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How to Manage Hemorrhoids During Pregnancy

Wendy (who prefers to not use her last name) is the mother of two boys, ages six and three. During the second trimester of both pregnancies, Wendy suffered from common hemorrhoid symptoms, including persistent pain and occasional bleeding. The pain got worse during the third trimester of her second pregnancy, but she admits she didn’t treat it continuously. It wasn’t until the birth of her second child that things began to worsen for Wendy and she became proactive in treating her hemorrhoids.

A hemorrhoid is a mass of dilated veins in swollen anal tissue that may itch or cause pain. The good news is that for most women hemorrhoids can be managed with a combination of proper diet, medication, and open dialogue with a physician.

Recognizing Hemorrhoids: What to Look For

There are several things women may notice that could indicate they have problem hemorrhoids, such as drops of blood after wiping or feeling a lump after a bowel movement. Discomfort and itching are also common. Here are the types of hemorrhoids to watch for:

External hemorrhoids are located in the opening of the anus and often do not require medical treatment unless a clot develops. They can be itchy or painful and sometimes bleed. You may feel them as lumps.

Internal hemorrhoids are located inside the anal canal. They are usually not painful, though they may itch and bleed. They can protrude (called a prolapsed hemorrhoid) and are measured on severity from first to fourth degree.

  • First degree: Will bleed but do not protrude from the anus.
  • Second degree: Will protrude on their own during a bowel movement and then go back into place. May bleed slightly.
  • Third degree: Will protrude and must be put back into place with assistance.
  • Fourth degree: Will protrude, can’t be put back into place, and contain blood clots

Managing the Pain: At-Home Treatments

You should contact your physician if you are experiencing pain. You’ll want to eliminate other possibilities including skin disease, infections, and tumors. If there has been bleeding, your colon should be examined to exclude the possibility of colon cancer and polyps.

One reason pregnant women tend to get problem hemorrhoids is frequent constipation due to hormonal changes. According to Dr. Pamela Berens, MD, professor of Obstetrics and Gynecology at the University of Texas Medical School at Houston, these changes include “increased venous pressure caused by the enlarging pelvic mass—otherwise known as the pregnant uterus and baby.”

You can ease constipation and potentially reduce hemorrhoid discomfort by exercising regularly (even gentle walking can help) and eating well-balanced, healthy meals including more fiber and liquids. Doctors may suggest a bulk stool softener or fiber supplement.

Despite drinking lots of fluids, LeBron’s situation didn’t improve. Her symptoms were accentuated by pregnancy but didn’t disappear after delivery. This is a common problem for many new moms, particularly if there were difficulties with a vaginal delivery or the use of pain medications with C-sections, which increase the likelihood of becoming constipated, explains Dr. Berens. “Studies report that 30 percent of women still experience hemorrhoids eight weeks after delivery,” she adds.

Wendy advises new moms to be proactive in treating constipation so it doesn’t lead to bad hemorrhoids or fissures, or small tear in the anal canal. “Use prune juice, stool softeners, and other safe remedies to keep your stool loose,” says Wendy. “Keep in mind that what works for one mom may not work for another—fiber product and mineral oil did nothing for me.”

Wendy admits she avoided taking stool softeners and sitz baths which ultimately led to more painful hemorrhoids and a fissure that had to be surgically removed. “If I would have followed with my self-care until I was fully healed, I could have avoided a lot of pain,” says Wendy.

So how can women learn from Wendy? Don’t ignore your symptoms and be proactive in solving your problem. Dr. Brad Imler, MD, president of the American Pregnancy Association, suggests the following to help tackle your hemorrhoids:

  • Place baking soda (as a wet paste or in dry powder form) in the area to remove the itch.
  • Take warm baths with baking soda and herbal sitz baths which increase circulation to the area. Herbs such as witch hazel, shepherd’s purse, lavender, and juniper help reduce swelling and speed up recovery.
  • Use witch hazel or lemon juice to reduce swelling and bleeding.
  • Use Tucks pads. Analgesic ointments such as Preparation H are helpful as well.
  • Use comfrey, which heals irritated skin, or yellowdock root ointment, which is soothing. Both can be found at organic and natural stores.

Dr. Moran also suggests ice packs and cool witch hazel compresses for reducing pain and inflammation.

Minimizing Hemorrhoids: What You Can Do

Hemorrhoids can’t be prevented, says Dr. Berens, “But some risk factors can be minimized such as constipation and eating a healthy diet with fiber.”

The American Pregnancy Association also suggests:

  • Drinking plenty of fluids, including prune juice
  • Eating fruits and vegetables
  • Eating a diet high in fiber—either by increasing your daily intake to 20 to 30 grams of fiber with food or with the assistance of fiber supplements
  • Not delaying going to the bathroom

Curing Hemorrhoids: Additional Treatments

Taking the advice of increasing water consumption, eating a high fiber diet, and using topical treatments and sitz baths may not always be enough. If your pain persists you may be in need of additional treatment—and there are several options available to you.

Non-surgical treatments for hemorrhoids include:

  • Bipolar coagulation: The use of special probes helps stop blood flow to the hemorrhoid and is effective for bleeding internal hemorrhoids.
  • HAL (Hemorrhoidal Arterial Ligation): A knot is tied to stop blood flow to the hemorrhoid.
  • Rubber Banding: A band is placed over the hemorrhoid to stop blood flow which causes the hemorrhoid to wither away within a few days. This procedure is commonly used for internal hemorrhoids and is one of the most popular treatments today.
  • Freezing: Liquid nitrogen freezes the tissue and new tissue is ultimately formed.

Surgery may be required for hemorrhoids when bleeding cannot be controlled and there are several hemorrhoids both internal and external. As with any surgery there is a greater cost and risk involved as well as a longer period of recovery. Even when surgery fixes the problem, it is essential that a good diet and changes in managing bowel movements takes place to avoid other outbreaks.

Getting Better: Be Proactive

If you choose to ignore your symptoms or feel uneasy about seeing a doctor for your pain, you run the risk of increasing that pain, which can lead to constipation, more pain, and serious hemorrhoid problems.

The good news is that most people can manage their hemorrhoids with at-home treatments. There may be reoccurrences from time to time, but with the proper healthy habits in place, communication between you and your doctor, and knowledge of your treatment choices you can quickly minimize your pain and avoid surgical treatment.

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