What to Do when You Have Hemorrhoids During Pregnancy

Hemorrhoids Pregnancy

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When you imagined your pregnancy, your rosy vision may not have included all the not-so-wonderful physical experiences that can come along with welcoming a baby into the world. One of the most common physical pregnancy symptoms, hemorrhoids, can be extremely unpleasant. Read on to learn more about why hemorrhoids arise and ideas for treating them.

Where do hemorrhoids come from?

Hemorrhoids are swollen veins that show up as an itchy or painful lump just outside the anus. In the case of internal hemorrhoids, they appear inside the intestine. Both external and internal hemorrhoids can be accompanied by bleeding, which might show up as a bright red spot on the toilet paper when you wipe, and general swelling. Though hemorrhoids can be uncomfortable, they are not usually dangerous.

Hemorrhoids are common during pregnancy because hormones slow down digestion, which can lead to constipation. Supplemental iron, which care providers sometimes suggest and is common in prenatal vitamins, can also cause constipation. Constipation leads to more time on the toilet, along with possible straining, which can put pressure on the vessels in and around the large intestine and the anus. The growing uterus also puts pressure on the inferior vena cava, the large vein responsible for sending blood from the lower half of the body back to the heart. Thus the veins around the anus may not drain as well, which can also lead to swelling and increased pressure. All of this increased pressure can lead to stretching, bulging, and hemorrhoids.

Ways to treat hemorrhoids during pregnancy

The best way to deal with hemorrhoids during pregnancy is to focus on preventing constipation. Try these suggestions to avoid problems:

  • Try having a cup of warm water or pregnancy-safe tea when you wake up.
  • Drink plenty of water throughout the day. This practice helps your amniotic fluid levels stay high and keeps your digestive tract moving.
  • Be active: take walks, go swimming, dance to music you love.
  • Eat foods that are rich in fiber: veggies, fruits, whole-grain carbohydrates, legumes.
  • Talk to your care provider if you are concerned that your iron supplement is making you constipated. They might have another suggestion for ways to get more iron in your diet.
  • Practice good pooping habits: elevate your feet with a stool so that you are squatting more than sitting on the toilet, and go to the bathroom right away when you feel the urge. Try not to strain.

If you do develop hemorrhoids, you can still test out the strategies above, which likely will help your hemorrhoids get smaller or go away completely. But if you try the suggestions to no avail, there are some other treatment options available:

  • Stool softeners: many are safe during pregnancy. Speak to your care provider to get suggestions.
  • Topical hemorrhoid creams or gels: these medications generally contain some combination of painkillers, anti-inflammatory agents, and steroids. Because they are locally applied—just to the anus where the hemorrhoid is—it is unlikely that they would have adverse effects on a third trimester fetus. If you would like to try this treatment strategy, it is important to speak to your care provider to see what they would recommend.
  • Home remedies—including topical application of aloe and witch hazel, warm baths with or without Epsom salts, and cold compresses—may help relieve the immediate hemorrhoid symptoms.

The best way to deal with hemorrhoids during pregnancy is to focus on preventing constipation.

What about hemorrhoids after baby comes?

Sometimes the pressure of vaginal birth can create hemorrhoids where there were none before or worsen hemorrhoids that were already there. Healing hemorrhoids after both vaginal and cesarean birth can be further complicated by postnatal constipation, which can be especially intense after cesarean birth or if you are taking narcotic pain medications. Follow the tips above—especially the stool softeners and frequent, gentle movement—in order to give yourself the best chance of avoiding the issue.

If you have extreme pain or hemorrhoids that persist for multiple months after birth, your doctor may recommend a more aggressive treatment strategy, which could include surgery or injections of salt or botulinum toxin, though the safety of this particular treatment during lactation remains questionable.

Regardless of how severe your hemorrhoids are, seek advice from your care provider and take comfort in the fact that hemorrhoids are very common in pregnancy. You are not alone.

Abby Olena
Dr. Abby Olena has a PhD in Biological Sciences from Vanderbilt University. She lives with her husband and children in North Carolina, where she writes about science and parenting, produces a conversational podcast, and teaches prenatal yoga.

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