Hemorrhoids are swollen veins in the anus and rectum that can cause pain, itching, and bleeding. Estimates suggest that between 30% to 40% of pregnant individuals experience them, most frequently in the third trimester. The increased likelihood of developing hemorrhoids is due to several physiological changes, including hormonal shifts that relax blood vessel walls and the growing uterus, which places added pressure on the veins in the lower pelvis and rectum. When considering treatment during gestation, the primary focus is on symptom relief and conservative care, as the condition often resolves spontaneously shortly after delivery. Surgical removal during pregnancy requires careful consideration of maternal and fetal safety versus the severity of the symptoms.
Conservative Management Strategies
Conservative management involves non-invasive, at-home measures to reduce swelling and prevent constipation. Diet modification is foundational, requiring increased daily intake of dietary fiber (approximately 30 grams) through fruits, vegetables, and whole grains. Adequate hydration, particularly water, works alongside fiber to soften stool and prevent straining, a major contributor to hemorrhoid development.
Lifestyle adjustments also provide significant relief. Individuals should avoid sitting or standing for prolonged periods and elevate their feet when resting to reduce pressure on the rectal veins. Taking a warm sitz bath, where the anal area is soaked in warm water for 10 to 15 minutes several times a day, is an effective way to soothe pain and irritation.
Topical treatments are frequently employed for localized relief, but their use must be discussed with a healthcare provider during pregnancy. Over-the-counter preparations like medicated pads containing witch hazel can reduce inflammation. For more pronounced symptoms, a provider may recommend a short-term course of topical medications containing hydrocortisone or a local anesthetic like lidocaine to manage discomfort and itching.
Safety of Invasive Procedures
Procedures such as hemorrhoidectomy, rubber band ligation, or sclerotherapy are generally deferred until after delivery. This delay minimizes risk to both the pregnant individual and the fetus, and accounts for the high likelihood of the condition resolving postpartum. Physiological changes of pregnancy, such as increased blood volume and pelvic pressure, contribute to engorgement, making surgical sites more prone to bleeding and complications.
Procedures requiring general or spinal anesthesia, such as a traditional hemorrhoidectomy, are typically avoided due to potential risks to the developing fetus, especially during the first trimester. Even minimally invasive office procedures like rubber band ligation are often postponed because the elevated pressure within the veins increases the risk of recurrence and significant pain. Specialists recommend continuing conservative management until at least six weeks postpartum, allowing the body’s vascular and muscular systems to return to their pre-pregnancy state.
In rare instances where a procedure is necessary due to intractable pain or severe symptoms, a surgeon opts for the least invasive approach, typically performed under local anesthesia. The goal in these exceptional cases is targeted symptom relief rather than complete removal of the hemorrhoidal disease. Some specialized centers have safely performed procedures like infrared coagulation or local excision for highly symptomatic cases during any trimester.
Recognizing Severe Complications
While surgical removal is usually avoided, complications may necessitate intervention during pregnancy. The most common is a thrombosed external hemorrhoid, which occurs when a blood clot forms within the swollen vein outside the anal opening. This condition causes sudden, severe pain and a firm, often purple, lump.
If diagnosed within 48 to 72 hours of formation, a specialist may perform an external thrombectomy. This simple procedure involves making a small incision under local anesthesia to remove the clot, offering rapid pain relief. This procedure is distinct from a full hemorrhoidectomy as it removes only the clot, not the entire hemorrhoid tissue, and is considered safe for both mother and fetus.
Another urgent, though rare, indication is uncontrollable bleeding or a severely strangulated hemorrhoid, where the blood supply is cut off, causing tissue death. These situations demand immediate assessment by a colorectal specialist or obstetrician, prioritizing maternal health. In these extreme circumstances, a limited surgical procedure focused on preserving tissue and stopping the immediate crisis may be performed only when conservative measures have failed.