Hemorrhoids during Pregnancy

What are hemorrhoids

Hemorrhoids, also referred to as piles, can be defined as varicose veins (swollen painful veins) of the anal canal or rectum ^[1]. Being one of the most common pregnancy symptoms, it affects around 50% of all pregnant women ^[2]. Although some women may develop the symptom in the first or early second trimester, it is not considered a sign of pregnancy as it is more common in the third trimester ^[3].

Signs and symptoms of hemorrhoids during pregnancy

Despite being quite harmless ^[4], the condition can be quite annoying to extremely painful, making it difficult to carry on with your daily routine. They can be classified into two types depending on the location of the swelling – internal and external hemorrhoids. The internal hemorrhoids are usually painless, causing mild discomfort and bleeding during bowel movements ^[5]. In more severe cases, the swollen veins may protrude in clusters around the rectum, leading to symptoms like:

Extreme pain and discomfort around the anus
Itching around the rectal area ^[6]
Blood in stools
Bleeding when sneezing, laughing or coughing ^[7]
Leakage of feces
A sensitive lump near the anus that may make it difficult to sit and walk ^[8]

What does a hemorrhoid look like?

Internal hemorrhoids are not visible unless extreme swelling causes them to protrude out of the anus. External swelling in the veins causes them to resemble a cluster of skin-colored rubbery lumps. However, thrombosed hemorrhoids usually have a bluish or purplish color due the presence of blood clots in the affected blood vessels ^[9].

What causes hemorrhoids during pregnancy

There are several factors believed to be responsible for a higher incidence of hemorrhoids in pregnant women, with the possible causes being:

The increased blood flow that may cause the swelling and irritation in the veins ^[10]
The higher pregnancy hormone levels slowing down the passage of food through the digestive tract, causing constipation, thus contributing to the painful symptom ^[11]
The increased estrogen levels relaxing the venous walls, making them prone to swelling and irritation ^[3]
The additional pressure applied by the growing uterus on the inferior vena cava and the pelvic veins that slow down the blood flow, increasing the pressure on the veins underneath the uterus, leading to dilation and swelling. ^{[12, 3]} (the most common cause of the problem in the third trimester ^[13])

The condition may aggravate during these nine months for those with chronic hemorrhoids, while women with a history of hemorrhoids in a previous pregnancy are also more likely to get them in a subsequent one ^[3].

Causes of hemorrhoids after pregnancy

Some women may develop the problem after labor and childbirth due to the extreme pressure of pushing during delivery [http://www.webmd.com/digestive-disorders/tc/hemorrhoids-cause].

How to prevent hemorrhoids during pregnancy

Eating plenty of fiber-rich foods (whole grains, fresh fruits, leafy green vegetables) to avoid constipation ^[14]
Drinking lots of fluids ^[15]
Avoiding standing or sitting in the same position for long periods as it may increase your risk of developing hemorrhoids by putting further pressure on the area ^[16]
Those more prone to constipation may consider talking to their physician regarding the use of over-the-counter stool softeners
Trying not to strain too much during bowel movements
sleeping on your side to reduce pressure on your backside
Keeping yourself clean by using warm water and white, unscented toilet paper after each bowel movement
Performing Kegel exercise, as it can lower the chances of hemorrhoids by improving blood circulation in the area ^[7]

How long do pregnancy hemorrhoids last

In most cases, the swollen veins shrink back to their normal size after your baby is born, as the blood volume and hormone levels go down gradually after delivery ^[3].

Post-pregnancy hemorrhoids usually go away on their own within 2 to 4 weeks, or even sooner with proper care.

How to get rid of hemorrhoids during pregnancy

Home remedies for hemorrhoids during pregnancy

Taking regular sitz bath (a large basin designed to fit into your toilet seat) or warm bath, 2 to 4 times a day for 10 minutes, to help the painful swollen veins to shrink (Make sure the water is warm, not hot as it may worsen the condition) ^[17]. You can also add some epsom salt to the bath water to relieve the pain and itching.
Placing some ice on a piece of cloth, covering it and sitting on it or applying a cold compress on the painful area (3 to 4 times a day for about 10 minutes) ^[17]
Sitting on a pillow or donut cushion to reduce the pressure on your rectum ^[18]

Natural hemorrhoid treatment in pregnancy

Cooling some witch hazel for a few hours in the refrigerator and then applying it on the affected area with clean cotton balls for relief ^[19]
Applying some dry or wet baking soda on the swollen veins; you may also add some baking soda to your bath water ^[16]
Applying essential oils such as geranium and cypress (diluted in water or witch hazel) on the external lumps, using a clean cotton ball ^[20] (however, use of these essential oils is not considered safe before the late second trimester) ^{[21, 22]}
Placing a cotton ball dipped in coconut oil on the affected area to sooth the irritation

Hemorrhoid medical treatment

There are many pregnancy-safe topical OTC creams, ointments (e.g. Preparation H, Anusol), suppositories and sprays available for treating hemorrhoids. Medicated pads infused with witch hazel or astringent lotions can help as well ^[19]. These are often recommended for curing the problem after pregnancy. However, pregnant women should consult their doctor before using them to ensure the safety of the baby.

Severe cases may call for medical procedures liker rubber band ligation or removing the hemorrhoid by infrared light, laser or freezing ^{[23, 17]}. In a rubber band ligation, the doctor ties a band around the base of the enlarged vein before surgically removing the blood clots ^[24].

A surgical procedure called hemorrhoidectomy, involving removal of the hemorrhoid under local anesthesia, may be necessary in some rare cases ^[17].

When to call the doctor

Consider contacting your health care provider in case of excessive or recurring rectal bleeding as it may indicate serious complications like an ectopic pregnancy or some life-threatening disorders such as colon cancer ^{[7, 17]}.

Hemorrhoid ICD-9 and ICD-10 Codes

Its ICD-9 code is 455 ^[25], while the ICD-10 code used for the condition in K64.8 ^[26].

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