How To Care for Hemorrhoids During Pregnancy

Hemorrhoids can be a frustrating, upsetting, and even embarrassing part of some women’s pregnancy experience. Unpleasant but not uncommon, hemorrhoids during pregnancy affect at least 25-35% of pregnant women. They’re more likely to appear as pregnancy progresses toward the third trimester.¹ Having hemorrhoids during pregnancy can affect the quality of life for expectant mothers who may face self-consciousness about this health issue, as well as the physical symptoms.² Understanding what hemorrhoids are, why they occur during pregnancy, and how to manage and prevent them through self-care and medical interventions is crucial for the emotional and physical well-being of both mom and baby.

Hemorrhoids are varicose veins in the rectum and anus. The surface veins in this area, called the hemorrhoidal veins, can become inflamed and twisted during pregnancy.^1,3 Hemorrhoids can be internal, where veins pop out in the lower rectum, or external, where veins pop out surrounding the anal opening.² This venous enlargement can cause itching, burning, soreness, generalized swelling, pain with bowel movements, and bleeding from the rectum. The severity of hemorrhoids can vary from mild irritation to painful protrusions.¹

The causes of hemorrhoids are largely the same whether you’re pregnant or not; they’re caused by high abdominal and pelvic pressure. When pressure builds in your midsection, this can make rectal veins swell and pop out or protrude.² Pregnancy itself causes higher abdominal pressure as your belly grows to accommodate your growing baby. Straining, which happens when performing actions like trying to pass a bowel movement or even lifting weights, can also contribute to intra-abdominal pressure.² The physical effects of pregnancy, such as hormonal changes and constipation, can make pregnant women more susceptible to the causes of hemorrhoids.⁴

Hemorrhoids are more common during pregnancy because this is when the causes listed above are more prevalent. This is due to several factors, including:¹

Your expanding uterus and the weight of your growing baby put extra pressure on the pelvic veins and the inferior vena cava. This slows down the return of blood from the lower body, which can cause the pooling of blood and swelling of the rectal veins.⁵

The hormone progesterone surges throughout gestation to maintain a healthy pregnancy. A side effect of progesterone is that it weakens or relaxes the walls of veins, including the rectal veins. These weakened venous walls are more prone to swelling.⁴

Pregnancy hormones can slow down digestion, leading to dryer, harder stools. Abdominal pressure and dietary changes can also cause constipation during pregnancy. When women are constipated, they often strain to push out their stool. This straining further increases pelvic pressure and can cause hemorrhoids during pregnancy.⁴

Because a hemorrhoid is simply a swollen vein, it can come and go throughout pregnancy. Hemorrhoids are most common in the third trimester, and childbirth can worsen them. However, they usually resolve on their own during the early postpartum period.^1,3

While you may be looking for the fastest way to get rid of hemorrhoids during pregnancy, the treatment of pregnancy hemorrhoids consists mainly of managing their symptoms. You can manage hemorrhoid symptoms with a combination of self-care measures and medical interventions:¹¹

Self-care plays an essential role in managing hemorrhoids during pregnancy. These self-care measures include:¹¹

Drinking plenty of fluid helps soften stools to prevent constipation and straining. Have a water bottle on hand to help encourage you to drink more throughout the day. Less constipation and straining make passing bowel movements easier, which shrinks hemorrhoids and reduces associated symptoms.¹

Consuming high-fiber foods (such as fruits, vegetables, and whole grains) can also ease constipation and promote regular bowel movements. One study in particular showed that a high-fiber diet helped to relieve hemorrhoid symptoms.¹

Soaking in a shallow tub of warm or hot water can temporarily decrease rectal pressure, reduce swelling, and alleviate pain. You can do this multiple times per day for relief.⁶

Engage your pelvic floor muscles with kegel exercises as you would if you were trying to stop the flow of urine. Hold for five to 10 seconds and repeat 10 to 20 times. This exercise can strengthen your pelvic floor muscles, improve rectal circulation, and minimize hemorrhoids.⁷

You can use witch hazel for hemorrhoids to decrease swelling, constrict blood vessels, and relieve pain.⁸ If you’re wondering how to use witch hazel on hemorrhoids, look for an over-the-counter cream or ointment or ask your provider. Apply it directly to the affected area as needed. Alternatively, you can use witch hazel pads. Try them on top of an ice pack for an extra cooling and relieving effect.³

In cases of severe hemorrhoids, medical interventions may be necessary. These may include:

Over-the-counter or prescription-strength creams containing numbing agents, steroids, and anti-inflammatory agents can improve the symptoms of hemorrhoids. While none of these creams, ointments, or gels have been specifically tested for safety in pregnancy, it’s unlikely that they would cause harm to your unborn baby because of the limited systemic absorption.¹

If your hemorrhoids are protruding and bleeding, your doctor may eventually recommend a surgical procedure. Different types of procedures can either drain the swollen veins or repair the vessels using rubber bands or staples.²

Many of these interventions used to treat hemorrhoids during pregnancy can also help prevent them from emerging.

Hemorrhoids during pregnancy are common and sometimes unavoidable. However, there are steps you can take to reduce your risk of developing hemorrhoids and managing their severity:

Weight gain is essential and inevitable during pregnancy; however, it does add to abdominal and pelvic pressure. This pressure can contribute to hemorrhoids during pregnancy. Keeping your pregnancy weight gain within your provider’s suggested limits can help to minimize extra pressure and hemorrhoids.^3,8

Exercise can help you manage pregnancy weight gain. It can also decrease pressure on the pelvic area caused by prolonged sitting. Finally, exercise can encourage blood flow to keep moving and avoid pooling in the hemorrhoidal veins. Exercise during pregnancy doesn’t have to be strenuous, and actually, heavy weightlifting can worsen hemorrhoids. Instead, simply getting up from your chair to walk around and take some weight off your bottom can help prevent them.^3,4

Dietary fiber intake and adequate hydration can help prevent constipation, which is a significant risk factor for hemorrhoids. Aim for 25-30 grams of fiber per day from sources such as fruits, vegetables, and some whole grains. This will bulk up your stools and make them easier to pass, decreasing straining and the risk of hemorrhoids.^3,9

In addition to fiber, be sure you’re drinking enough fluids. A pregnant woman needs more water than the average person and should drink at least eight to 12 glasses of water per day.¹⁰ Eating a balanced diet rich in fiber and staying hydrated can also manage weight gain, another risk factor for hemorrhoids.¹

If you do develop pregnancy constipation, it can be tempting to sit on the toilet for a long time and push to try to pass stool. While this may temporarily relieve constipation, straining during bowel movements can worsen hemorrhoids. So, avoid straining during bowel movements and try not to sit on the toilet for prolonged periods. This can shrink hemorrhoidal veins inside the rectum and reduce pain. If you’re struggling to move your bowels, try other methods of softening your stool (hydration, fiber, and exercise), and try again later as soon as you feel the urge. Finally, don’t ignore the urge to use the bathroom. Getting to the bathroom as soon as you first feel like you need to can improve constipation and prevent hemorrhoids.^1,4

Hemorrhoids during pregnancy are a common discomfort, but you can manage them effectively with self-care measures and medical interventions. By understanding their causes and risk factors, expectant mothers can take proactive steps to prevent the occurrence of hemorrhoids and alleviate their symptoms when they arise. With proper care and attention, women can navigate pregnancy hemorrhoids with greater comfort and confidence.