I am 32 weeks pregnant and have recently found a hemorrhoid. It’s so painful, and apparently there is nothing you can really do! I’m terrified about giving birth with this thing if it doesn’t clear up. Any advice? It’s even painful to do my pelvic floor exercises.
––Anonymous
I am so sorry that happened!
Hemorrhoids are very common in pregnancy — more than 50% of pregnant people will develop hemorrhoids at some point, but not everyone will have the same severity of symptoms. Hemorrhoids themselves are normal vascular structures found in the anal canal. When they become dilated, they can protrude through the anus and cause symptoms such as pain, itching, irritation, and bleeding.
In pregnancy, they are common because of the increased blood volume and general dilation of all veins in pregnancy, and also because of the pressure exerted on the veins by the growing uterus. They develop in pregnancy for the same reasons pregnant people often develop varicose veins in their legs or vulva.
Hemorrhoids are sometimes classified as “external” or “internal” based on where in the anal canal they originate. Internal hemorrhoids start higher up, are less likely to protrude through the anus, and don’t tend to be as painful. External hemorrhoids start lower down and have similar nerves to the skin around the anus, so they hurt a lot more than internal hemorrhoids. A hemorrhoid can also thrombose, which means the blood inside it clots, which can be exquisitely painful.
The good news, though, is that hemorrhoids can be treated in pregnancy. Treatments include:
- Stool softeners to reduce the straining during bowel movements, to reduce pressure on the hemorrhoids and hopefully prevent further ones from developing
- Localized treatments such as numbing creams, steroids, or other topical treatments to reduce swelling and vein dilation
- Office surgical procedures to band hemorrhoids can sometimes be done in pregnancy
Usually if stool softeners and localized treatments do not work, I refer patients to gastroenterologists or colorectal surgeons for evaluation and possibly more aggressive treatment. If you are having that much pain and you’ve tried the typical local treatments, I would see a colorectal surgeon.
People have tried various interventions to reduce the chance of hemorrhoids developing or worsening with labor and delivery. Anal barriers have been developed to hold pressure on the anus during pushing. It is unclear if these help, and to what degree, but I do not think they are harmful.
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As someone who experienced (my even thrombosed) this during my pregnancy and even postpartum I feel your pain and I’m so sorry you have to go through it. My husband happens to be a gastroenterologist so his advice for me was to do sitz baths as often as possible. This actually helped a lot. Also increase your water intake. I was so scared of bowel movements I used to take all the stool softners there is (miralax, colase) and laxatives (fiber pills). This helped immensely. Just letting you know what worked for me because I know from experience how painful they can be.