Hemorrhoids are swollen veins located in the rectum and anus, causing discomfort, itching, and bleeding. They can be internal, forming inside the rectum, or external, developing under the skin around the anus. For women, an Obstetrician-Gynecologist (OB-GYN) frequently serves as the first point of contact for diagnosis and initial management. Clarifying the extent of an OB-GYN’s role in treating hemorrhoids is important for understanding the appropriate path for care.
Connection Between Pregnancy and Hemorrhoids
The anatomical and hormonal changes during pregnancy are the primary reasons an OB-GYN is involved in hemorrhoid management. The growing uterus places mechanical pressure on the pelvic veins, impeding blood flow from the lower body and contributing to the swelling of the anal veins. This mechanical obstruction is a major factor in development, with up to 50% of pregnant women experiencing hemorrhoids, especially in later stages.
Hormonal shifts also increase susceptibility. Increased progesterone causes the smooth muscle walls of the veins to relax, making them more prone to distension and swelling. Constipation, often exacerbated by supplements, leads to straining during bowel movements, which directly stresses the rectal veins. Labor and delivery also increase pelvic pressure, which can cause new hemorrhoids or worsen existing ones postpartum.
Initial Management by an OB-GYN
An OB-GYN can effectively diagnose and manage most mild or moderate cases of hemorrhoids. The initial approach focuses on conservative, non-surgical measures aimed at reducing symptoms, as many pregnancy-related hemorrhoids resolve after childbirth. Diagnosis is made through a physical examination and a detailed patient history regarding symptoms like pain, itching, and rectal bleeding.
The primary goal of treatment is to promote regular, soft bowel movements to avoid straining, which involves recommending a high-fiber diet (25 to 35 grams per day) and increased water intake. An OB-GYN can suggest over-the-counter topical treatments, such as creams, ointments, or suppositories, to relieve discomfort and inflammation. Sitz baths, involving soaking the anal area in warm water several times a day, are frequently recommended for soothing pain and swelling. They may also advise using stool softeners or mild laxatives that are safe during pregnancy.
When Advanced Treatment is Necessary
While an OB-GYN handles conservative management, a referral to a specialist, such as a colorectal surgeon or gastroenterologist, becomes necessary. This transition is indicated when conservative treatments fail to relieve symptoms after several days or when there is persistent or significant rectal bleeding. Specialist evaluation is crucial to rule out more serious conditions that mimic hemorrhoid symptoms, such as inflammatory bowel disease or colorectal cancer.
Specialist intervention is also required for complicated hemorrhoids needing procedural treatment. For instance, a thrombosed external hemorrhoid (involving a blood clot) may need an excision procedure to relieve severe pain. Advanced procedures for internal hemorrhoids, like rubber band ligation, injection sclerotherapy, or surgical removal (hemorrhoidectomy), are typically performed by specialists. These treatments are generally postponed until after delivery, but an OB-GYN will refer the patient if the condition is severe or unresponsive to all other measures.