What are Hemorrhoids in Pregnancy?

Pregnancy Hemorrhoids mainly occur 3 months before childbirth. The chance of suffering from hemorrhoids is 20-50%. Besides suffering from back pain, pregnant women also suffer the pain of hemorrhoids. For severe hemorrhoids, hemorrhoids may rupture and bleed during natural childbirth process, and increase the childbirth pain.

Underlying causes

Growing uterus and fetus cause a continuous increasing pressure on the pelvic veins and lower body vein. The lower body venous pressure makes anus, vulva and lower extremity veins to dilate causing hemorrhoids, vulvar varices, and varicose veins, vulvar varices respectively. During pregnancy, progesterone increases, bowels move more slowly, increase the chance of constipation, causing hemorrhoids or aggravate the severity.

Symptoms

Patients with less severe hemorrhoid may experience the following symptoms:

  • Anal pain
  • Little bleeding from the anus
  • Lump after bowel opening
  • Anal itchiness
  • Anal discomfort

Patients with severe hemorrhoid may experience:

  • Excessive anal bleeding
  • Severe anal pain (Thrombosed external hemorrhoid)

If hemorrhoids continue to enlarge, thrombose, and cause more pain, patients may reduce bowel movements in order to prevent pain during defecation. Over time, the stool may become dry and hard, leading to increasing constipation, hemorrhoid bleeding, or painful prolapsed thrombosed hemorrhoids.

Prevention

  • Drink plenty of water: 2 - 3 liters a day
  • Eat 2 portions of fruit and 3 portions of vegetables per day
  • Develop a daily bowel habit to prevent constipation
  • Avoid prolonged sitting or standing; change posture frequently
  • Exercise twice a week for 30 minutes each time

Is Surgery suitable for pregnant women?

Nowadays, many researches and clinical studies indicate that many drugs, treatments, and even surgery are safe for pregnant women and the growing fetus:

  • Take oral drugs to improve venous blood circulation
  • Take oral drugs to soften the stool
  • Anal suppository
  • Anal cream
  • Haemorrhoids surgery (using ultrasonic or bipolar cutter)

Please consult your surgeon for advice.

Case discussion: 30-year-old woman had Hemorrhoidectomy to cure hemorrhoids in pregnancy

Hemorrhoids occurred during her first pregnancy. As she thought it was not severe, she only used hemorrhoid ointment for conservative treatment over the years.

This time, hemorrhoids became worse from 24 weeks of pregnancy. Hemorrhoid prolapsed during bowel opening, with severe pain and there was lots of bleeding after defecation. She was diagnosed with Grade 4 hemorrhoids, with prolapse, thrombosis, and bleeding as complications.

Hemorrhoidectomy under local anesthetic was done immediately to stop the bleeding in a private hospital. It took only 25 minutes to complete the surgery. She had a smooth hospital discharge the next day after the surgery.

Before surgery, her visual analogue scale for resting pain score was 8 (scale from 0 to 10, 0 = painless, 10 = most painful). Immediately after surgery, her resting pain score was 0. One day after surgery, the resting pain score was 1. Two days after surgery, the resting pain score was 2. Three days after surgery, the resting pain score was 1. Afterwards, the resting pain score remained at 0.

Natural childbirth was successful at 40 weeks of pregnancy and her baby was in good health.