How To Treat Postpartum Hemorrhoids

Giving birth to your new baby can be a meaningful and transformative experience, but it’s also quite a physical feat and has its fair share of aftereffects. One common issue many women face after childbirth is postpartum hemorrhoids. And when you’re already recovering from potential vaginal tears and other pains leftover from pregnancy, labor, and delivery, hemorrhoids can make your postpartum period even more challenging. Hemorrhoids can even affect the quality of life in some early postpartum women.¹ However, with the right knowledge and strategies, finding treatment for postpartum hemorrhoids can become more manageable. In this article, we’ll equip you with knowledge about postpartum hemorrhoids, including why they occur after birth, their symptoms, how to heal them after delivery, prevention strategies, and when to seek medical assistance.

Hemorrhoids are swollen, bulging veins just beneath the skin in the anal and rectal regions. They can cause itching, burning, swelling, pain, discomfort, and sometimes bleeding. Hemorrhoids can be internal (inside the rectum) or external (around the anus). External hemorrhoids can even form on the front part of the anal opening toward the vagina, called the perineum. They’re similar to varicose veins.^2,3

Between 40% and 70% of women develop hemorrhoids during their pregnancy and postpartum journeys, mostly during the third trimester and the month immediately following delivery.^4,5 The causes of hemorrhoids (including pressure, straining, constipation, and hormonal changes) are more prevalent in pregnant and postpartum women. This makes hemorrhoids more common after birth.^4,5,6

Popping veins around the anus are caused by excess pressure in the lower rectal and anal areas.¹⁵ Pressure in this region of the body is common during pregnancy and postpartum for many reasons.¹⁶ Factors that contribute to the development of postpartum hemorrhoids include:

The weight of the growing baby and uterus during late pregnancy can put pressure on the veins in the pelvic area, increasing the risk of hemorrhoids. While hemorrhoids can resolve within a week, they can also worsen if left untreated or if other factors exacerbate them. Hemorrhoids that develop during pregnancy can worsen postpartum due to your childbirth and postpartum experience.⁷

The pushing and straining during labor can put pressure on the rectal area, leading to the development or worsening of hemorrhoids. One study found that pushing for longer than 20 minutes was especially associated with postpartum hemorrhoids.⁴ Because straining and pushing can cause hemorrhoids, women who have had vaginal births (especially instrumental vaginal births with forceps or a vacuum) are more likely to develop hemorrhoids than women who have had C-sections. In addition to long pushing time, labors that go longer than 12 hours, pregnancies longer than 40 weeks, and birthing a baby larger than 3,800 to 4,000 grams (8lb 6oz to 8lb 13oz) are associated risk factors for hemorrhoids.⁶

One study reported that constipation is the most important risk factor for developing hemorrhoids during pregnancy and postpartum.⁵ Constipation is common during pregnancy and postpartum recovery due to dietary changes, dehydration, activity level changes, and sometimes iron supplementation.⁶ Hard stools and straining to pass those hard stools can contribute to pressure in the rectum and anus. Postpartum constipation can exacerbate existing hemorrhoids or cause new ones to form.⁴

Hormones fluctuate so much during pregnancy and postpartum and can affect the strength and elasticity of your blood vessels. The walls of your rectal veins can weaken in response to progesterone and estrogen during pregnancy, making you more susceptible to swelling and hemorrhoids. At the same time, the hormone motilin decreases, slowing down digestion and contributing to constipation. Although these hormones are more of a symptom of pregnancy than postpartum, they can cause the weakening of the veins during pregnancy to the point that they ultimately bulge during delivery and postpartum.⁶

There are many contributing factors to hemorrhoids, whether or not they’re pregnancy- and postpartum-related. You may develop hemorrhoids as a result of your labor and delivery and should look out for signs and symptoms of postpartum hemorrhoids. They can manifest with various symptoms, including:^3,8,9

• Pain or discomfort in the anal region
• Itching or irritation around the anus
• Swelling or visible or palpable lumps near the anus
• Bleeding during bowel movements
• Difficulty sitting or discomfort when sitting for extended periods

The symptoms of postpartum hemorrhoids can range from annoying to debilitating. Fortunately, several effective remedies can help alleviate the discomfort and provide postpartum hemorrhoid treatment. Here are some tips for how to heal hemorrhoids after delivery:

A sitz bath is a great option for the relief of hemorrhoid symptoms. Soak the affected area in a warm, shallow water bath for about 10 to 15 minutes several times a day to help reduce swelling and relieve discomfort. You can do this in a plastic tub that fits over your toilet or directly in the bathtub filled with a few inches of water.⁹ Sitz baths improve blood flow to the area, encourage healing, and reduce pressure and pain for hemorrhoids.⁶

You can purchase ointments, creams, balms, and suppositories over the counter that can relieve the discomfort of hemorrhoids and even shrink them. Ingredients like hydrocortisone or witch hazel can help reduce itching, inflammation, and pain. Numbing creams are also available to relieve soreness from hemorrhoids. Talk to your provider or pediatrician before using medicated products if you’re pregnant or nursing, and don’t use these products for more than one week at a time.^7,10

Cold compresses cause vasoconstriction, which helps blood vessels tighten, reducing swelling and pain in the area.¹⁰ The hospital where I delivered both of my daughters was very generous with providing ice packs in the postpartum unit. These ice packs provided relief for my perineal trauma but were equally relieving for my postpartum hemorrhoids!

Dietary changes such as consuming a high-fiber diet rich in fruits, vegetables, and whole grains — as well as drinking plenty of water — can bulk up and soften your stool. This can help prevent constipation and reduce pressure and strain in the rectal area.^7,14 If you’re suffering from constipation despite these interventions, talk to your doctor about trying a stool softener or laxative to relieve constipation and make bowel movements more comfortable.

Encouraging gentle, controlled bowel movements and avoiding straining can help prevent further irritation of hemorrhoids. Go to the bathroom when the urge strikes, but don’t sit on the toilet for too long, as this can cause hemorrhoids.^2,6

After the birth of my first baby, I would sometimes end up withholding stool because I was in the middle of feeding her, playing with her, or otherwise tending to her. In the immediate postpartum days, I also withheld because I was afraid of the pain of passing stool on my fresh perineal wounds. This only made my constipation and hemorrhoids worse by ignoring the urge to go.

Increased time sitting is associated with an increased risk of hemorrhoids.¹¹ It can be difficult to get up and move around while you’re healing from birth and tired from having a newborn, but getting off your butt (literally!) can help your hemorrhoids to heal. If you must sit, try sitting on a pillow or donut pillow to relieve pressure from the perineal area.³

Sometimes, hemorrhoids are just an unfortunate side effect of pregnancy and birth. While it may not be possible to prevent postpartum hemorrhoids entirely, certain measures can help reduce the risk of developing them:

Many providers encourage you to start pushing your baby out as soon as you hit 10 centimeters of dilation. Directed pushing, or “purple pushing,” often involves holding your breath, bearing down, and pushing as hard as you can for eight to 10 seconds at a time, multiple times during a contraction. However, if you wait to push until you experience the fetal ejection reflex, or the sometimes-unstoppable urge to push your baby out, pushing may require less effort and be more comfortable and effective. Even women who have an epidural will experience the fetal ejection reflex if they wait long enough. Waiting to push allows the force of a contraction to help push your baby out and exerts less pressure on your pelvic floor, reducing the risk of hemorrhoids.¹²

2. Maintain Good Bowel Habits

Just as straining to push a baby out can cause or worsen hemorrhoids, straining to have a bowel movement can have a similar effect. Minimize straining to stool by keeping stools easy to pass. Use the bathroom as soon as you have the urge; this way, you’re working with, not against, your body to pass your stool. Avoid constipation, and keep stools soft by consuming plenty of fiber and water, getting daily movement, and using stool softeners as needed with your doctor’s approval.²

Keeping the anal area clean and dry can prevent aggravating hemorrhoids. Consider using a gentle, unscented wet wipe or wetting your toilet paper after using the bathroom. Don’t wipe too harshly, as this can exacerbate hemorrhoids. If you have access to a bidet, postpartum is a great time to use it! Otherwise, many hospitals provide a peri-bottle or squirt bottle to rinse your bottom with warm water after using the bathroom. Gently pat yourself dry after rinsing and wiping. Avoid harsh or scented products, soaps, or wipes to prevent irritation or allergic reactions.¹³

Postpartum hemorrhoids are common and usually heal on their own with home remedies.⁶ However, if you experience any of the following, be sure to seek medical attention:

• Your symptoms persist or worsen despite home treatment: If you’ve been treating hemorrhoids at home for a week or more with no resolution or relief, it may be time to talk to your doctor about trying other solutions or interventions.⁹
• Rectal bleeding is severe or persistent: Hemorrhoids can cause slight bleeding when you wipe. Or you might notice a bit of blood on your stool or in the toilet. However, if you’re experiencing rectal bleeding, it’s important to see a doctor to rule out other causes of this condition, such as ulcerative colitis or colon cancer.⁹
• You experience signs of infection: If you develop a fever or intense, lasting, or worsening pain in the anal area, these can be signs of an infection, which sometimes needs treatment with an antibiotic. Reach out to your doctor if you have any of these symptoms.³
• You suspect a thrombosed hemorrhoid: A thrombosed hemorrhoid is when a blood clot forms within a hemorrhoid, causing a painful lump to form and get stuck in the anus. It’s usually acutely and intensely painful, and you should reach out to your doctor immediately if you experience this.⁶

Hemorrhoids after birth can be an unfortunate and annoying part of your postpartum experience. With knowledge and understanding of the causes, symptoms, and treatment options, you can take preemptive steps to alleviate discomfort and promote healing for postpartum hemorrhoids. A combination of home remedies, lifestyle modifications, and medical interventions, when necessary, can heal hemorrhoids effectively after delivery, allowing new moms to focus on postpartum healing and bonding with their newborns.