Pregnancy Hemorrhoids: What You Need to Know

Hemorrhoids occur when vascular tissue in the anus or rectum becomes swollen and irritated. Hemorrhoids can be internal (inside the anus or lower rectum) or external (under the skin around the anus). They are not usually serious, but they can cause itching, pain, and bleeding.

Hemorrhoids affect up to 40% of pregnant people. Typically, symptoms are managed during pregnancy, and the hemorrhoids clear up after delivery.

Read on to learn why hemorrhoids are common in pregnancy and how to treat them.

Symptoms of Hemorrhoids in Pregnancy

Symptoms of hemorrhoids depend on their location. They are usually most noticeable in the third trimester.

External Hemorrhoids in Pregnancy

External hemorrhoids are located under the skin around the anus. Symptoms can include:

• A lump (or more than one) near the anus that may feel hard or tender
• Itching in the anal area
• Soreness, ache, or pain in the anal area, particularly when sitting

While cleaning the area is important, rubbing or excessive cleaning can make symptoms of external hemorrhoids worse.

Symptoms from minor external hemorrhoids tend to ease within a few days.

External hemorrhoids, and less often internal hemorrhoids, can become thrombosed. A thrombosed hemorrhoid occurs when a blood clot forms inside the hemorrhoid. This blocks blood flow, causing a sudden and severe swelling. The swelling is painful and often causes a lump that may be bluish in color.

Thrombosed hemorrhoids tend not to respond well to topical treatment, but the pain and swelling usually peak at 48 hours and resolve after four days.

Internal Hemorrhoids in Pregnancy

Internal hemorrhoids are located inside the anus.

The main symptom of internal hemorrhoids is bright-red blood on the stool (typically coating the outside), on toilet paper, or in the toilet bowl after a bowel movement. It is usually a small amount of blood, but can look like more when mixed with toilet water.

Minor internal hemorrhoids are usually painless, but ones that are prolapsed may be painful or uncomfortable. A prolapsed hemorrhoid is when the hemorrhoid comes down through the anal opening.

Causes of Hemorrhoids in Pregnancy

Pregnancy increases the chances of developing hemorrhoids for a number of reasons, including:

• Hormonal changes that cause the veins to relax
• Blood volume increases, which can cause veins to enlarge
• The growing uterus and baby increase intra-abdominal pressure, which can make it harder for the veins to empty/move blood effectively
• Constipation (including having too few bowel movements, a feeling of not passing stool completely, or having hard stools) is common in pregnancy and can cause straining during bowel movements

Having a vaginal birth can also contribute to hemorrhoids due to straining during labor and delivery.

Pregnancy Hemorrhoid Treatment

Usually, hemorrhoids that occur during pregnancy gradually resolve after giving birth. Treatment during pregnancy typically focuses on symptom relief rather than cure.

Over-the-Counter (OTC) Treatments

Fiber supplements and stool softeners are generally safe for pregnant people and can help with constipating and straining during a bowel movement.

Topical (on the skin) and oral medications lack strong evidence of safety and efficacy in pregnancy, but a short course of topical medications may be recommended under the guidance of a healthcare provider.

Home Treatments

Home remedies are the most common treatment for hemorrhoids during pregnancy.

Things you can try to relieve hemorrhoid symptoms include:

• Avoid standing or sitting for long periods of time (get up and move around or lie on your left side).
• Exercise regularly (under the guidance of your healthcare provider).
• Eat a high-fiber diet.
• Drink plenty of liquids.
• Try to avoid straining during a bowel movement.
• Soak in a warm (not hot) bath or use a sitz bath (a shallow tub) a few times a day.
• After a bowel movement, gently cleanse the area with moist toilet paper instead of dry, then gently pat dry (don't rub).
• Cool the area using an ice pack or a cloth wrung out in ice water (don't apply ice directly to the skin; instead, use a cloth).
• Use witch hazel pads on the area to relieve pain and reduce swelling.
• Do Kegel exercises, which tighten the pelvic floor.

Medical Procedures

While removal of hemorrhoids is rare, removal of a thrombosis is more common.

Thromboses are commonly removed in-office using local anesthetic, and are considered low risk to the pregnant person and fetus. Typically, patients requiring this procedure are referred to a specialist, such as a colorectal or general surgeon, to perform.

If necessary, in-office procedures can shrink hemorrhoids by creating scar tissue and cutting off blood supply to the hemorrhoids. These procedures can include:

• Rubber band ligation (RBL): A special rubber band is placed around the base of the hemorrhoid
• Sclerotherapy: A solution is injected into the hemorrhoid
• Infrared photocoagulation: Infrared light is directed at the hemorrhoid
• Electrocoagulation: A tool is used to send an electric current into the internal hemorrhoid

Never attempt these procedures yourself.

Surgery

Surgery during pregnancy and in the immediate postpartum period is uncommon and used only if the hemorrhoids are severe and other treatments have not worked.

Surgery for hemorrhoids is usually done as an outpatient procedure in the hospital under anesthesia. Surgical options include:

• Hemorrhoidectomy: The surgical removal of hemorrhoids, typically large external hemorrhoids, and prolapsing internal hemorrhoids that are unresponsive to other treatments
• Hemorrhoid stapling: A special stapling tool is used to remove internal hemorrhoid tissue and pull a prolapsing internal hemorrhoid back into the anus
  

Prevention

Ways to prevent the development or worsening of hemorrhoids are similar to the measures used to treat them, including:

• Avoiding constipation by eating high-fiber foods and staying hydrated
• Not straining during bowel movements and minimizing time sitting on the toilet
  
• Avoiding regular heavy lifting
  

When to See a Healthcare Provider

See your healthcare provider if:

• You have rectal/anal bleeding (your provider may want to rule out other possible causes of the bleeding rather than assume it is hemorrhoids).
• Your hemorrhoid symptoms do not improve within a week with home treatment.
• You are concerned or have questions.

Seek medical help right away if:

• You are bleeding heavily or have lost a lot of blood.
• You feel dizzy, light-headed, or faint, especially with bleeding.

Summary

Hemorrhoids are common during pregnancy. They are usually minor and resolve after birth. They can cause pain or itching in the anal area or rectal bleeding.

Hemorrhoids during pregnancy are typically treated with home treatments, such as by preventing constipation, using ice packs, and soaking in sitz baths. Occasionally, medical procedures or surgery may be performed in more serious cases.

A Word From Verywell

If you are experiencing hemorrhoids during pregnancy, don't worry. They are common and will most likely resolve on their own after you give birth. If your hemorrhoids are causing you concern or discomfort, speak with your healthcare provider about treatment options.