2nd trimester. The first is from a sitting position, spreading the legs to the sides as much as possible and pressing them tightly to the floor. If possible, do not bend your knees. Make a forward tilt, touching alternately with your left and right foot hands alternately, then straighten up. Repeat the inclinations 5-7 times. 

The second is to sit as in the previous one, perform bends to the sides, holding the opposite hand on the belt. It is necessary to repeat in each direction 5 times. The third is to lie on your back, stretch your arms along the body. Tighten the legs bent in the knee exercise to the stomach, then return to the starting position. Repeat 7-10 times is recommended.

Threth trimester – exercises for hemorrhoids

Over time, preventive exercises for hemorrhoids during pregnancy will be more difficult due to an increasing abdomen. In the 1st trimester and in the 2nd trimester, you can still do the exercise, lying on your right side with your right hand bent at the elbow, which lies under your head. At the same time, you need to bend your left leg at the knee and press it against your stomach, 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.

But in the 3rd trimester with hemorrhoids during pregnancy, the most gentle motor actions are already permissible. For example, from the initial position sitting on a chair, stretching out the right arm to the side. The left leg bent at the knee is raised to the left and forward. Making an exhalation, you need to try to bring it to the surface of the abdomen on the side, helping yourself with your left hand. On inhalation, you can return to the starting position. You need to repeat 5 times for both legs.

Treatment options

Diagnosed hemorrhoids during pregnancy are strictly forbidden to treat without the supervision of a specialist proctologist. At home, you can use only ointments and medications prescribed by him that are guaranteed not to harm the developing fetus. In addition, it is important to know that with hemorrhoids during pregnancy, different treatments can be prescribed depending on the form and stage of the course of the disease.

Some women try to fight the disease without resorting to medical help – using folk methods. However, it is not possible to cope with the problem without full treatment – it is possible only temporarily to alleviate the condition of a woman who has been diagnosed with hemorrhoids during pregnancy. Only drug treatment or surgical intervention will be effective.

Medical treatment

As a rule, choosing funds to treat hemorrhoids during pregnancy, the specialist takes into account the external or internal appearance of the disease in a particular woman. If there are the first – prescribe ointments, if the second are found – prescribe suppositories.

If hemorrhoids during pregnancy have not acquired severe forms, the doctor usually prescribes phlebotonic drugs to reduce the blood filling of hemorrhoids nodes, but with great caution.

Since only the drug Detralex is a phlebotonic, which has been scientifically tested for harmlessness during pregnancy. Assign it 2-4 times a day for 1-2 tablets. Other medicines such as Troxerutin, Venarusa can not be recommended for use, since they do not have confirmation of harmlessness to the fetus.

Preparations for treatment

While hemorrhoids during pregnancy can be treated with medication, the doctor selects drugs according to the nature and stage in which it resides. For the acute stage, phlebotonic, analgesic, anti-inflammatory and hemostatic drugs are used, which have a systemic and local effect. Effective treatment is possible only with the combinatorial use of drugs of both groups.

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

System action preparations

With conservative treatment of hemorrhoids during pregnancy, NSAIDs (Diclofenac, Xefokam) are used as systemic drugs. The anti-inflammatory effect of such drugs is provided by inhibiting the biosynthesis of prostaglandins, which are important in the pathogenesis of inflammation and BS. The decision to use certain systemic drugs in the treatment of hemorrhoids during pregnancy is made only by a proctologist who observes a particular pregnant woman.

Usually, specialists prescribe drugs to normalize blood circulation and metabolic processes, strengthen the walls of veins and suppress inflammation, improve the rheological properties of the blood – those that prevent the formation of blood clots, but do not allow bleeding.

Local remedies – suppositories, ointments

A safer choice would be to treat hemorrhoids during pregnancy by prescribing funds that have a local effect directly on the hemorrhoidal zone and the fissure. We are talking about ointments such as Hepatrombin G, Troxevasin, Levomekol, Relief, heparin ointment and suppositories with sea buckthorn oil. Local treatment is prescribed in order to anesthetize and relieve inflammation.

Specialists among the drugs of this group highlight Procto-Glevenol. In its composition – lidocaine, which reduces pain, eliminates burning and itching, as well as tribenoside, which relieves inflammation, improves microcirculation and increases vascular tone. The drug is available in the form of rectal suppositories and cream. With complex treatment with its use in the form of cream and suppositories, the main symptoms of the disease – bleeding, pain, itching – decrease on the 7th day. By the 15th day, the symptoms of hemorrhoids during pregnancy disappear in 92.9–97.6% of cases.

Finnish tools and innovations

Medical science does not stand still in the search for new methods of treating hemorrhoids during pregnancy. Good results are given by an innovative development in which a rectal generator of sound vibrations is effectively used. The device consists of a special nozzle and a generator of sound vibrations.

The principle of its operation is based on the fact that when it vibrates at a certain frequency in the canal, the device accelerates the healing of cracks, relieves swelling, pain, secondary spasm. At its tip, a candle with oil is inserted into the anus. If necessary, this procedure can be carried out as many times as necessary, since it helps to correct the fallen internal hemorrhoids.

Eventions that alleviate the condition of a pregnant woman

Against the background of taking medications prescribed by a specialist, with hemorrhoids during pregnancy, certain actions contribute to alleviating the discomfort caused by the manifestations of the disease. They are simply carried out at home on their own. With the manifestation of even the most minor symptoms of the disease, it is necessary to prevent the possibility of diarrhea and constipation, and also to avoid tension during defecation.

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

At the earliest stages, you can use an ice pack.

Surgical therapies

Chronic hemorrhoids during pregnancy can be exacerbated by bleeding and prolapse of hemorrhoids. In such a situation, it will not be possible to do without surgical intervention. If a pregnant woman has such complications, such a minimally invasive method as infrared photocoagulation is used, in which hemorrhoids are affected during pregnancy by heat flux using infrared rays.

They also use the removal of the hemorrhoidal node using a special latex ring – ligation. Sclerotherapy is often used – chemical cauterization of the vessels that feed the nodes, and laser vaporization, in which they are cauterized by means of a laser beam. The proctologist decides to treat hemorrhoids during pregnancy surgically if the woman’s disease is severe and there is a risk of developing acute infections.

Hemorrhoid after pregnancy

If the bearing of a child by a woman who has been diagnosed with the disease has successfully ended in childbirth, this does not mean that it has disappeared by itself, since there have been many reasons that provoked it. Moreover, the process of delivery is associated with additional factors that contribute to the further development of the disease, exacerbation, the appearance of dangerous complications. Treatment of hemorrhoids after pregnancy has its own characteristics and allows the proctologist more opportunities to use drastic measures. 

So, along with the medical method of treatment, he can, within a few months after the birth of the baby, offer the mother a planned surgical operation that will save the woman from the disease. At the same time, its implementation can be combined with breastfeeding and will not require prolonged hospitalization.

Medication after pregnancy

The principle of treating hemorrhoids after pregnancy with medications is that the drugs used, both systemic and local, do not get into breast milk, do not affect the lactation process and do not pose a danger to the child. This, of course, applies to cases where the baby is breastfed. Usually, if the disease is in the first stages and proceeds in a mild form, the specialist prescribes venotonic drugs that improve blood circulation in the veins, laxative drugs. 

For topical use, rectal sea buckthorn suppositories and ointments are used. Natasild suppository is also prescribed – a medicine based on brown seaweed, the active ingredient is sodium alginate. The composition has a hemostatic and anti-inflammatory effect, helps to restore damage to the mucous membrane.

Additions of surgical techniques – laser removal

If hemorrhoids after pregnancy could not be cured in a conservative way, the doctor recommends that a woman resort to surgical methods of treatment. Depending on the patient’s history, laser removal of internal and external hemorrhoids may be proposed. This minimally invasive surgical intervention is performed on a CO2 laser. Its essence lies in the simultaneous excision and cauterization of hemorrhoids with a high-frequency laser beam without harming the tissues surrounding the node in the Channel. 

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

Ligation, laser sclerotherapy, desarterization

Hemorrhoids after pregnancy can be eliminated by ligation with latex rings. With the help of a special apparatus, they are applied to the nodes and squeeze them, which leads to tissue necrosis due to the cessation of blood circulation in the node. Blood circulation in the local veins stops, which leads to tissue necrosis. The node disappears within 10-14 days, causing the patient a minimum of discomfort. Another progressive technique is laser sclerotherapy of hemorrhoids. Consists in the introduction into the hemorrhoidal a laser fiber node, causing it to stick together and then fuse together. 

The procedure usually involves a diode laser. The most common ultrasound detection of the vessels that feed the hemorrhoids and their ligation is performed. The method is called “desarterization with mucopexia”. The internationally recognized name is Hemorroidal Artery Ligation and Recto Anal Repair or HAL and RAR.

Prophylaxis of hemorrhoids after childbirth

Prevention of the disease after the birth of the baby is no less important than during its gestation. Doctors advise for the purpose of prevention, firstly, to eat a balanced and proper diet, paying special attention to products containing a lot of dietary fiber – bran, a variety of vegetables and greens. Limited use of fermented milk products, dairy, flour products will eliminate constipation, since intestinal peristalsis improves.

Secondly, in order to prevent the disease after childbirth, experts advise drinking a lot. The volume of clean water is 30 ml per 1 kg of body weight. Of course, juices, teas and so on are not included in this amount. An active lifestyle is mandatory. It will allow you to look good, improve the condition of the pelvic floor and muscle tone – this will help daily morning exercises, yoga, swimming in the pool, Pilates. Mast have – hygiene of the anus after defecation with the exception of attempts.

Reviews

Many women who have hemorrhoids after pregnancy or during the period of bearing a baby share their feelings and impressions of going to specialists and the effectiveness of the measures they propose for the prevention and treatment of the disease. Most of them they were useful and led to good results.

So, the patient Diana, who is 5 months pregnant, thanks the proctologist for the prescribed treatment regimen, including ointments, suppositories and creams that could significantly alleviate the symptoms of the disease. 
Another woman, Maria, whose illness worsened after childbirth, shares her impressions of her sclerotherapy operation to eliminate hemorrhoids. The disease existed before, and after delivery there were complications that required surgical intervention.