Hemorrhoids during pregnancy

Haemorrhoids during pregnancy: Why do they occur, and what can you do?

Haemorrhoids are one of the most common - and least talked about - complaints during pregnancy and the postnatal period. Up to 25-35% of all pregnant women experience symptoms in the third trimester, and the incidence increases further in the first few weeks after childbirth [1,2]. The good news: most cases resolve on their own, and almost all can be treated without surgery.

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Why do pregnant women get haemorrhoids more often?

Three factors work together:

• Increased pressure in the pelvic veins. The growing womb presses on the vena cava and pelvic veins, making it harder for blood to flow back from the vessels in the rectum [3].
• Hormonal changes. Progesterone relaxes the blood vessel walls and slows down the bowel, which increases the risk of constipation [4].
• Pressure during childbirth. A vaginal delivery, especially with a longer pushing stage or a large baby, increases the risk of both internal haemorrhoids and thrombosed external haemorrhoids [2,5].

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Symptoms to be aware of

• Fresh, bright red blood on the toilet paper or in the toilet bowl
• Itching, burning, or a feeling of "something bulging out"
• A tender lump at the anal opening (typically thrombosed haemorrhoids)
• Discomfort when sitting down, especially after childbirth

In cases of heavy bleeding, fever or severe pain, you should always contact a doctor to rule out other causes such as an anal fissure or an abscess.

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Safe treatment during pregnancy and breastfeeding

The first choice is always lifestyle changes and local treatment - and almost all procedures can be postponed until after childbirth.

What works best:

• Fibre and fluid: 25-30 g of fibre daily and 2 litres of water. Psyllium (HUSK) is well-documented and safe during pregnancy [6].
• Lactulose can be used as a mild laxative if diet is not enough [7].
• Local anaesthetic ointments (lidocaine) used for a short time are safe, while corticosteroid ointments should only be used after consulting a doctor.
• Sitz baths in warm water for 10-15 minutes 2-3 times a day relieve both itching and pain.
• Avoid straining and do not spend more than 3-5 minutes on the toilet.

What about surgery?

Surgery is rarely recommended during pregnancy. An acute thrombosed external haemorrhoid can be evacuated under local anaesthetic within the first 48-72 hours, which provides rapid pain relief [8]. Formal surgical treatment for haemorrhoids or McGivney banding treatment is typically not offered until 6-8 weeks after childbirth, once hormones and the pelvic floor have returned to normal.

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Prevention after childbirth

• Continue with a high-fibre diet and plenty of fluid - especially if you are breastfeeding
• Use stool softeners for the first 2 weeks after delivery (lactulose or psyllium)
• Pelvic floor exercises benefit both continence and venous return
• Avoid heavy lifting for the first few weeks

Most pregnancy-related haemorrhoids resolve spontaneously within 6-8 weeks postpartum [2]. If your symptoms persist, you are welcome to contact the clinic - treatment on an outpatient basis is quick, gentle and covered by public health insurance.

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References

1. Poskus T, et al. Haemorrhoids and anal fissures during pregnancy and after childbirth: a prospective cohort study. BJOG 2014;121(13):1666-71.
2. Quijano CE, Abalos E. Conservative management of symptomatic and/or complicated haemorrhoids in pregnancy and the puerperium. Cochrane Database Syst Rev 2005;(3):CD004077.
3. Sandler RS, Peery AF. Rethinking what we know about hemorrhoids. Clin Gastroenterol Hepatol 2019;17(1):8-15.
4. Vazquez JC. Constipation, haemorrhoids, and heartburn in pregnancy. BMJ Clin Evid 2010;2010:1411.
5. Abramowitz L, et al. Anal fissure and thrombosed external hemorrhoids before and after delivery. Dis Colon Rectum 2002;45(5):650-5.
6. McRorie JW. Evidence-based approach to fiber supplements and clinically meaningful health benefits. Nutr Today 2015;50(2):82-9.
7. Rungsiprakarn P, et al. Interventions for treating constipation in pregnancy. Cochrane Database Syst Rev 2015;(9):CD011448.
8. Gebbensleben O, et al. Treatment of thrombosed external hemorrhoids - a systematic review. Coloproctology 2009;31:227-34.