Hemorrhoids in pregnancy

definition

Hemorrhoids are an extension of the so-called Corpus cavernosum recti, a type of vascular cushion that is located around the anus.
Together with the sphincter muscle, it ensures a sufficient seal of the intestine and is therefore an important part of the Continence organ.

When hemorrhoids cause discomfort, it is called one Hemorrhoid disease. Hemorrhoids are not uncommon during pregnancy.

Also read our main page on: hemorrhoids

causes

The exact causes for the development of hemorrhoids are not sufficiently understood. However, there are certain factors that contribute to the development of hemorrhoids during pregnancy.
A certain familial predisposition to hemorrhoids cannot be dismissed out of hand. Women with high levels of hemorrhoids in their families are therefore at greater risk of hemorrhoids in general and during pregnancy.

Furthermore, increased pressure in the abdomen seems to play a certain role in the development of hemorrhoids.
Examples of factors that can increase pressure in the abdomen are:

• Constipation,
• Obesity
• or pregnancy.

Pregnancy as such also seems to contribute to hemorrhoids to a certain extent.

However, it is wrong to view pregnancy as the cause of hemorrhoids.
Rather, it increases the risk of hemorrhoids with other negative influencing factors. Especially women who suffered from hemorrhoids outside of pregnancy have an increased risk of developing hemorrhoids again during pregnancy.

Diet and bowel habits also seem to play a role. A low-fiber diet and inadequate hydration seem to increase the risk of hemorrhoids.

In addition, both chronic constipation and chronic diarrhea are unfavorable. Constipation in particular is not uncommon during pregnancy.

Please also read: Constipation in Pregnancy

One should be careful with dissolute theories about the development of hemorrhoids during pregnancy. Although these are widespread, they are not considered secure. It is often said that water retention during pregnancy is responsible for hemorrhoids. However, this has not been proven.

Furthermore, it is often claimed that hormonal changes during pregnancy cause hemorrhoids. This is also not scientifically proven.

What are the signs?

Hemorrhoids often go unnoticed because they don't always cause symptoms.
So what are the signs of hemorrhoids during pregnancy? Depending on the severity and location of the hemorrhoids, itching and burning sensation can occur in the area of ​​the anus.

Sometimes the bowel movements, especially hard bowel movements, cause easy bleeding. These are noticeable as droplets of blood on the toilet paper.
Light bleeding is not uncommon during pregnancy as the frequent constipation often results in hard stools.

This irritates the hemorrhoids when defecating. Mucus secretions or a dull feeling in the anal area can also be signs of hemorrhoids.

Read more about this at: Symptoms of hemorrhoids

Which doctor is responsible for this?

If you suspect haemorrhoids during pregnancy, it is advisable to first consult your gynecologist and address the complaints.
They will perform a rectal exam and possibly confirm the suspicion of hemorrhoids.

The family doctor can also identify the hemorrhoids and treat them if necessary.

If the treatment of the hemorrhoids is beyond the competence of the general practitioner or gynecologist, a referral to a proctologist will be made. The treatment of hemorrhoids falls within its specialty.

Concomitant symptoms

Hemorrhoids are an uncomfortable but very common issue during pregnancy.

Depending on the severity and stage of the hemorrhoids, various accompanying symptoms can occur. However, hemorrhoids can also be completely normal - even during pregnancy.

The most common symptom is light, bright red bleeding, which is particularly noticeable when using the toilet.
The irritation caused by defecation causes slight bleeding, which usually appears as red droplets on the toilet paper.

Hemorrhoids can also be itchy or painful. But the latter is rather rare.

Much more often, hemorrhoids feel a bit "strange" to put it simply. Many pregnant women describe this as a kind of pressure feeling in the anus. Very large hemorrhoids can even feel like a foreign body

Bleeding hemorrhoids

Hemorrhoids are enlargements of blood vessels. These vessels hang together like a kind of cushion and are called Plexus designated.
So you are very well supplied with blood, so bleeding can easily occur. Light bleeding is not uncommon, especially when defecating.

The mechanical irritation, which is particularly high in very hard stool, leads to injuries to the enlarged vessels and thus to bleeding. These can vary in strength: from small drops of blood to very heavy bleeding, anything is possible.

The bleeding is bright red and can occur once or repeatedly. It is the most common hemorrhoid symptom during pregnancy. Bleeding during pregnancy is also promoted by frequent constipation and hardened bowel movements.

Pain

Contrary to popular belief, pain is a rare symptom of hemorrhoids.
Even during pregnancy, hemorrhoids rarely cause pain. However, in some cases there is pain. Small injuries to the hemorrhoids that occur during bowel movements can become inflamed and painful due to contamination with stool. The pain is especially great if the hemorrhoids are stressed by sitting or standing for long periods of time.

Special seat cushions for hemorrhoids relieve the affected area when sitting and are perceived as very pleasant by those affected.

Hemorrhoids without pain

In the vast majority of cases, hemorrhoids are painless during pregnancy.
In spite of freedom from pain, hemorrhoids can be present.

However, other symptoms such as easy anal bleeding, itching, or a burning sensation in the anus are possible signs of hemorrhoids during pregnancy, even if there is no pain. A discharge of mucus or a dull feeling in the anus can also be signs of hemorrhoids.
In advanced stages, hemorrhoids can even cause a kind of foreign body sensation in the anus, which does not have to be painful.

Treating Hemorrhoids - What Will Help?

There are several treatments for haemorrhoids during pregnancy. What they all have in common is a conservative approach. Surgical procedures are usually not common during pregnancy and are only used in exceptional situations.

In principle, hemorrhoids require treatment if they cause symptoms or if they are in an advanced stage.
In the early stages, hemorrhoids can be treated very well with conservative methods. The focus is on eliminating triggering or promoting factors. During pregnancy, increased pressure in the abdomen and constipation are factors that favor hemorrhoids. Treatment can begin at these points. Unfortunately, a genetic predisposition to hemorrhoids cannot be influenced.

During pregnancy, women should therefore pay particular attention to a diet rich in fiber and a sufficient amount of water to drink in order to avoid constipation.

Please also read: Diet in Pregnancy

Furthermore, it makes sense to pay attention to your body weight in order to reduce the pressure in the abdomen. However, that doesn't mean that excessive diets make sense. Rather, you should focus on a healthy diet and regular exercise in the form of light activities such as yoga or walks.
An average weight gain of 11 kilograms during pregnancy is normal and absolutely desirable.

To relieve the discomfort, ointments and suppositories with anti-inflammatory and pain-relieving ingredients are used. You can obtain this from your pharmacist on prescription.

Plant-based, over-the-counter ointments and suppositories - usually with hammamel extract - are also very suitable for alleviating the symptoms of pregnancy.

After the birth, parts of the hemorrhoids regress. Therefore, one should be patient and assess the final condition only about 3 months after the birth. If the hemorrhoids show no signs of regression then surgical procedures are appropriate.

Please also read: Treating hemorrhoids successfully

surgery

At an advanced stage, hemorrhoids are treated surgically. However, surgery is rarely necessary during pregnancy.

Usually the birth is awaited. Since hemorrhoids often regress or at least improve somewhat in the so-called puerperium - the time after the birth - a wait-and-see behavior is very useful.

An operation during pregnancy is only carried out in exceptional cases. Such exceptions are profuse bleeding or a prolapse of the anus (anal prolapse). However, these complications are very rare.
In this case, surgical bleeding and removal of the hemorrhoids must be performed. The preferred surgical procedure is the so-called Milligan-Morgan open hemorrhoidectomy.

Read more about this at: Surgery for hemorrhoids

Hip bath

Frequently, no drug or surgical therapy measures are necessary for hemorrhoids.

If the symptoms are less pronounced and only minor findings are made, Sitz baths can help improve the symptoms.
A recommended measure is, for example, a chamomile seat bath. To do this, fill about a handful of chamomile into one liter of water and take a hip bath for about 15 minutes after you have sieved off the chamomile.

However, the hip bath should only be viewed as a supportive measure. It cannot lead to a regression of the hemorrhoids and can therefore only be used in combination with a causal therapy.

Creams and ointments

Various creams and ointments are available for the treatment of hemorrhoids during pregnancy, which can be applied with the help of applicators.
A distinction is made between over-the-counter and prescription creams that have to be prescribed by a doctor.

During pregnancy, creams are a very good way to relieve the symptoms of hemorrhoidal disease. Doctor-prescribed creams contain either cortisones or local anesthetics.

Creams that contain cortisone inhibit the inflammation of the hemorrhoids and soothe the swelling. They may only be used for a few days and are also suitable during pregnancy.

Please also read: Cortisone in Pregnancy

Creams that contain local anesthetics - mostly lidocaine - numb the hemorrhoids superficially and so relieve the pain. These creams should also not be used for longer than 3 to 4 days.
However, if the application time is adhered to, they are also very well tolerated during pregnancy.

Please also read: Local anesthetics in pregnancy

Over-the-counter creams usually contain herbal ingredients that are supposed to help reduce swelling, itching and pain. They are also a good supportive treatment option during pregnancy. However, since the ingredients vary greatly from manufacturer to manufacturer, you should first clarify the use of over-the-counter creams with your own gynecologist. So you can be sure that these are also suitable during pregnancy. Plant-based creams often contain Hammamelis extract or Aloe Barbadensins.

Medication

The treatment of hemorrhoids takes place conservatively in the early stages - also during pregnancy.
This means that no surgical procedures are used.

Medicines play an important role in this. However, they are only suitable for symptomatic therapy and do not eliminate the cause of the hemorrhoids. The drugs are often available in the form of ointments or suppositories, which have either anti-inflammatory or pain-relieving effects, thereby relieving the symptoms.

Your family doctor may prescribe a light cortisone ointment, which is good for decongesting inflamed hemorrhoids. Cortisone ointments can also be used during pregnancy as long as their application period is limited. Usually they are only recommended for a few days.

There are also ointments that contain a light local anesthetic. These will relieve the pain in the hemorrhoid area. During pregnancy, the local anesthetic lidocaine can be used in the form of an ointment. This drug should only be used for a few days.

There are also over-the-counter creams and ointments that contain herbal ingredients. For your own safety, you should seek advice from your gynecologist or pharmacist regarding tolerability during pregnancy.

Please also read: Medication during pregnancy

Home remedies

There are several hemorrhoid home remedies that can be used to support the treatment of hemorrhoids during pregnancy. They have different starting points and effects on the complaints.

Hemorrhoid home remedies should always be part of a majority treatment. Depending on the stage of the hemorrhoids, other therapeutic options, such as surgery or sclerotherapy, must also be considered in order to induce healing.

Below are the most effective home remedies for hemorrhoids during pregnancy:

1. Regulation of stool behavior as a hemorrhoid home remedy:
   Proper stool behavior can be a causal treatment for early stages of hemorrhoids or a very good supportive measure for advanced stages. Eat a high-fiber diet and try to avoid constipation as this promotes hemorrhoids. Sufficient fluid intake also prevents constipation during pregnancy. Plums also help against constipation - as juice or dried fruit, flea seeds or apple juice.
2. Sitz baths against the complaints: chamomile seat baths or Sitz baths with oak bark reduce the itching of the hemorrhoids and cool the affected area in the acute situation.
   They are very helpful in relieving the discomfort. To do this, fill a liter of water into a seat tub. Put a handful of chamomile or oak bark into the water and then sift it out again after 15 minutes. You have to try whether a warm or a cold hip bath will help you better.

Read more about this at: Home remedies for hemorrhoids

Are the hemorrhoids a threat to childbirth?

Hemorrhoids usually do not pose a threat to childbirth, even though this is often feared by expectant mothers. They are not an obstacle to birth.
Furthermore, there is no need to be afraid of the hemorrhoids becoming inflamed during childbirth.

The pressure of contraction just causes the hemorrhoids to protrude a little more than they usually do. However, there is no danger to the birth.

Duration / forecast

One topic of understandable concern to pregnant women with hemorrhoids is the prognosis of the disease.

In principle, hemorrhoids should also be viewed as a benign change during pregnancy. They can be treated well by a variety of methods that alleviate the discomfort.
The stage of the hemorrhoids and size is important to ease of treatment, so hemorrhoids should be treated as early as possible.

Hemorrhoids often recede a little after birth. With good therapy and the avoidance of triggering factors, the unpleasant topic can usually be dealt with well.

However, hemorrhoids do not just heal on their own, which is why you should always seek additional medical advice. In the early stages, weight loss and a high-fiber diet are sometimes enough to clear the hemorrhoids. The duration of the haemorrhoid disease is an individual matter and cannot be given in a generalized manner. Gradients from several weeks to months are possible. Even after successful therapy, hemorrhoids can recur years later or during a new pregnancy.