- ATHENS OFFICE MED4WOMAN ATHENS
- VOLOS OFFICE MED4WOMAN VOLOS
Obstetrician-Gynecologist
PhD, University of Athens Medical School
Obstetrician-gynecologist Panagiotis Polyzos practices at the Institute of Life, the IVF Unit of IASO Maternity Hospital.
Hemorrhoids can be extremely uncomfortable, although they rarely cause serious problems, and are often due to constipation. In most cases, this symptom disappears after the birth of your baby. However, if the pain is severe or you notice bleeding, you should contact your doctor, who may suggest practical solutions or prescribe ointments to relieve the symptoms.
Hemorrhoids are blood vessels in the rectal area that have become swollen. They may cause mild or painful itching, or even bleeding from the rectum, especially during bowel movements. They are a common condition during pregnancy, particularly in the third trimester.
Some women experience them for the first time while pregnant, while others who had hemorrhoids before pregnancy are likely to have them again.
In most cases, hemorrhoids that develop during pregnancy begin to subside soon after childbirth — especially if you take care to prevent or manage constipation.
During pregnancy, hemorrhoids — as well as varicose veins in the legs or even in the vulva — often occur. The progressive enlargement of the uterus puts pressure on the pelvic veins and the inferior vena cava (a large vein on the right side of the body that carries blood from the lower limbs to the heart). This can slow down blood return from the lower part of your body and increase pressure in the veins below the uterus, causing swelling.
Constipation, a common complaint during pregnancy, can also cause or worsen hemorrhoids. In addition, the rise in the hormone progesterone during pregnancy causes the walls of your veins to relax, allowing them to swell more easily. Progesterone also contributes to constipation by slowing down your bowel movements.
Although hemorrhoids are more likely to occur during pregnancy, they are not inevitable.
First and foremost, it is important to prevent constipation as much as possible:
Adopt a fiber-rich diet (whole grains, fruits, and vegetables), drink plenty of water (8–10 glasses a day), and exercise regularly — even a brisk one-hour walk can help. If, despite a healthy diet and exercise, you still experience constipation, consult your doctor about taking a fiber supplement or a stool softener.
It is also advisable to use the toilet as soon as you feel the urge, to avoid excessive pressure in the rectal area.
Do Kegel exercises daily. These exercises involve contracting the muscles used to stop urination (but not during urination itself). They improve circulation in the rectal area and strengthen the muscles around the anus, reducing the likelihood of hemorrhoids. Kegel exercises also help tone the muscles around the vagina and urethra.
Avoid standing or sitting for long periods. If you have a sedentary job, try to stand up and walk around for a few minutes every hour.
Finally, prefer lying on your left side when sleeping, reading, or watching TV. This position helps relieve pressure on the inferior vena cava and rectal veins, promoting better blood return from the lower part of your body.
Hemorrhoids do not show up the same way in every pregnant woman. The likelihood increases as the stages of pregnancy progress and the uterus grows, while the picture depends mainly on whether they are internal or external and how swollen they have become.
They are located inside the anal canal, in an area with very few nerve endings. That is why they often do not hurt. The most common sign is a little bright red blood on the toilet paper or in the bowl after a bowel movement. As they grow, they may prolapse, meaning they come out when you strain on the toilet.
They form under the skin around the anus. The skin there is very sensitive, so they cause itching, burning, a feeling of heaviness and pain, especially when you sit for a long time. They feel like soft lumps.
During pregnancy, most women have grade 1 or 2 hemorrhoids, which are managed with simple measures. The grade matters because it determines what your doctor will recommend and what to expect after delivery.
Sometimes the blood inside an external hemorrhoid clots and forms a thrombus. The picture changes suddenly: a hard, purple or bluish lump appears at the edge of the anus and is very painful to touch, when sitting and when walking. The pain usually peaks in the first 48 to 72 hours and then gradually subsides as the clot is absorbed over one to two weeks.
A thrombosed hemorrhoid is not dangerous for the baby, and it is not related to blood clots in the leg veins. It does, however, need to be assessed by a doctor, because in very painful cases seen early, the clot can be removed through a small incision under local anesthesia, a simple procedure that can also be done during pregnancy. Do not try to squeeze it or “pop” it yourself.
Simple measures are the foundation of treatment and are often enough. They work best when you use them consistently, not only on the days you are in pain.
If you see no improvement after one week of these measures, let your doctor know.
Many pregnant women hesitate to use any cream at all. Topical products are absorbed very little and several are considered safe, but the choice should always be made after talking with your doctor, not picked off the pharmacy shelf.
The venotonic pills sold for hemorrhoids do not have enough safety data in pregnancy and should not be taken without medical advice. The same applies to herbal products and essential oils, which can irritate already sensitive skin.
Many women worry that hemorrhoids will affect labor. They do not. They are not a reason for a cesarean section and they do not make it harder to give birth.
The reverse, however, is common. In the second stage of labor, when the mother is pushing, the pressure on the pelvic veins is very high and hemorrhoids may grow or appear for the first time. That’s why many women notice them in the first days after giving birth.
Most postpartum hemorrhoids go away within a few weeks. If they are still there after your six-week checkup, talk to your gynecologist, who may refer you to a general surgeon or proctologist.
Not every pain or bleeding around the anus is a hemorrhoid. Some conditions look similar and need different treatment.
Dark or black blood, blood mixed with stool, mucus, a persistent change in bowel habits, weight loss or fever need investigation, even if you know you have hemorrhoids. In such cases, your doctor will decide whether further evaluation by a gastroenterologist is needed.
Almost never. Pregnancy hemorrhoids are caused by temporary factors, namely hormones, pressure from the uterus and constipation, which ease after the birth. That’s why procedures such as rubber band ligation or hemorrhoidectomy are postponed for at least a few months after delivery, once it is clear what remains.
The exceptions are a very painful thrombosed external hemorrhoid, which can be treated with a small incision under local anesthesia, and rare cases of heavy or persistent bleeding that causes anemia. The decision is made jointly by the obstetrician and a surgeon, depending on the week of pregnancy.
At your regular prenatal care checkups, you can mention your symptoms without embarrassment. It is one of the most common topics an obstetrician discusses, and the earlier you catch them, the easier they are to treat.
They are very common, mainly in the third trimester, because of pressure from the uterus and constipation.
In most women they go away within a few weeks.
Lukewarm sitz baths, cool compresses, avoiding sitting for long hours, and topical products recommended by your doctor.
When there is heavy or persistent bleeding, severe pain, or a hard, painful lump, which may indicate thrombosis.
Yes. Hemorrhoids are not an indication for a cesarean section and do not prevent a vaginal delivery. They may get temporarily worse from pushing, but they usually ease over the following weeks with simple measures.
No. The blood comes from the veins of the anus and is not related to the uterus or the placenta. If the bleeding is frequent or heavy, your doctor may check you for anemia. If you are not sure where the blood is coming from, you need prompt assessment.
It brings relief to some women, while in others it increases swelling because it leaves the area unsupported. A simple soft cushion often helps more, and above all, not sitting for long periods at a time.
It is possible, since the same factors return. Preventing constipation from early pregnancy, staying active every day and doing Kegel exercises significantly reduce the chances and the severity.
