Hemorrhoids/ Piles during/after pregnancy – Causes, Symptoms, Diagnosis & Treatment

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Piles in Pregnant Women – Hemorrhoids During Pregnancy

Hemorrhoids, commonly known as piles, are swollen hemorrhoidal cushions inside the anal canal or in the skin surrounding the anus. They develop when the hemorrhoidal cushions (which are normal structures in every human being) inside the anal passage become swollen and inflamed resulting in bleeding during defecation and/ or protrusion of pile mass during defecation. There might be some painful swelling near the anal opening. Piles after delivery are very common in pregnant women, especially during the third trimester and 1st month after delivery. This is due to the excess pressure on the hemorrhoidal cushions placed by the enlarged uterus. 
 
Hemorrhoids/ Piles during/ after pregnancy can be very problematic and disturbing. Contact Piles To Smiles to get optimal care for piles during pregnancy. 

Causes of Hemorrhoids/ Piles During Pregnancy

Some of the most common causes of hemorrhoids during pregnancy are explained below- 
  • Increased Pressure on the Hemorrhoidal cushions: The pressure on the pelvic area and the lower abdomen increases significantly due to the added weight of the fetus. The pressure makes it difficult for the veins to circulate blood properly, due to which the blood starts to pool and causes swelling in these hemorrhoidal cushions. The blood volume also increases during the pregnancy to support the fetus’s growth. The added volume further increases the amount of blood pooling in the veins. 
  • Hormonal Changes: Progesterone levels increase during pregnancy which causes the veins to relax. Relaxation of blood vessels, halts the blood circulation in the hemorrhoids, leading to bleeding/ swelling/ protrusion of Pile mass during defecation. 
  • Too much straining during defecation: Straining during defecation is another factor that increases pressure in the lower abdomen and the anal region which may lead to the development of Hemorrhoids/ Piles during pregnancy.
  • Constipation: Around 16% to 39% of women get constipated during pregnancy due to the increase in progesterone levels, fetus size, iron supplements, and/or lifestyle habits. Due to constipation, the patient is more likely to strain or push hard to pass stools which can cause bleeding/ swelling/ protrusion of Pile mass during defecation.
  • Poor Dietary Habits: Eating foods that are low in fiber content increases the risk of constipation, which ultimately leads to hemorrhoids/worsens the existing condition. 
  • Inactive Lifestyle: during pregnancy, movements are restricted, as many women are advised to take rest. Which results in constipation which later leads to piles during pregnancy. 
All these factors can directly contribute to the development of hemorrhoids/ piles during pregnancy. 

Causes of Hemorrhoids/ Piles after Pregnancy or Causes of Postpartum Hemorrhoids/ Piles:

  • Straining and pushing during childbirth:  During pushing to deliver the baby, blood is forced into the veins around the anus. This causes the veins to become filled with blood that may clot and cause a thrombosed hemorrhoid. The longer the straining—particularly if it is for more than 20 minutes, the greater the chances of developing hemorrhoids.
  • An instrumental delivery (where an instrument, such as forceps, is used to assist delivery): can also increase the chances of developing postpartum hemorrhoids.

While those who have a vaginal or instrumental delivery, are more likely to develop postpartum hemorrhoids, hemorrhoids after c-section delivery can also develop; the delivery does not need to be complicated for a hemorrhoid to result.

  • Baby’s size can be another factor: Giving birth to a newborn weighing 8.4 pounds or more may increase the chances of getting postpartum hemorrhoids.
  • Constipation is also common after giving birth. In many women, this could be caused by a combination of changing hormones, pain medication, dehydration, or a fear of pain from their hemorrhoids or episiotomy site (a surgical cut made between the vagina and anus as a woman gives birth).

Symptoms of Postpartum Hemorrhoids

How will I know I have hemorrhoids after pregnancy? 
 
Hemorrhoids can be located internally or externally and sometimes switch between protruding out of or going back inside the anal passage. Symptoms of hemorrhoids after pregnancy include:
  •  Bright red bleeding from the anus during defecation
  • Feeling of something coming out from the anus which may go inside by itself or need to be pushed back manually
  • Pain/ irritation/ discomfort might be there as long as the pile mass remains outside.
  • There might be mucous discharge when the Pile mass is outside. 
  • Sitting/ standing/ movement may be very difficult because of the protruding Pile masses.
  • Painful swelling near the anus 

If any of these symptoms arise during pregnancy, it’s crucial to get in touch with an experienced proctologist to take the necessary measures to manage the condition.

Types of Hemorrhoids during/ after Pregnancy:

Depending upon the location of blood in hemorrhoidal cushions hemorrhoids during/ after pregnancy can be of the following types:
  • External hemorrhoids: These develop under the skin around the anus and are visible as they are located outside the anus. External postpartum hemorrhoids are the most common.
  • Internal hemorrhoids: These develop inside the anus and therefore are not visible. They can cause bleeding and later protrusion of Pile mass.
  • Prolapsed hemorrhoids: These form internally but protrude outside and remain outside until one tries to push them inside. Initially, these can be pushed back inside but if they remain outside for a longer period, it will become difficult to push them back. 
  • Thrombosed hemorrhoids: These occur when a blood clot forms within a hemorrhoidal cushion, obstructing the blood flow and leading to painful swelling. Thrombosed hemorrhoids can exist internally or externally.

How are hemorrhoids during pregnancy diagnosed?

Hemorrhoids during pregnancy are common enough that an experienced proctologist will likely know if someone is having hemorrhoids by the symptoms she tells. To be sure, a proctologist may:
  • Take a closer look at the anal region. An experienced proctologist can easily spot external hemorrhoids.
  • Do a digital rectal examination. He may insert a gloved finger inside the anus to feel for any internal hemorrhoids.
  • Do an anoscopy or sigmoidoscopy. They allow a proctologist to see inside the patient’s anal passage.

How to prevent Hemorrhoids/ Piles during/ after Pregnancy:

Here is something that can be done to prevent hemorrhoids/ Piles during/ after Pregnancy:
  • Take the pressure off your hemorrhoids: There is nothing one can do about the added pressure from the fetus that is putting strain on the body, but you can change your habits so that you are reducing the strain that you can control. Here are some tips:
    • Do not remain standing or sitting for too long. Instead, lay on your side to take pressure off your pelvic area and bowel.
    • When you do sit, use a donut pillow.
    • Do not strain or linger too long on the toilet while defecating. Instead, focus on relieving your constipation.
  • Avoiding constipation: Constipation often involves more straining to pass a bowel movement, increasing the risk of hemorrhoids during/ after pregnancy. To avoid constipation, ensure your diet is full of fiber-rich foods—such as vegetables, whole grains, and magnesium—and fluids. You may take a stool softener if needed after consulting your obstetrician.
  • Eat a high-fiber diet: Try to soften your stools by eating foods that are high in fiber. High-fiber foods include vegetables like broccoli and green peas, fruits like pears, legumes like lentils and black beans, as well as whole grain cereals and breads.
  • Increase liquid intake: liquid intake in any form should be encouraged. Liquid content in feces makes it soft and easy to move in the intestine.
  • Get some exercise: Try to move around more, even if it is just a short walk. Exercise helps prevent constipation. Check with your doctor before you start any exercise program during pregnancy or after giving birth. 
  • Avoid straining during bowel movements, and do not resist the urge to pass stools. Consider using a footstool to elevate the feet while sitting on the toilet. 
  • Do not delay: delaying defecation even after having an urge for defecation leads to the absorption of fluid from stool which makes it hard. So never delay/ suppress an urge to defecate to prevent pregnancy Piles. 
  • Add Kegel exercises into your daily routine to encourage healthy circulation in your anus and rectum.
  • Keep the anal region clean and dry to prevent irritation and itching. Use soft wipes to clean the area instead of soaps or cloth. 
By following these tips and instructions, women can reduce the risk of developing or progression of piles during/ after pregnancy. 

How Long Do Postpartum Hemorrhoids Last?

According to Dr. Ravinder Sharma, a leading proctologist in Delhi NCR, postpartum hemorrhoids can look very “large and alarming” right after birth but should shrink quite a bit over the next few days. They are typically most problematic for 5-7 days after childbirth but improve noticeably by two weeks postpartum. 

Proctologists agree that, while some postpartum hemorrhoids may last longer and require treatment. However, some women may experience skin tags afterward. This happens when the blood within the hemorrhoid is reabsorbed by the body, but the skin remains stretched.

When should I consult an experienced Proctologist?

You should consult a nearby proctologist if:
  • You notice any bleeding during a bowel movement. 
  • You are experiencing pain in your anal area that does not get better with at-home treatments.
  • You are experiencing painful swelling near the anus.
  • You are feeling that something is coming out during defecation which needs to be pushed back manually. 
  • You are thinking of trying over-the-counter laxatives, stool softeners, creams, oils, or supplements. Your doctor should approve any medications you take when you are pregnant.

Treatment Options for Piles During Pregnancy

There are several treatment options for women who develop piles during pregnancy. The general methods used for treatment are explained below – 
  • Lifestyle modifications, including eating habits and exercising, to alleviate the symptoms. These changes include improving dietary habits and engaging in physical activities. The diet should include fiber-rich foods, such as wheat bran, prunes, apples, pears, lentils, whole wheat bread, broccoli, tomato, citrus fruits, beans, etc. These foods improve water retention in the colon and make the stool soft to ensure they do not rub against the hemorrhoidal cushions and cause inflammation.
  • Avoid the intake of processed foods that have higher fat, sugar, and refined carbohydrates, as they increase the risk of constipation. 
  • Along with diet, the woman should also exercise regularly to improve blood circulation throughout the body and prevent blood from pooling in the rectal area. 
  • Kegel exercises are known to be helpful in pregnant women to prevent and manage piles after delivery. 
  • Use warm soaks/ Sitz Bath: A sitz bath is a small plastic tub filled with warm water that you soak in to soothe your anal region for about 10-15 minutes. It will help ease the pain and discomfort from hemorrhoids and childbirth.
  • Hemorrhoid cushions or donut pillows comfort while sitting. 
  • Non-surgical procedures, such as rubber band ligation or Kshar Karma for women. 
The most suitable treatment method is recommended by the proctologist after a thorough diagnosis of the patient’s condition. 

Is Surgery Recommended for Pregnancy Piles?

Surgery is generally not recommended for hemorrhoids during pregnancy unless the condition is very severe and other treatments have not been effective. 

The risks of piles surgery during pregnancy are very high. It can cause excessive bleeding, infection, and even premature labor. Due to this, proctologists suggest watchful waiting and lifestyle modifications to manage the condition until childbirth. Once the woman delivers the baby, surgical treatment will be considered if the piles are still problematic after delivery. 

The decision to undergo surgery during pregnancy is made by the doctor after considering the potential benefits and risks of the procedure to the woman and her child. The different types of surgical/para-surgical treatments that can be performed to treat Postpartum piles include:
  • Rubber Band Ligation: This is a para surgical treatment which involves ligation of rubber ring at the root of Pile mass. Generally, it is considered a very safe treatment option for Piles after giving birth. 
  • Ksharsutra Treatment: In this treatment; Ksharsutra – a medicated thread is ligated at the root of Pile mass. It is also another safe treatment option for hemorrhoids after delivery.  
  • Hemorrhoidectomy: This is a surgical procedure in which the hemorrhoidal tissues are removed using a scalpel. It is an invasive procedure with considerable risks and post-op complications. 
Book an Appointment to consult with the best Proctologist in Delhi NCR to manage Piles/ Hemorrhoids during pregnancy or Postpartum Hemorrhoids.
 

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