Bleeding during bowel movements after childbirth, known as postpartum rectal bleeding, is a frequent and widespread experience for new mothers. While seeing blood can be unsettling, this symptom is often due to benign conditions. Understanding the underlying causes and appropriate responses is important.
Understanding Common Causes
One of the most frequent reasons for postpartum rectal bleeding is the presence of hemorrhoids. Hemorrhoids are swollen veins located in or around the anus and lower rectum that can appear as flesh-colored, balloon-like structures. Pregnancy itself increases the likelihood of developing hemorrhoids due to increased blood volume and pressure from the growing uterus on the pelvic veins. The intense pushing during vaginal delivery can further contribute to their formation or worsen existing ones, as blood is forced into these veins, causing them to distend. Approximately 40% of women experience hemorrhoids in their last trimester of pregnancy and the initial days after childbirth.
Another common cause is anal fissures, small tears in the thin lining of the anal canal. These tears can result from straining during bowel movements, particularly when passing hard or large stools, a common issue postpartum. Hormonal changes after childbirth can make the anal mucosa more susceptible to micro-injuries, and constipation can exacerbate the problem. Both hemorrhoids and anal fissures present with bright red blood, which may be seen on toilet paper, in the toilet bowl, or on the stool itself.
Constipation is a significant contributing factor to both hemorrhoids and anal fissures in the postpartum period. Changes in hormones, pain medication, dehydration, and even fear of pain during a bowel movement can lead to constipation. Straining to pass hard stools places additional pressure on the rectal veins and can cause tears in the anal lining. Addressing constipation is often a primary step in managing and preventing these conditions.
When to Seek Medical Care
While postpartum rectal bleeding is often benign, certain symptoms warrant prompt medical attention. Contact a healthcare provider if bleeding is heavy, does not improve with self-care measures, or involves passing large amounts of blood.
The color of the blood can provide clues about its origin. Bright red blood indicates bleeding from the lower part of the colon, such as from hemorrhoids or anal fissures. Dark red or maroon blood, or black, tarry stools (melena), may signal bleeding higher up in the digestive tract and requires urgent assessment.
Other concerning symptoms that necessitate a doctor’s visit include severe pain that is not relieved by home remedies, dizziness, lightheadedness, or signs of infection such as fever. Changes in bowel habits, such as persistent diarrhea or severe constipation, accompanied by bleeding, should also be discussed with a healthcare professional. These indicators suggest the need for a thorough examination to determine the cause and ensure appropriate treatment.
Self-Care and Treatment Options
Managing postpartum rectal bleeding often begins with practical self-care measures aimed at promoting softer stools and reducing irritation. Increasing dietary fiber intake is foundational, as it adds bulk and softens stool, making it easier to pass. Foods rich in fiber include vegetables, fruits, legumes, and whole grains. Adequate hydration by drinking plenty of water is important to prevent constipation and soften stools, especially for breastfeeding mothers who have higher fluid needs.
Stool softeners, if recommended by a healthcare provider, can also aid in easing bowel movements by making stools easier to pass. Avoiding prolonged sitting and refraining from straining during bowel movements can help reduce pressure on the rectal area. Using a pillow or a foam doughnut when sitting can also provide comfort and alleviate pressure.
Warm sitz baths offer significant relief by soothing the perineal area, increasing blood flow, and promoting healing. Soaking in warm water for 15-20 minutes several times a day can reduce pain and discomfort. Applying witch hazel or ice packs wrapped in a cloth can also help reduce swelling and provide a cooling sensation. Over-the-counter topical creams and suppositories containing ingredients like hydrocortisone or witch hazel can alleviate itching and inflammation.
Should self-care measures prove insufficient, medical interventions are available. Doctors may prescribe stronger topical ointments to help relax the anal sphincter and promote healing of fissures. For persistent or severe hemorrhoids, procedures like banding or other minimally invasive options may be considered. For chronic anal fissures that do not respond to conservative treatment, minor surgical interventions might be recommended to reduce muscle tension and facilitate healing. It is important to consult a healthcare provider before starting any new treatment, particularly during the postpartum period.