Pregnancy often comes with minor unforeseen ailments, such as hemorrhoids. What can be done to avoid this unpleasant occurrence?

Hemorrhoids: a minor or major issue?

Hemorrhoids are a common issue many people will experience at least once in the course of their lifetime. They are caused by the dilation of anal or rectal veins that can be promoted by various factors, including pregnancy.

It is estimated that 25 to 35% of women will be inconvenienced by hemorrhoids during pregnancy (especially during the third trimester) or after childbirth.

Hemorrhoids are generally considered to be a minor health issue that can be resolved using simple measures.

The signs and symptoms of hemorrhoids

When a woman has hemorrhoids during pregnancy, she will note certain signs or experience various symptoms, including the following:

• a burning or itching sensation in the rectal or anal area
• discomfort that is exacerbated in the sitting position
• pain during a bowel movement or in other circumstances
• difficulty evacuating stool
• bloody stools or blood in the toilet bowl after having had a bowel movement
• swollen tissue or a bump around the anus

Internal hemorrhoids, or the ones located inside the rectum, are generally less painful. However, they can sometimes cause bleeding or give the impression that the rectum is full (feeling of having to have a bowel movement). 

Hemorrhoids located around the anus generally cause more pain, itching and burning.

Lifestyle changes

The prevention and treatment of hemorrhoids during or after pregnancy is based above all on non-medicinal measures. Making simple lifestyle changes can really contribute to reducing symptoms. Here is some advice to this end.

• Constipation promotes the development of hemorrhoids. The following measures can help to prevent or eliminate it:
  • Drink plenty of fluids, preferably water.
  • Gradually increase your daily fibre intake. It is recommended that Canadians consume at least 25 grams of fibre a day.
  • In order to reach this objective, you should eat more fibre-rich foods: fruits and vegetables, legumes (dry beans, dry peas or chickpeas, lentils, etc.), nuts, grains, whole wheat products (cereals, breads, crackers, oatmeal, brown rice, etc.).
  • If you think your diet does not provide an adequate intake, consider taking a natural fibre supplement. Always speak to your pharmacist before taking an over-the-counter medication, including natural health supplements and products.
  • Exercise regularly, such as walking or swimming, by taking into account your abilities and boundaries.
• Be sure to have regular bowel movements whenever the need is felt. Do not hold back when you feel the urge to have a bowel movement.
• Avoid straining when you evacuate stool.
• Do not remain sitting on a toilet seat for an extended period.
• After a bowel movement, gently clean the affected area without rubbing, using a slightly moist paper, compress or wipe.
• Avoid lifting heavy objects.
• Do Kegel exercises. It is a pelvic floor strengthening exercise with several advantages, including reducing the risks of hemorrhoids, bladder weakness and other problems related to pregnancy or childbirth.
• Take sitz baths with warm water for about 10 to 15 minutes, two to four times a day. Do not add any other substances to the water. 

Hemorrhoid treatments

If lifestyle changes are insufficient to provide relief, you can consider medication. There are several over-the-counter drugs intended to relieve hemorrhoids that have proven effective and safe for pregnant women.

Among the treatments considered acceptable, some of them are available in the following formats: capsules, tablets, powder or liquid to be taken orally. They are especially used to prevent or eliminate constipation. If strong pain is experienced, acetaminophen (Tylenol®) can be considered.

Others are available in the following formats: cream, ointment, gel or a suppository to be applied locally in the rectum or anus. They are intended to relieve symptoms such as swelling, redness and itching.

Among the medications provided without a prescription, some should not be used during pregnancy. Again, be sure to always speak to your pharmacist, who can help you make a suitable choice to keep your health as well as your baby’s safe.

In more serious or resistant cases, various medical treatments may be considered, such as surgery. 

You should see a doctor if you:

• notice bloody or black stools
• are unable to evacuate stool
• have been constipated for more than 48 hours
• experience debilitating or alarming symptoms (e.g., fever, nausea, vomiting, abdominal pain, difficulty eating, severe fatigue, shortness of breath, etc.)
• experience sharp anal pain, and
• feel your hemorrhoids compromise quality of life or daily activities

Don’t hesitate to speak to your pharmacist for additional information about hemorrhoids during pregnancy and its treatment.