How common are hemorrhoids during pregnancy?

From the Guidelines

Hemorrhoids are extremely common during pregnancy, affecting approximately 80% of pregnant persons, particularly during the third trimester. This high prevalence is attributed to the compression of the rectum by the gravid uterus, as well as hormonal and physiological changes that occur during pregnancy 1. The symptoms of hemorrhoids during pregnancy can include itching, pain, and bleeding, and are often exacerbated by constipation, which is also a common issue during pregnancy due to hormonal changes slowing digestion.

Some key factors that contribute to the development of hemorrhoids during pregnancy include:

• Increased pressure from the growing uterus on the pelvic veins
• Constipation caused by hormonal changes
• Increased blood volume during pregnancy
• Compression of the rectum by the gravid uterus

To prevent or alleviate hemorrhoids during pregnancy, the following strategies can be employed:

• Staying hydrated by drinking plenty of water
• Consuming fiber-rich foods, such as fruits, vegetables, whole grains, and legumes, to promote regular bowel movements
• Engaging in regular physical activity as approved by a healthcare provider
• Avoiding prolonged sitting or standing
• Using over-the-counter treatments like witch hazel pads, sitz baths, and topical creams containing hydrocortisone to reduce symptoms.

It is essential to note that most pregnancy-related hemorrhoids improve after delivery as the pressure is relieved, though they may worsen temporarily during the pushing stage of labor 1.

From the Research

Prevalence of Hemorrhoids During Pregnancy

• Hemorrhoids occur in about 40% of pregnant women and women during the postpartum period, usually during the third trimester of pregnancy and 1-2 days after giving birth 2.
• The prevalence of hemorrhoids during pregnancy is significant, making them a common ano-rectal disease at this stage 3.
• Hemorrhoids can affect the quality of life of pregnant and postpartum women, causing symptoms such as intermittent bleeding from the anus and pain 3.

Risk Factors for Hemorrhoids During Pregnancy

• Constipation during pregnancy, perianal diseases during previous pregnancy and childbirth, instrumental delivery, straining duration of more than 20 min, and weight of the newborn more than 3,800 g are associated with hemorrhoids 2.
• Pregnancy and the puerperium predispose to symptomatic hemorrhoids, which can be influenced by various factors, including dietary habits and bowel movements 3.

Management and Treatment of Hemorrhoids During Pregnancy

• Treatment during pregnancy is mainly directed to the relief of symptoms, especially pain control, using conservative management approaches such as dietary modifications, stimulants or depressants of the bowel transit, local treatment, and phlebotonics 3.
• Fiber supplement, stool softener, and mild laxatives are generally safe for pregnant women, while topical medication or oral phlebotonics may be used with special caution due to limited evidence on their safety and efficacy in pregnancy 4.
• Hemorrhoidectomy is reserved for strangulated or extensively thrombosed hemorrhoids, and hemorrhoids with intractable bleeding 4.
• Tribenoside + lidocaine can be a safe and effective option for the treatment of hemorrhoids in pregnant women, especially after the first trimester of pregnancy 5.