Piles during pregnancy

During pregnancy, along with other physical changes, piles can be an additional problem. Gojnic et al. in 2005 stated that approximately 85% of pregnant women in their third trimester may report haemorrhoids. In India, piles are known to affect nearly 40 million people, but the true occurrence in pregnant women is unknown due to cultural, personal and socio-economic reasons. Piles or haemorrhoids are swollen and enlarged veins in the anal and rectal region. Depending upon their location, piles can be internal (inside the rectal region) or external (near the anal region). Depending upon the appearance and whether the haemorrhoids prolapse or not, internal haemorrhoids are further classified into four types or grades- Grade I, II, III and IV. In this blog we will discuss the causes, symptoms and treatment options available for managing piles during pregnancy.^1-3

Acute hemorrhoidal crisis can occur in the pregnant female. When medical therapy fails to relieve pain, operative intervention may be necessary. The surgeon, however, may be reluctant to operate due to potential complications to the mother and fetus. Hemorrhoidectomy in selected pregnant patients is safe in our experience.

Dr. M.G. Kartheeka – MBBS, MD(Pediatrics)

Symptoms ^4,5

Haemorrhoids in pregnancy are usually seen in the third trimester of pregnancy or after one-two days of delivery. Following are the symptoms of piles during pregnancy: 

• A burning sensation in the anal region
• Itching near the rectum and anal region
• Bleeding while urinating
• Pain in or around the anal region
• Feeling of fullness 

It is best not to avoid the management of piles during pregnancy as they may complicate the situation with bleeding, anaemia and excessive pain.

Dr Ashish Bajaj – M.B.B.S, M.D.

Causes

As your uterus gets enlarged during pregnancy, the pressure it exerts on the veins in the anal and rectal region can cause them to swell resulting in piles. In addition, the hormone progesterone relaxes the smooth muscles of the intestine and causes a reduction in their motility which results in constipation which is considered as a risk factor for piles.

Sitz bath is often one the very useful and commonly recommended measures to pregnant women suffering from piles. Talk to your doctor in case of extreme discomfort and do not let the pain stress you during pregnancy.

Dr. Arpit Verma, MBBS, MD (Pharmacology)

Risk factors: ⁴

• Constipation
• History of perianal disease (affecting areas around the anal region)
• Straining (stretching muscles) during delivery (>20 minutes)
• Normal delivery ⁵
• Newborns with birth weight > 3.8kg⁵
• Prolonged birth >12 hours⁵
• Prolonged pregnancy >40weeks⁵ 

Also Read: What is a Sitz Bath: Understanding the Benefits and Uses

Complications⁵

• Thrombosed internal haemorrhoid: Characterised by intense pain and occurs when nodules of the internal haemorrhoid gets stuck in the anal canal.
• Perianal venous thrombosis characterised by a clot or a bulge near the edge of anal region which can be extremely painful.

Hemorrhoidectomies, are not the preferred option for taking care of hemorrhoids during pregnancy. However, this type of surgery is possible and not very uncommon during pregnancy or shortly after, in case medical or other interventions are not of much help.

Dr Ashish Bajaj – M.B.B.S, M.D.

Diagnosis⁶

• Your doctor will take a detailed history and thorough physical examination to confirm hemorrhoids. 
• He/she may do a digital rectal examination to assess the presence of blood. If still a confirmed diagnosis could not be made, your doctor or proctologist will use instruments like anoscope or colonoscope. 

You should give a detailed medical history which will help the physician rule out these other causes of bleeding like inflammatory bowel disease, colorectal polyps and colon carcinoma.

Read More: 8 Best Home Remedies For Piles

Treatment⁴

If you are wondering how to treat piles in pregnancy, find out important points below. In pregnancy, the management of piles starts with conservative management which is described below:

1. Dietary recommendations: 

• Add high-fibre foods to your diet like fruits, vegetables, lentils, etc. 
• Drink plenty of fluids
• Eat at regular time intervals daily say every 3-4 hours.
• Avoid eating fried food, salty food, caffeinated beverages and chocolates.
• Eat brown rice instead of white rice.
• Eat whole grain bread instead of white bread.

2. Exercise

having a sedentary lifestyle, not exercising or actively doing any activities may increase the risk of piles. Sitting on a cushion instead of hard surface may also prevent worsening of existing haemorrhoids and formation of new ones. You should do moderate aerobic exercises like brisk walking for 20-30 minutes a day to improve bowel function. At the same time, avoid exercises or yoga which may cause exertion.

3. Behavioral recommendations: 

• Practise good anal hygiene every time after passing stools
• Avoid using soaps or hot water to wash the anal area 
•  Make a habit of emptying your bladder completely 
• Do not ignore the urge to urinate

If still you have complaints of constipation, you can consult your physician and he may prescribe you stool softeners for the same.

4. Topical relief:⁶ 

• Many over-the-counter medications like creams, ointments, lotions are available which can be topically applied for a soothing effect for pain. Placing an ice pack for a few minutes near the anal region may help reduce swelling and pain.
• Sitz bath: after each bowel movement, a 20-minute warm water bath for the hips and buttocks may help relieve irritation and itching. Ensure to gently pat and dry the anal region afterwards, avoid rubbing hard.

Medications should only be taken after consultation from a doctor. Many ayurvedic medicines for piles during pregnancy are available in the market, but you should never self-medicate.⁶

5. Minimally invasive procedures:

If conservative management does not help in piles treatment during pregnancy, the following procedures may be recommended by your doctor.⁶

• Rubber band ligation
• Sclerotherapy
• Infrared photocoagulation
• Stapled hemorrhoidopexy

If still the symptoms do not resolve, surgical excision of the piles may be needed in some women.

Read More: What is the Cost of Piles Surgery in India?

Conclusion

Pregnant women due to increased intra-abdominal pressure, constipation and hormonal changes are predisposed to piles. The management of piles starts with dietary and behavioral recommendations, exercises, topical and oral medications. If still conservative management is ineffective, minimally invasive procedures like rubber band ligation, sclerotherapy and infrared photocoagulation may be done after consulting with a doctor or proctologist. If still there is no relief, surgical excision of piles may be required.

Also Read: Headaches During Pregnancy: Causes, Remedies, and When To Seek Help

Frequently Asked Questions

Disclaimer

The information provided at this site is for educational purposes only and is not intended to be a substitute for medical treatment by any healthcare professional. As per unique individual needs, the reader should consult his/her physician to determine the appropriateness of the information provided for his/her situation.

References:

1. Staroselsky A, Nava-Ocampo AA, Vohra S, Koren G. Hemorrhoids in pregnancy. Canadian Family Physician. 2008 Feb 1; 54(2):189-90. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2278306/
2. Gojnic M, Dugalic V, Papic M, Vidaković S, Milićević S, Pervulov M. The significance of detailed examination of hemorrhoids during pregnancy. Clinical and Experimental Obstetrics & Gynecology. 2005 Jan 1; 32(3):183-4. Available at: https://europepmc.org/article/med/16433160
3. Das KD, Ghosh S, Das AK, Ghosh A, Mondal R, Banerjee T, Ali SS, Ali SS, Koley M, Saha S. Treatment of hemorrhoids with individualized homeopathy: An open observational pilot study. Journal of intercultural ethnopharmacology. 2016 Sep; 5(4):335. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5061475/
4. Poskus T, Sabonyte-Balsaitiene Z, Jakubauskiene L, Jakubauskas M, Stundiene I, Barkauskaite G, Smigelskaite M, Jasiunas E, Ramasauskaite D, Strupas K, Drasutiene G. Preventing hemorrhoids during pregnancy: a multicenter, randomized clinical trial. BMC pregnancy and childbirth. 2022 Apr 30; 22(1):374. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9055760/
5. Bužinskienė D, Sabonytė-Balšaitienė Ž, Poškus T. Perianal diseases in pregnancy and after childbirth: frequency, risk factors, impact on women’s quality of life and treatment methods. Frontiers in surgery. 2022 Feb 18; 9:35. Available at: https://www.frontiersin.org/articles/10.3389/fsurg.2022.788823/full
6. Avsar AF, Keskin HL. Haemorrhoids during pregnancy. Journal of Obstetrics and Gynaecology. 2010 Apr 1; 30(3):231-7. Available at: https://pubmed.ncbi.nlm.nih.gov/20373920/