Hemorrhoids during pregnancy

Every second woman faces such a problem as hemorrhoids during pregnancy. After childbirth the condition worsens, so you should not ignore the first symptoms and seek medical help in time. With the development of hemorrhoids, blood circulation processes in the pelvic area are disturbed, and nodes are formed.

When the disease progresses, these nodes become inflamed, and their bleeding and prolapse appear. All this is accompanied by severe discomfort and pain. Treatment of hemorrhoids in pregnant women directly depends on the severity of the condition and the severity of the symptoms.

What are hemorrhoids and why are they important?

Hemorrhoids are vascular plexuses located under the mucous membrane of the rectum and around the anal sphincter. They are a collection of veins and arteries immersed in a spongy structure.

Types are:

• Internal (located in the submucosal layer of the rectum).
• External (located in the anal sphincter area).

How it works.

• When emptying the rectum, the blood vessels spasm, and the cavernous bodies become smaller in volume, so the contents leave the body without problems.
• After emptying the intestine, the place is vacated, the vessels dilate and fill with blood, the spongy (cavernous bodies) acquire their original shape, and the anal sphincter closes.

If for some reason (for example, due to constipation), there is a violation of the emptying of the rectum, the hemorrhoids remain enlarged and filled with blood. This leads to venous stasis, thrombosis and inflammation in this area. This is how hemorrhoid itself is formed.

Stages of development of hemorrhoids during pregnancy

According to the nature of the course, acute thrombosis of hemorrhoids and chronic hemorrhoids are distinguished.

Acute thrombosis of hemorrhoids is possible even when nothing changes in the hemorrhoidal plexuses. However, with a sudden impact of a traumatic factor, such as constipation, diarrhea, heavy physical exertion, or long sitting during bowel movements, the venous outflow from the hemorrhoidal plexus slows sharply, contributing to the formation of a blood clot.

A gradual slow development characterizes chronic hemorrhoids with an increase in symptoms.

Types of hemorrhoids

Depending on the localization, doctors distinguish:

• External (damage to the anal sphincter nodes) hemorrhoids.
• Internal (damage to the nodes of the submucosal rectum) hemorrhoids.
• Combined hemorrhoids (both are affected).

According to the speed and nature of the increase in symptoms, they distinguish:

• Acute hemorrhoids (thrombosis is necessarily present); maybe with bleeding and inflammation and may be without them.
• Acute hemorrhoids complicated by thrombosis, bleeding, or inflammation is always treated in a hospital.
• Chronic hemorrhoids, which are characterized by an increase in varying degrees and prolapse of hemorrhoids
• Acute hemorrhoids are almost always a complication of chronic.

Causes of hemorrhoids during pregnancy

Both external and internal factors play an essential role in the development of the disease.

External factors include :

• Deficiency of fiber and water in the diet (less than 20 g and 1 liter per day).
• Rare meals (less than three times a day).
• Sedentary lifestyle.
• Sports activities associated with heavy weight lifting.
• An extended stay in the toilet (more than 15 minutes) and excessive straining during bowel movements.

Internal factors include :

• Changes in hormonal levels, primarily due to progesterone, slow down intestinal contractility.
• Chronic constipation (according to statistics, 11 to 38 % of pregnant women suffer from constipation).
• Dense stool consistency.
• Frequent diarrhea.
• Heredity.
• Age changes.

Many people mistakenly think that hemorrhoids appear only in case of straining in natural childbirth. It does not threaten women who give birth by surgery (cesarean section). It’s not like that at all. The stress of childbirth is just one minor reason why hemorrhoids can occur.

Among the most common causes of hemorrhoids during pregnancy are:

1. Constipation and difficulty with defecation. During the gestation period, disturbances in the digestive system are often observed. The ever-growing fetus puts a lot of pressure on the entire intestine. Peristalsis is disturbed. There are difficulties with emptying the rectum. In excretion, the woman is forced to make efforts and constantly push.
2. Growing uterus. The fetus grows, and the uterus enlarges. It exerts intense pressure on the walls of the intestinal tract. This disrupts the full circulation of blood in the pelvic organs. Hemorrhoids begin to become inflamed and bleed.
3. Unbalanced nutrition. During the period of bearing a child, many women are faced with the fact that their body requires unusual products. Many people crave spicy and salty foods. If the menu contains foods with a lot of spices, blood flow to the pelvic organs increases, which can also provoke the development of hemorrhoids.
4. Leading a sedentary lifestyle. In the early stages of gestation, physical inactivity may be associated with the threat of spontaneous abortion. The woman is forced to stay in bed. In the second and third trimesters, an activity often decreases. With prolonged physical inactivity, stagnation of blood occurs in the pelvic organs. Hemorrhoids increase in size and begin to become inflamed.
5. Changes in the hormonal background. The production of progesterone and prolactin increases, and the body prepares for the further bearing of the child and breastfeeding. Hormonal surges also cause blood stasis and swelling.
6. Weight set. Normally, a woman during gestation should gain no more than 10-12 kilograms due to the baby and amniotic fluid. But various factors cause weight gain to exceed these figures. This also negatively affects the condition of the veins and hemorrhoids.
7. Pregnant women are often prescribed iron and calcium supplements by gynecologists. These substances cause constipation and digestive disorders.

Hemorrhoids often develop during pregnancy in the 2nd trimester, from about 14-15 weeks. At this time, there is an active growth of the fetus and weight gain in the pregnant woman. The load on all internal organs increases, and there is pressure on the rectum. In most cases, such a problem is encountered in the third trimester since the load on the internal organs is maximum during this period.

That is why expectant mothers are the most vulnerable category regarding hemorrhoids.

Hemorrhoids in pregnant women in different trimesters

After the fetal egg is attached to the walls of the uterus, cardinal hormonal changes begin in the body. All changes are aimed at preserving and enduring the child. These hormonal changes affect all internal organs and systems. The digestive system functions in a new way. There are difficulties with bowel movements. 

In the first trimester of gestation, a problem such as constipation often appears. With systematic stool retention, intra-abdominal pressure increases since a woman must constantly strain during defecation.

If the stool is too hard, microcracks and injuries occur in the vessels and the rectum. And this is fraught with bleeding, an increase in the size of hemorrhoids. If such changes occur in the first trimester of pregnancy, it is important to take appropriate measures on time. A visit to the doctor and timely treatment will help avoid various problems in the future since the constantly growing fetus and the increasing pressure can cause various gestation complications.

In the second trimester of gestation, the uterus constantly increases due to the growth of the fetus. There is compression of the intestine, fraught with the development of constipation. Hormonal changes continue to negatively affect the digestive organs. Stagnation of blood appears in the pelvic organs. Their function is disturbed. The outflow of blood is difficult because the enlarged uterus presses on the walls of the veins in the abdominal cavity.

In the third trimester, activity decreases, the uterus grows, and pressure on the intestines increases. Pathological processes are aggravated. Inflamed and bleeding hemorrhoids fall out. In a running form, they do not return to their original state alone.

Intra-abdominal pressure is constantly growing because the uterus increases in size. With constant blood stagnation and a systematic increase in intra-abdominal pressure, the veins in the hemorrhoidal plexuses begin to expand. This causes thrombosis, pain and discomfort. Suppose there is chronic constipation. The risk of pathological processes increases. It is important to carry out the treatment in the early stages of the disease because the condition will only worsen with increasing pressure and weight gain.

Symptoms of hemorrhoids

 The development of hemorrhoids during pregnancy in the 3rd trimester is accompanied by bleeding during defecation and pain in the rectum. 

• In the first stage, there are no pronounced symptoms. Discomfort during bowel movements may be felt, and blood on toilet paper is also often observed.
• The second stage is manifested by constant itching in the perianal area. In the process of emptying the intestines, pain appears, but it quickly passes. There is an increase in hemorrhoids. During attempts, they fall out but fall back into place when the muscles contract.
• The third stage of the disease is manifested by constantly intense pain of an aching or pulsating nature. There is also bleeding and itching in the rectal area. Hemorrhoids fall out, but the tissues are so inflamed that efforts must be made to set the nodes. The pain becomes more intense in a sitting position. In such a situation, a visit to the proctologist should be mandatory since such a condition is an obstacle to natural childbirth.
• The symptoms are intense with the development of the fourth stage of hemorrhoids. Hemorrhoids cannot be set independently. At this stage, only surgical intervention is performed. Conservative therapy will be ineffective. But such advanced forms of the disease are observed in very rare cases. If a pregnant woman systematically visits the right doctors and takes care of her health, such a problem can be dealt with even at the initial stages of development.

In the initial stages of the disease, minor symptoms may occur that the patient, preoccupied with other problems, may not pay attention to:

• A feeling of incomplete emptying of the intestines (enlarged hemorrhoids bulge into the rectum, creating a feeling that there is something there).
• Itching and burning in the anus (caused by overfilling with the blood of the hemorrhoidal plexuses in the anal region).

In the later stages of the disease, these symptoms are joined by:

• Blood smearing with fresh scarlet blood after defecation (hard feces injure enlarged nodes), and then bleeding after defecation or even out of touch with it.

IMPORTANT: Blood with hemorrhoids is always fresh scarlet, as it is released from the lowest parts of the intestine and does not have time to mix with feces.

• Pains of varying intensity, first with defecation, then with sitting, and then out of touch with external events, Particularly intense pain in thrombosis and inflammation. This is an occasion to contact a specialist immediately.
• Prolapse of hemorrhoids.

How to avoid hemorrhoids during pregnancy

Knowing where hemorrhoids come from and how it manifests, it is easy to understand what needs to be done to minimize the risk of the disease. The main thing is to lead a healthy lifestyle.

What does it include?

1. Timely access to a doctor and treatment of all proctological problems, if they existed before pregnancy. The likelihood of problems during pregnancy is highest in women who had hemorrhoids before pregnancy. In most cases, surgical treatment during pregnancy is not carried out – only for health reasons. The period of breastfeeding is also not the best time for surgical intervention. Therefore, the problem, if any, must be solved in advance.
2. The fight against excess weight, since excess weight is an additional burden on all vessels without exception, including hemorrhoidal ones. Remember that during the expectation of the baby, your weight will continue to grow. Do not create additional difficulties for your body. Optimize body weight before pregnancy.
3. Sufficient physical activity – walking, Nordic walking, jogging (for those with no contraindications), swimming in the pool- improves blood circulation and increases muscle tone. If there is no prohibition from the gynecologist, the expectant mother should have daily physical activity.
4. Proper nutrition. The diet should be designed so that the risk of constipation is minimized. It is necessary to achieve soft stools daily (ideally twice daily). This mode of bowel movement is the best prevention of hemorrhoids.

Rich bakery products, sweets (except for homemade jams, marshmallows and marshmallows in moderation), fatty, fried, spicy, spicy and, salty, carbonated drinks are excluded.

Fermented milk products, cooked (side dishes) and raw (salads) vegetables, fruits in moderation (otherwise you can cause bloating and worsen peristalsis), dried fruits, especially prunes, and compotes from it, wholemeal bread are consumed daily.

In addition, every woman should monitor her digestion herself and, based on the results of these observations, exclude or, conversely, include additional foods in her diet. For example, with a tendency to constipation, it is logical to exclude rice, potatoes and bananas and add beets.

If it is impossible to avoid the problem despite preventive measures, you should immediately consult a doctor so the disease does not progress. Hemorrhoids during pregnancy are treated mainly conservatively. Laxative suppositories, anti-inflammatory and antithrombotic suppositories, ointments, and vagotonic drugs are prescribed. Usually, these measures, combined with an adequate lifestyle, are enough to maintain rectal health at the proper level until delivery.