Hemorrhoids - during Pregnancy and after Birth

What they are and how to handle.

In my job as a gynecologist, I often get the question: "Mrs. Krämer, I have such an unpleasant swelling down there and now during my pregnancy or after birth it has gotten worse. What can I do?"

Then I briefly think about what it might be in the area and after checking, I try to reassure the women directly. Because if it is (as I already thought) hemorrhoids, it is annoying but not dangerous.

But how do so-called hemorrhoids - or rather enlarged hemorrhoids - develop?

Hemorrhoids in themselves are completely normal, because everyone has them. At the end of the intestinal system, around the anus, there are small, well-perfused vascular cushions - the hemorrhoids. Together with the sphincter muscles, they ensure that we do not constantly leak stool. We therefore need the hemorrhoids. During pregnancy and/or after birth changes occur in our body. Our tissue and the walls of the blood vessels lose their firmness. They become more elastic. This process is caused by hormonal changes and in particular by the hormone progesterone. Our blood volume also increases during pregnancy, which causes the blood vessels to stretch. As a result, the vascular cushion in the rectum also expands. The haemorrhoids bulge outwards and cause discomfort. 
The resulting backlog of blood causes a feeling of pressure, pain, constipation and itching in the rectal area.

Doctors divide hemorrhoids into four different degrees/stages:

• In the first stage, the hemorrhoids are only slightly pronounced, cannot be felt and can only be seen with a special microscope. Normally there are no symptoms at this stage.
• In the second stage, the hemorrhoids become visible during bowel movements, but then retract again. Possible symptoms may include itching, eczema, bleeding or a burning sensation.
• In stage 3 hemorrhoids protrude during bowel movements and do not retract back into the anal canal on their own. However, those affected can easily push back the protrusions with their finger. Symptoms can include severe pain, bleeding, oozing and stool residue in the underpants. Some report a foreign body sensation.
• In stage 4, the hemorrhoids are permanently outside the anus and cannot be pushed back into the anal canal. Symptoms can again include pain, itching, bleeding, foreign body sensation, skin irritation and sometimes even incontinence.

When I have examined the women, I can usually reassure them that although hemorrhoids are annoying, they are not normally dangerous. Only if there is a thrombosis in this area, or a 4th degree hemorrhoid causes too much discomfort a proctologist should be consulted and treatment started during pregnancy / after birth.

But what do you do now being pregnant or just haven given birth with these vascular protrusions?
Can you do anything to prevent them from getting worse?

Yes, definitely.

• For most pregnant women/ women who gave birth, the symptoms are exacerbated when they push hard during bowel movements and strain the pelvic floor. So the first tip is to use a little stool or some books to put your feet on when going to the toilet to get your knees closer to your upper body. This gives you a better angle for bowel movements and puts less strain on the pelvic floor. Do not try to press but be patient.
• Sitting baths with Tannolact or oak bark reduce itching and skin irritation. However, it is important to only dab the skin after the bath and not to rub it.
• If the pain is severe, a small inflatable swimming ring or special hemorrhoid cushion can provide relief. However, lying on your side for a short time often helps to alleviate the discomfort. Sitting for too long is a stress test for existing hemorrhoids.
• There are suppositories that contain witch hazel leaves (Hamamelisblätter) or camomile, for example, which also provide relief. There are also ointments and suppositories with a local anesthetic. However, please always consult your doctor. Zinc oxide ointments are also helpful for weeping hemorrhoids in particular.
• Diet also plays a role. If you have regular, not too firm bowel movements, this means less pressure on the rectal area. So plenty of fluids (2.5-3l/day) and a high-fiber diet (e.g. dried fruit, muesli, psyllium husks) plus regular movement / exercise help a lot here.

And after the birth - some of my patients come to me after the birth and report new complaints in the rectum.

The pressure during childbirth naturally promotes the development of larger protrusions. This is because the tissue is still soft and stretchy. The birth position can influence the development to some extent. This is because if gravity helps during the birth (upright positions), the rate of hemorrhoids is somewhat lower. In the end, strong pressure is sometimes unavoidable.

What happens then? After the birth, I can only reassure my patients that in most cases the protrusions improve significantly - but it takes time. In any case, the 4th trimester, i.e. 6-8 weeks.

In the first few weeks after the birth, care should be taken not to put too much pressure on the pelvic floor. (Using the toilet with a stool, standing up and lying down on your side, not carrying more than the baby plus the tips above) After 6-8 weeks at the earliest, it definitely helps to train the pelvic floor in a supervised postnatal course.

If the hemorrhoids continue to cause discomfort and do not go away, you should see a proctologist. There are various ways to treat hemorrhoids. For example, he can clamp them with a rubber band or use a syringe to sclerotize them.

However, it is important that you allow yourself a few weeks after the birth. The body needs this time to get back into shape hormonally and structurally.

Gravidamiga - Dr. Christine
This blog post has been prepared with the greatest possible care and does not claim to be correct, complete or up-to-date.“  Please see a doctor if in any doubt. Picture: Adobe Stock licensed.

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