Hemorrhoids, which are swollen veins in the rectum and anus, are a common and uncomfortable reality during pregnancy. While rarely harmful, the pain and discomfort can significantly affect a pregnant person’s quality of life. Understanding the safety of surgical intervention during gestation, along with effective alternatives, is important for making informed decisions about care. This article discusses the causes of hemorrhoids in pregnancy and when surgery is considered safe before delivery.
Why Hemorrhoids Develop During Pregnancy
Physiological changes during pregnancy promote the development of hemorrhoids. The total volume of blood circulating in the body increases by up to 50% to support the growing fetus, causing veins, particularly those in the pelvic area, to swell more easily. The hormone progesterone also rises dramatically, relaxing smooth muscles, including the walls of blood vessels. This relaxation allows the veins in the anal canal to become dilated and engorged with blood.
The most significant factor relates to increased mechanical pressure within the abdomen. As the uterus expands, it exerts pressure on the inferior vena cava and the pelvic veins. This compression slows the return of blood from the lower body, causing blood to pool in the veins below the uterus. Constipation, which is frequent in pregnancy due to hormonal changes slowing the digestive tract, contributes further by increasing straining during bowel movements.
Is Elective Surgery Recommended While Pregnant?
Elective hemorrhoid surgery, such as a traditional hemorrhoidectomy, is nearly always postponed until after delivery. The primary concern is the risk the procedure and associated anesthesia pose to both the mother and the fetus. General anesthesia and the stress of a major operation increase the risk of complications, including preterm labor, miscarriage, and fetal hypoxia. Therefore, non-urgent procedures are deferred to the postpartum period.
Surgical intervention during pregnancy is reserved only for highly symptomatic and complicated cases where conservative treatment has failed. One exception is a severely thrombosed external hemorrhoid, which is a blood clot causing severe, acute pain. In this urgent scenario, a specialist may perform a simple, local excision of the clot under local anesthesia for immediate pain relief. This procedure is palliative and not a full, curative hemorrhoidectomy. If surgery is deemed unavoidable, the second trimester is the preferred time, as the risk of birth defects from anesthesia is lower than in the first trimester, and the risk of preterm labor is lower than in the third.
Safe Home and Medical Management Options
For most pregnant individuals, the initial and most effective treatment involves conservative, non-surgical measures focused on symptom relief and prevention. Increasing dietary fiber intake, primarily through fruits, vegetables, and whole grains, helps soften stools and prevent straining. Adequate hydration by drinking plenty of fluids is also necessary to keep the stool soft and manageable.
Lifestyle adjustments can further alleviate symptoms and prevent recurrence. Avoiding sitting or standing for extended periods is helpful, as this increases pressure on the rectal veins. When sitting, using a doughnut cushion can relieve direct pressure on the painful area. When resting, lying on the left side can improve blood flow by taking pressure off the inferior vena cava.
A variety of over-the-counter and prescription topical treatments are considered safe during pregnancy. Soaking the anal area in a sitz bath—a shallow, warm-water bath—for 10 to 15 minutes several times a day can relieve pain and soothe inflammation. Medicated pads containing witch hazel can be applied directly to reduce swelling and irritation. Topical preparations containing a mild anesthetic or hydrocortisone may be used for short periods, but pregnant individuals should always consult their obstetrician before use.
When to Seek Definitive Treatment After Delivery
Hemorrhoid symptoms frequently resolve without further intervention once the pregnancy is over and pressure on the pelvic veins is relieved. The body’s increased blood volume and hormonal levels return to normal in the weeks following childbirth, leading to a natural reduction in hemorrhoid size. Most healthcare providers recommend waiting through the postpartum recovery period, typically six to eight weeks, to see if the condition improves on its own.
If symptoms persist beyond this recovery time, a range of definitive non-surgical and surgical treatments can be safely considered. Minimally invasive office procedures, such as rubber band ligation, can be performed for persistent internal hemorrhoids. For more extensive or severe cases that do not respond to conservative management, an elective hemorrhoidectomy may be planned to offer a lasting solution.