Hemorrhoids During Pregnancy

A. When do they occur

Hemorrhoids develop when the veins in and around the anus become swollen due to the pressure caused by the weight of your pregnant uterus and little one. The most common symptoms are anal itching and burning, and pain when you have a bowel movement. Internal hemorrhoids will bleed when a hard bowel movement passes over the swollen veins. External hemorrhoids appear as swollen, bluish-coloured lumps on the outside of the anus and are painful but usually don’t bleed.

Hemorrhoids tend to show up either in your first trimester or your last. “In the first couple of months of pregnancy, women tend to become constipated due to hormonal changes. They strain, and we know straining is a risk factor for the development of hemorrhoids,” says Arthur Zaltz, chief of obstetrics and genecology, and head of the Women and Babies program at Sunnybrook Health Sciences Centre in Toronto. In the final trimester of pregnancy, he says, your heavy uterus and little one puts pressure on nearby veins, causing tiny clumps of blood vessels in and around the rectum to bulge.

One way to prevent hemorrhoids is to minimize straining. That includes avoiding heavy lifting, like picking up your three-year-old toddler. To alleviate the strain of constipation, Toronto-based registered dietitian Cassandra Reid recommends changing your diet. Along with hormonal fluctuations, she says, constipation in pregnancy can also be caused by a lack of fiber. “Eating during pregnancy can be hard,” says Reid. “Hormonally, you might be going for more of your wants versus what you really need, which is a balanced diet.” Along with foods that are rich in fiber, Reid also suggests drinking plenty of water and taking probiotics.

When veins function normally, blood flows through them, traveling in one direction. Extra weight and pressure on the pelvis can cause the veins to swell in the lower body causing unpleasant issues, such as hemorrhoids.

Hemorrhoids are common during pregnancy, and according to the OWH, reasons include:

• pressure from the increasing weight of the developing fetus and uterus on the pelvis

• increased blood volume

• constipation

According to the National Institute of Diabetes and Digestive and Kidney Diseases Health Information Center, other common causes of hemorrhoids include:

• chronic constipation

• straining during bowel movements

• a low fiber diet

• sitting on the toilet for prolonged periods

• lifting heavy objects

• the weakening of supportive tissue around the anus

• pregnancy

B. Options for relief

Hemorrhoids due to pregnancy may gradually resolve by themselves after delivery. However, a woman can relieve the symptoms by:

consuming more fiber in their diet

• doing Kegel exercises

• lying on the left side

• using a donut cushion

• taking fiber supplements

• using stool softeners

• taking mild laxatives

• ice packs or a cold compress

• applying witch hazel to external hemorrhoids using gauze or cotton

• A person can purchase a donut cushion.

A pregnant woman can also have a sitz bath. A sitz bath may help to alleviate the symptoms of hemorrhoids, before and after birth.

Although mild laxatives, stool softeners, and fiber supplements are generally safe for pregnant women to use, topical ointments may not be safe.

Pregnant women should talk to their doctor about which medications are safe for them to use.

If a pregnant woman is experiencing a large amount of bleeding, a healthcare provider may suggest anal packing, which is an internal dressing.

In some cases, a doctor may recommend surgery to remove the hemorrhoids.

C. When to talk to your provider

If you suspect you have hemorrhoids, mention it at your next ob/gyn or midwife appointment. Don’t be embarrassed—they’ve seen this many times. It’s crucial to raise the issue if you’ve seen blood, says Zaltz, because “there can be other, more serious causes of bleeding.” Want to know sooner? Grab a mirror. If they’re the external kind, you’ll be able to see them around the opening of your anus. Internal hemorrhoids should be looked at by a doctor. Treat the symptoms Though hemorrhoids can’t be cured, the symptoms can be treated until the hemorrhoids go away on their own. Brenshaw’s case appeared seven months into her pregnancy, and she was told to manage her symptoms until after delivery. For most women, that’s the case. “They probably won’t completely disappear until after the baby is born,” warns Zaltz.

If you’re still struggling with discomfort once you’ve increased your fibre and water intake, Ottawa-based pharmacist Shelita Dattani suggests talking to your doctor about using an over-the-counter (OTC) hemorrhoid product containing pramoxine, which relieves pain. Soaking in a bath with witch hazel or Epsom salts will ease discomfort. An OTC stool softener may also help.

Discussing hemorrhoids isn’t fun—so even if the topic doesn’t come up in your prenatal class, know that a few of the women in the group are probably struggling too. “It’s not a subject people openly talk about,” says Brenshaw. “They probably prefer to talk about their kid’s poops, not their own.”