Being pregnant is wonderful and miraculous, but it is also a physically demanding experience. Pregnant women must endure and adapt to many physical and hormonal changes when carrying a child, and those changes can even affect other bodily systems that aren’t directly related to the reproductive organs. One example of this is the gastrointestinal system; in addition to things like diarrhea, constipation, nausea, gallstones, and a variety of other conditions, pregnant women are also unfortunately more likely to get hemorrhoids.
What are Hemorrhoids?
Though we only hear about hemorrhoids when they’re a problem, the truth is that everyone already has them. Also known as piles, these pillow-like vascular structures surround the anal canal and lie just under the skin that encircles the anus. In a normal, healthy person, piles act as a sort of cushion that aids in the passage of stool. As clusters of veins, they are susceptible to being stretched and misshapen in a similar way as varicose veins in the upper thigh.
So even though everyone already has these structures as a normal part of gastrointestinal function, someone is said to “have hemorrhoids” when they have become swollen or inflamed. Regardless of the underlying cause, inflammation leads to swelling (also known as distension), and the swelling can become very painful. In addition to the direct discomfort of swelling and inflammation, the presence of hemorrhoids can make normal defecation and hygiene practices especially unpleasant. In fact, the discomfort can compel people to not clean the area well enough, and that can subsequently make the situation even worse.
Piles can be either internal or external. Internal hemorrhoids occur inside the lower rectal area and may not even present with symptoms. External hemorrhoids occur on the skin directly surrounding the anus and are responsible for most of the symptoms associated with the condition. A third type, known as thrombosed hemorrhoids, happens when too much blood collects in one of the clusters and causes a clot. The thrombosed versions often bleed along with causing notable pain, and if left untreated can leave behind a solid lump.
Hemorrhoids are fairly common in the United States, and it is estimated that around 5% of all Americans have them at any given time. Moreover, it is estimated that nearly half of adults over the age of 50 and around half of all pregnant women will develop a hemorrhoid problem. Symptoms vary depending on the person and the cause, but the following are some of the common symptoms:
- Anal itching
- Anal pain, particularly when seated
- Hard, tender lumps in the area around the anus
- Rectal bleeding after a bowel movement
- Prolapsed hemorrhoid (when an internal hemorrhoid protrudes from the anus)
What Causes Hemorrhoids in Pregnant Women?
In general, hemorrhoids can be caused by a variety of factors like straining during bowel movements, sitting on the toilet too long, the overuse of laxatives, or even lifting heavy objects. Chronic constipation and chronic diarrhea are also potential causes, mostly because of regularly straining and wiping associated with irregular bowel movements. Also, one of the reasons they affect half of people over 50 is that aging weakens the tissues and muscles that surround and support the rectum and anus.
For pregnant women, hemorrhoids tend to show up during the third trimester, when the fetus is larger and puts pressure on the pelvic floor and many of the organs of the digestive system. This pressure is especially notable on the perineum, the space between the anus and the vulva. As the fetus grows and the body prepares for childbirth, the combination of increased blood flow to the area and the pressure of the fetus’ weight can cause them to swell and become inflamed.
One of the other main causes of hemorrhoids in both pregnant women and all groups is constipation. For many people, a low-fiber diet can cause constipation and lead to hemorrhoids, but for pregnant women the answer is a little more complicated. During pregnancy, an increase in progesterone (a hormone associated with the relaxation of muscles, among other things) can cause bowel motility to slow down and lead to less frequent bowel movements, otherwise known as constipation. Once constipated, the additional straining during bowel movements and other factors can cause piles to become inflamed.
Tips for Managing Hemorrhoids During Pregnancy
Perhaps the best news about having hemorrhoids during pregnancy is that they usually improve or heal not long after the baby is born. In some cases, they can get worse or originally form postpartum as a result of pushing hard during delivery. Either way, there are numerous methods and home remedies for avoiding or easing the discomfort of hemorrhoids even while still pregnant:
- Regular Bowel Movements: While you can’t always control whether or not you can become constipated, taking steps to stay regular is a way to prevent hemorrhoids from becoming inflamed in the first place. Staying hydrated and increasing dietary fiber intake (through food choices or a fiber supplement) are two of the easiest ways to avoid constipation.
- Move Around: Though mobility is often reduced during pregnancy, avoiding a purely sedentary lifestyle is important. Standing or sitting for long periods of time can increase the kind of pressure on the perineum that can lead to hemorrhoids. It’s important for pregnant women to go on short walks, for example, to help improve circulation.
- Kegel Exercises: These exercises are primarily designed to prepare the pelvic floor for the birthing process, but they can also similarly improve circulation to the area of the perineum. Strengthening the pelvic floor is beneficial for delivery and the avoidance of hemorrhoids circulation and swelling problems.
- Side Sleeping: Pregnant women are already discouraged from sleeping on their backs after the first trimester, but it is additionally valuable to sleep on your side in order to reduce perineal pressure. Laying on your side can also be valuable as a technique used throughout the day to likewise reduce pressure.
- Sitz Bath: Taking a sitz bath means sitting in water up to the hips. Whether it’s just warm water or water mixed with Epsom salt or baking soda, taking a 10-minute sitz bath a few times a day can be soothing to the perineal area.
- Wipe Gently: Sometimes the instinct to wipe vigorously in order to really clean the anus can go too far and end up adding to the potential for a hemorrhoid flare up. Instead, clean and wipe the area gently. Flushable wipes can also be helpful if regular toilet paper is too harsh.
- Cold Compresses: Gently pressing a simple ice pack onto the affected area can reduce swelling and inflammation.
- Witch Hazel: Per the American College of Obstetricians (among others), witch hazel, a type of flowering shrub, is highly effective at easing both vaginal discomfort and the hemorrhoids associated with pregnancy. Witch hazel is readily available as an over-the-counter supplement at your local pharmacy.
- Medication: Over-the-counter medications like Preparation-H are designed to provide quick relief for pain and discomfort.
Like many of the bodily changes involved in pregnancy, hemorrhoids can be related to and affected by both the reproductive system and the gastrointestinal system. Indeed, pregnancy in general often has a major impact on digestive function. It is in light of this that the Women’s Center for GI Health at Cary Gastroenterology Associates offers specialized digestive care for women that is compassionate and centered on women’s needs.
Whether or not you’re pregnant, Cary Gastro is a healthcare provider dedicated to getting you the care you need. Men and women alike can be treated for hemorrhoids via hemorrhoid banding ligation, the most effective method available. If you’d like to learn more, contact us to request an appointment.
Medically Reviewed By: Juliana Miller, M.D.