Haemorrhoids (piles) in pregnancy and childbirth: why they occur and how to treat them

• In pregnant women, piles usually appear during the last three months of pregnancy or even after childbirth. In fact, 20-50% of pregnant women suffer from piles.
• One of the reasons why many women suffer from haemorrhoids (piles) is pregnancy or childbirth.
• The best way to avoid piles during pregnancy and childbirth is to eat a diet rich in fibre, among other measures.
• After childbirth, piles may disappear, otherwise the patient may undergo surgery to have them removed.

The main reason for piles in pregnant women is the enlargement of the uterus, which swells to accommodate the baby. 

As the size of the uterus increases and the size of the baby increases, it puts pressure on the veins in the pelvic area, which reduces blood circulation in the pelvic area, causing dilation of the blood vessels and inflammation of the veins.

In addition to this cause, there are other common causes:

• Hormones produced by women during pregnancy (the hormone progesterone) can also contribute to the appearance of haemorrhoids in pregnant women, as they cause the walls of the veins to relax and, as a consequence, the blood vessels to dilate and swell more easily.
• The digestive system also slows down during pregnancy, which causes many pregnant women to become constipated (also due to the hormone progesterone, which slows down bowel movements). This constipation makes bowel movements more difficult when they go to the toilet, and straining increases the pressure on the haemorrhoidal veins and leads to haemorrhoids (piles).
• During childbirth, there is sometimes severe compression of the nodes in the anal canal, although they usually disappear on their own once the birth is over.
• Having suffered from piles before childbirth increases the likelihood that they will recur during childbirth.

When piles occur during pregnancy, there are a number of symptoms that are very common:

• Anorectal bleeding: sometimes, after defecation, a small trace of blood may be left on the toilet paper or in the stool (especially in the case of internal piles). This blood is usually bright red in colour. The bleeding may frighten or alert the pregnant woman, as it occurs in a place quite close to the birth canal, but she should not worry because this symptom is very common with piles and the baby is completely safe.

If you are not sure whether the bleeding is caused by haemorrhoids or not, you should consult your doctor.

• Pain: haemorrhoids (piles) are not always painful, however, they can cause discomfort to the patient when sitting, lying down or changing position. When piles are in grade IV severity, they do cause pain to the patient.
• Anal itching or burning: these are often the most annoying symptoms, along with pain. Sometimes (especially when the piles are internal), mucus is released and may come out and cause itching or burning in the rectum. It may also stain underwear.
• Feeling that you need to evacuate: sometimes, the itching or mucus that comes out or the lumps of external piles can give the sensation that you have not evacuated completely or give the feeling that you need to evacuate urgently.

Here are some measures and recommendations that pregnant women should follow to prevent the onset of piles:

• Avoid constipation: this is one of the main measures to be taken, since the more constipation, the more difficult it is to pass stools and, therefore, the greater the pressure and inflammation of the haemorrhoidal veins. To avoid this, you should eat a diet rich in fibre and drink plenty of fluids, among other measures.
• Do not stand or sit for long periods of time: if your work requires you to sit or stand for long periods of time, the best thing to do is to get up and move around for a few minutes at intervals of about an hour.
• Avoid eating certain foods: these foods include spicy food, coffee, alcohol, etc.
• Do not gain too much weight: the risk of suffering from piles is greater when pregnant women gain more weight than normal, as this puts pressure on the rectum. You should consult your doctor about the ideal weight you should maintain.
• Avoid seasoned foods: foods with a lot of salt or preserved in salted water favour constipation and, therefore, the appearance of piles.

• Kegel exercises: these exercises improve circulation in the rectal area and can relieve the symptoms of piles and even prevent them from occurring. These exercises are effective and can be performed without any difficulty as follows: firmly tense the muscles of the vagina and anus (what we commonly do when we suppress the urge to urinate) for as long as possible for 10 seconds. Then slowly relax the area, releasing it little by little. Do at least twenty-five repetitions of this exercise, preferably several times a day. These exercises also strengthen the muscles around the vagina and urethra, which is good for childbirth and the postpartum period.
• Lie on your left side: when lying down, lie on your left side to take pressure off your rectal veins.
• Eat a diet rich in fibre: this diet will make it easier to pass stool and the stool will not damage the walls of the anorectal duct. There are many foods rich in fibre that can be eaten: fruit, vegetables, nuts, cereals, legumes, wholemeal foods, etc.
• Drink plenty of fluids: drinking plenty of fluids (at least one and a half litres a day is recommended) softens the stool and makes it easier to pass.
• Being active: simply walking or doing other non-hazardous exercise for about 30 minutes a day can help the digestive system to function better. Before doing any exercise, check with your specialist, as he or she will recommend the best course of action.
• Drug treatment: in addition to the other measures, the specialist may also recommend an anti-hemorrhoidal ointment or topical ointment to apply to the area of the piles to prevent symptoms such as itching, pain or inflammation if they occur.
• Maintain hygiene in the area: it is recommended that, after each bowel movement, sitz baths are performed to clean the area. These baths should be done in the bidet with cold or lukewarm water and soap. When wiping with toilet paper, it is advisable to use white, unscented paper, which irritates the area less than coloured and scented paper. Wet wipes can also be used.
• Apply ice: ice can be applied to the area of the piles, but always wrapped in a towel or similar, as this can damage the area further. Ice relieves inflammation.

These treatments may work if the piles are not very serious, otherwise they may not work and, in this case, another treatment, such as surgery, would be recommended. This is only indicated when the symptoms have no effect and it will be the specialist who will recommend certain treatments for the elimination of piles.

Having explained the treatments to alleviate the symptoms of piles or prevent them, it must be said that piles in pregnant women may disappear on their own after childbirth, but may reappear with subsequent pregnancies or even with age.

Haemorrhoidectomy in pregnant women, not recommended

The indication for haemorrhoidectomy in pregnant women must be made by the surgeon after a thorough assessment of the state of gestation and if it is really strictly necessary, as it may jeopardise the viability of the pregnancy, so it is better not to perform it and wait until after giving birth.

Haemorrhoidectomy consists of the removal of the haemorrhoidal veins, which are the cause of haemorrhoids (piles). Once the operation has been performed, neither piles nor their symptoms tend to reappear, which is a great advantage for those who suffer from them. 

Haemorrhoidectomy can be performed in two different ways:

• Open or Milligan-Morgan haemorrhoidectomy, which involves the removal of the vascular plexus (the bundle of veins) that gives rise to the piles. The piles are dissected at their highest point and the surgeon leaves the wound open. In cases where it is difficult to suture the surgical wound, the surgeon chooses to leave it open, which is not inconvenient for the patient, as it heals in the same way as a closed wound. 
• Closed or Ferguson haemorrhoidectomy, which is the same as open haemorrhoidectomy, but in this case the surgeon stitches the wound. This is the only difference we can point out.

Both types of haemorrhoidectomy have the same duration: 60 minutes, although it may be more or less depending on each case. In addition, the surgeon will choose one technique or the other to correct the problem.