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There are many lovely aspects to being pregnant. The building sense of excitement, preparation for the new baby, just becoming a parent – the list is endless. But it’s only fair to say that pregnancy is not always pleasant. Right up on the list of the not so wonderful pregnancy experiences are haemorrhoids. You may have heard them referred to as “piles” – which are the same thing, just a different name.
Essentially, haemorrhoids are varicose veins of the rectum and one of the more common physical conditions during pregnancy. They don’t actually constitute a complication because they are so common – around 20-50% of women will experience pregnancy haemorrhoids to a greater or lesser degree. Most women don’t have an issue with haemorrhoids though until their third trimester.
The increasing weight of the baby as it grows within the uterus places pressure on all of the mother’s internal organs and tissues. Space becomes limited so there is a slowing down and pooling of the blood flow into and out of the veins which supply the mother’s pelvis. The veins in the bowel wall become distended and engorged, which also weakens them.
Pregnancy hormones also cause a general relaxation of the tissues, including the vein walls. This means they are not as firm as they usually are, so they tend to swell and enlarge.
Another contributing factor is the overall increase in the mother’s circulating blood volume. In order for her baby to be well oxygenated and have an adequate supply of nutrients, the amount of blood a mother carries needs to increase from its normal amount by another 50%. All this extra fluid and blood needs to be transported by her veins and arteries. It is common for the valves and vessel walls to struggle to return the blood back up to the mother’s heart and lungs to load up again on oxygen.
If you had haemorrhoids before pregnancy, then you are more likely to develop them when pregnant. Pushing during the second stage of labour can also lead to haemorrhoids developing. If the second stage is long and protracted, there is an even greater risk.
There are lots of things which can be done, but there is no guarantee of success. But you could try any or all of the following tips to try and reduce the likelihood of you developing pregnancy haemorrhoids;
Haemorrhoids can occur internally or externally. If they are internal you may not be aware you have them until you notice some blood on the toilet paper. External haemorrhoids feel like a bulge coming out of the anus and have a grape like appearance. If you are in doubt, then get a mirror and have a look. They are not the prettiest of sights, so be prepared.
The size of the haemorrhoid/s is not necessarily an indicator of how they feel. Some women describe the pain of haemorrhoids as being “like a knife in my bottom” or a “hot poker”. If, however, you can see you have haemorrhoids but don’t have any pain, then don’t worry. But still mention this to your maternity care provider.
Bleeding can also occur if the haemorrhoids are distended and large. This can be very scary as it is easy to be confused about where exactly the blood is coming from. Have a check with your health care professional if you are at all concerned. It’s always better to be sure.
Women who have vulval varicosities (varicose veins of the vulva) tend to be more prone to developing haemorrhoids. Being overweight before pregnancy, carrying multiples; extra fluid or being inactive all contribute to the risk of pregnancy haemorrhoids.
Haemorrhoids can feel very uncomfortable, and create and aching feeling in and around the anus. They can also feel itchy and create pressure – all very distinctive sensations if you’ve not had them before.
Some women find that after sex, there is an increase in the aching and throbbing sensation around their haemorrhoids. This is due to a general increase in blood flow and engorgement to the vaginal / perineal / anal area during intercourse.
It’s important that you find out first if what you think could be haemorrhoids, really are. Your GP or maternity care provider will be able to tell you for sure. Don’t feel shy, you can be sure they’ve seen a million haemorrhoids before and if they’ve had a baby themselves, will be able to empathise with you.
There are a number of haemorrhoid treatment options – each varies in their effectiveness. Ultimately, treatment helps to alleviate the symptoms, rather than get rid of them altogether. Most women find they don’t really feel completely free of symptoms until after they’ve had their baby. And even then, it can take some weeks for haemorrhoids to resolve altogether.
Haemorrhoids can be much more painful when they protrude from the anus. This leads to further engorgement and pain. Gently pushing the haemorrhoid back inside the anus reduces the discomfort and engorgement. Speak with your health care practitioner about the best and safest way to do this.