Hemorrhoids During Pregnancy: Risk, Causes, Cure

Hemorrhoids or piles are swollen veins present within the anal canal or around the rectal area. Usually, piles do not exhibit symptoms making pregnancy unaware of its presence until the third trimester. However, they do show irritating signs & symptoms like itching, burning sensation, pain & bleeding while passing stools and lumps that can be felt around the anus. Hence, hemorrhoids during & after pregnancy happen when the pad-like blood vessels in the short tube that connects the back passage or rectum with the anus become swollen due to the increased volume of blood circulating around & also the progesterone hormone that aids to relax the walls of the blood vessels and make hemorrhoids a lot more likely condition to occur.

What Are The Risk Factors Of Haemorrhoids During Pregnancy

Piles have become a common condition nowadays, especially during the last trimester of pregnancy & also at the time of delivery due to changed dietary & lifestyle patterns owing to hormonal adaptation that causes rectal veins to be at ease resulting in the risk of constipation. Pregnancy acts as a precipitating factor to develop hemorrhoids because of hormonal triggering changes with add-on intra-abdominal pressure. Some aggravating risk factors for having piles during or after the pregnancy are;

  • Haemorrhoid is most common among female bearing baby, >30 years of age & also in those women usually with BMI > 25 Kg/m sq.
  • Personal history of peri-anal history 
  • Family history of peri-anal diseases
  • Constipation during pregnancy as the excessive straining due to hard stools causes blood vessels to become swollen.
  • Straining during the second stage of labour for >20 minutes
  • Vaginal delivery, multipara also leads to hemorrhoids at some stages of women’s life.

What Are The Causes Of Haemorrhoids During Pregnancy

Though hemorrhoids can appear at any time, most females get them in the third trimester or during labour.

A: Intra-abdominal Pressure

  • During pregnancy, a woman’s blood volume increases significantly so the veins are bigger just from being pregnant. This leads to obstructed blood flow in the lower half of the body that puts even more pressure on the blood vessels.
  • During pregnancy, the enlarging uterus size around week 25 and also the increased blood flow to the pelvic area puts more pressure on the veins that run through the anus causing them to swell & bulge outwards. 
  • The weight of the baby as it grows puts more pressure on the veins, leading to their enlargement and hence increases the probability of piles. 
  • The increased intra-abdominal pressure results in the swelling of the veins below the uterus or womb making it stretch under the weight of the growing baby. 
  • Straining to push the baby out is a lot like straining to have a bowel movement resulting in piles. 
  • Increased intra-abdominal pressure slows down the fecal movement causing excessive straining.

B: Constipation

Pregnancy hormones slow down the bowel movements during pregnancy and cause piles to develop as a result of straining during bowel movements. Constipation exacerbates the grade of piles as hard stools result in the extra straining to evacuate it that ultimately put extra pressure on the veins in the rectal area causing them to swell and bulge due to certain factors viz;

  • Higher progesterone levels result in a longer interval for the passage of stools through the intestine.
  • Lower levels of motilin, which is responsible for increased intestinal movement
  • Being dull & physically inactive
  • Taking iron and calcium supplements, which contribute to constipation
  • A low-fiber & unwholesome diet contributes to hemorrhoids

C: Prenatal supplements & vitamins

  • The prenatal supplements contain synthetic iron and calcium doses resulting in constipation issues.  

D: Toilet- habits

  • Hard & dry stools result in excessive straining, making it harder to make a bowel movement as it puts extra pressure on the veins and leads to hemorrhoids. 
  • Prolonged sitting on the toilet to try and pass the stool increases the likelihood for hemorrhoids.

What Are The Symptoms Of Haemorrhoids During Pregnancy

When the uterus gets larger throughout pregnancy, it slows down the fecal movement added by the varicosity of the hemorrhoidal veins that causes itching, burning, painful swellings in the anal area along with painful bowel movements, and bleeding. 

A: Anorectal Pain

  • The primary sign of having first degree piles along with rectal bleeding.
  • Peri-anal area, sharp/dull in character
  • Pain or discomfort, especially observed only during defecation.
  • Pain increases during defecation

B: Bleeding per rectum

  • A small amount of blood on the toilet paper while wiping after defecation.
  • Painless bleeding, usually bright red blood in colour after passing the stools.

C: Other associated symptoms

  • Itching in & around the anal area
  • A tender lump at the verge of anus
  • Feeling like the bowels still need emptying after already passing the stools.
  • Mucus discharge after defecation is also responsible for a little soiling.

How to Manage Piles During Pregnancy 

Most of the internal hemorrhoids of first and second grade can be luckily treated by consuming a fiber-rich roughage diet, usage of safe & natural stool softeners, increasing water intake, and healthy toilet habits. Piles are not inevitable while having pregnancy but the best tactic is to make sure not to become constipated. Certain dietary & lifestyle measures can be taken to decrease the likelihood of constipation and therefore straining when passing a stool. These include the following:

A: Healthy diet & lifestyle regime

  • Maintaining a diet rich in fruit like apples, banana, oranges, pears, ripe papaya, strawberries whole-grain foods, and lots of vegetables like broccoli, pumpkin, beans, sweet potatoes, lemons, garlic, radish to ensure increased intake of fiber
  • Ensuring sufficient intake of fluids, which is about 1.5 to 2 liters per day so as to avoid dehydration.
  • Engaging in regular physical activity with pregnancy-specific yoga, pranayama & brisk walk for 15 minutes at least to improve circulation.
  • Avoid standing or sitting for long stretches at a time as it can increase the chances of varicosity of veins. Try taking a brisk 5-minute walk every hour or so to improve the circulation of the pelvis and flush things out.
  • Pelvic floor exercises such as Kegel’s exercise daily help to strengthen the muscles in the pelvic area, making bowel movements easier, and preventing piles from developing. It also helps during labor and speeds up recovery afterward by increasing blood circulation of the pelvic area.
  • Stay regular with the regime of drinking plenty of water and up the fiber intake to avoid constipation.
  • Sleeping on the side and not over the back especially after the first trimester helps to reduce pressure on the anal area.
  • Use the support of cushions or donut-shaped pillows to ease the pressure around the pelvic area.

B: Healthy toileting habits

  • Adopt a habit of passing stools in the morning and/or after eating, when the bowel is likely more active.
  • Don’t hold the urge of bowels & go to the toilet straight away when having the urge. Waiting can make stools harder, drier, and more difficult to pass.
  • Elevate the feet up a low stool while bowel evacuation as it helps in easy passage of stools.
  • Avoid excessive straining while defecating, take time, or try again later after drinking lukewarm water, some fiber, or some exercise.
  • Try pressing on the muscular area between the vagina and back passage or the perineum while having bowels as it aids in the stimulation of a reflex that increases muscle tone in the rectum and may make having defecation easier.
  • Maintain anal hygiene by cleaning the anus with moist toilet paper after washing with water-stream instead of dry toilet paper and pat the area, rather than rubbing it vigorously.

C: General Ayurvedic treatment aspects

  • Cold ice pack: Use a cloth wrung out in iced water & hold it gently against the sprouted pile mass, to ease the pain.
  • Hot sitz bath with 2 tbsp of Epsom salt and lukewarm water for 15-20 minutes, twice daily by submerging the anal opening and soaking it for at least 5-10 minutes.  Pat the anal area dry with a soft washcloth or towel after soaking, as any wetness or dampness may cause irritation or itching.
  • Safe laxatives like isabgol can be used to prevent piles during pregnancy to clean out the bowels and keep the digestive system healthy.
  • Apply a topical solution of natural anti-inflammatory herbs for relief like:
  • Use coconut oil over the surrounding area of the pile mass two-three times daily to relieve pain and inflammation and should help hemorrhoids heal within a few days.
  • Apply fresh aloe vera gel, extracted from the leaves of the plant to the inflamed area for relief otherwise be sure to use pure aloe vera without added chemicals and fragrances.

After proper examination and history taking, after a normal delivery, Kshar sutra procedure can be done after 15 days, while in surgical deliveries or so-called cesarean section, it can be performed after 2-3 months of delivery. During, that period also, there are medicines that can help get rid of anal burning, bleeding and discomfort. Normally piles arising during pregnancy get reduced spontaneously after delivery of the baby but if symptoms like bleeding and prolapse of lump/mass etc are still present, consult an expert physician for medications or further suggestions.