Hemorrhoids in Pregnancy

With pregnancy comes many emotional and physical changes, including some not-so-great conditions such as hemorrhoids. OBGYN Dr. Gleaton discusses what hemorrhoids are, their prevalence during pregnancy, and prevention and treatment options.

By Dr. Kenosha Gleaton

With pregnancy comes many emotional and physical changes, including some not-so-great conditions such as hemorrhoids. This is one of those topics that patients are often embarrassed to talk about, but don’t be! Hemorrhoids are quite common and nothing to be ashamed about. 

What are hemorrhoids?

Hemorrhoids are swollen veins in the rectum and anus. There are two types, internal and external hemorrhoids, both of which can be very uncomfortable and painful and may cause some bleeding. It’s common to develop hemorrhoids when pregnant, obese, or if you frequently strain during bowel movements. 

Hemorrhoids and pregnancy

You are more likely to get hemorrhoids when pregnant, especially in the last trimester. In fact, it has been estimated that 25% to 35% of pregnant women are affected by hemorrhoids. In certain populations, up to 85% of pregnancies are affected by hemorrhoids in the third trimester. The increase in hemorrhoids during pregnancy is usually due to constipation, an increase in blood volume, and increasing pressure on the pelvis.

How do you know if it’s a hemorrhoid or something else? Signs that it’s a hemorrhoid include seeing bright red blood after a bowel movement, rectal pain or pressure, or feeling a lump in your anal area. If it doesn’t clear up after taking the steps we outline below, it’s time to talk to your doctor. 

Seven ways to help prevent hemorrhoids

Luckily there are a several steps to help avoid hemorrhoids, and the key is to reduce strain and keep stools soft:

1. Maintain a high-fiber diet 
2. Drink plenty of fluids
3. Reduce consumption of fat, spicy foods, and alcohol 
4. Stay active! Standing or sitting for long periods of time puts strain on your body and can increase your chances of getting hemorrhoids
5. Improve anal hygiene (carefully wipe! Try wetting toilet paper with water first, and drying the anus afterwards)
6. Try not to sit on the toilet for too long or strain when having bowel movements; listen to your body and only use the restroom when your body is telling you to go
7. Performing kegel exercises can help strengthen your pelvic floor muscles and may reduce the risk of hemorrhoids 

Treating hemorrhoids with fiber

Hemorrhoids are easily treated at home and should go away within a week. One meta-analysis of seven randomized trials suggested that fiber has an apparent beneficial effect for symptoms and bleeding in the treatment of hemorrhoids.

Since passing hard stool may lead to hemorrhoids, research suggests increasing intake of fiber to help eliminate straining while having a bowel movement. In clinical studies of hemorrhoids, fiber supplementation reduced the risk of persisting symptoms and bleeding by approximately 50%. Since fiber supplementation is safe and affordable, taking fiber capsules is a commonly recommended treatment for women during pregnancy. 

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Take a hot bath to relieve pain

You may want to take a hot bath to relieve the pain. Some people like to add anti-inflammatory agents to the water, such as chamomile or tea tree oil. There isn't enough research on whether this helps with hemorrhoids, but it can certainly help you relax. Just avoid using harsh soaps since they can aggravate the sensitive skin of the anus.

Treat with a topical steroid 

Hemorrhoids may often be treated with a topical steroid cream or ointment such as hydrocortisone. These are safe in pregnancy and can help reduce inflammation and discomfort. In the early, most painful phase of hemorrhoids, a topical numbing or anaesthetic agent may be beneficial. Consult your doctor to see if that option is right for you. 

When to talk to your doctor

If you’ve made the suggested changes above and your hemorrhoids don’t get better after a week, it’s time to talk to your doctor. Or, if at any time you have severe pain and/or bleeding, definitely let your doctor know immediately.