Why Haemorrhoids Are Common During Pregnancy

Pregnancy brings many changes to your body, and not all of them are expected. If you've noticed itching, pain, swelling, or bleeding around the anus, you may have developed haemorrhoids, also known as piles.

Haemorrhoids are one of the most common conditions during pregnancy, affecting many women, particularly in the second and third trimesters. While they can be uncomfortable and sometimes painful, they are usually not dangerous and often improve after childbirth.

Understanding why haemorrhoids develop during pregnancy and knowing how to manage them safely can help relieve symptoms and reduce discomfort.

What Are Haemorrhoids?

Haemorrhoids are swollen blood vessels and tissues in or around the anus and lower part of the rectum. They can develop when there is increased pressure in this area, causing the blood vessels to swell or move out of their usual position.

There are two main types of haemorrhoids:

Internal Haemorrhoids

Internal haemorrhoids develop inside the anus or rectum. They may not be visible and are often painless.

Possible symptoms include:

• Bright red blood after passing a stool
• Mucus after a bowel movement
• A feeling that the bowel has not emptied fully
• Tissue coming out of the anus when passing a stool

External Haemorrhoids

External haemorrhoids develop beneath the skin around the anus.

They are more likely to cause:

• Pain or soreness
• Itching
• Swelling
• A lump near the anus

Sometimes a blood clot forms within an external haemorrhoid (thrombosed haemorrhoid), causing a firm, painful lump that develops suddenly.

Why Are Haemorrhoids Common During Pregnancy?

Pregnancy increases the likelihood of developing haemorrhoids because several natural changes place extra pressure on the veins around the rectum.

1. Pressure from the Growing Uterus

As your baby grows, the uterus places more pressure on the blood vessels in the pelvis and rectum. This can make it harder for blood to flow away from the area, causing the vessels around the anus to swell. Haemorrhoids may therefore become more noticeable during the second or third trimester.

2. Pregnancy Hormones Slow Digestion

Hormonal changes, particularly increased progesterone, relax the muscles throughout the body.

While this helps support pregnancy, it also slows the movement of food through the intestines, making constipation more likely.

Constipation is one of the biggest contributors to haemorrhoids during pregnancy.

3. Straining During Bowel Movement

When stools become hard or difficult to pass, you may need to strain. And every time you strain, the pressure inside the anal canal increases, causing haemorrhoids to develop or existing ones to worsen.

4. Pressure During Childbirth

Pushing during a vaginal delivery can place additional pressure on the pelvic and anal blood vessels. Haemorrhoids may temporarily become worse after childbirth. However, many pregnancy-related haemorrhoids gradually improve during the weeks or months after delivery.

What Are the Symptoms of Haemorrhoids?

Symptoms can vary depending on the type and severity of the haemorrhoids.

Common symptoms include:

• Itching or irritation around the anus
• Pain or soreness
• Swelling around the anus
• Pain when passing a stool
• A lump near the anus
• Mucus after a bowel movement
• A feeling that the bowel has not emptied fully
• Bright red blood on the toilet paper, stool or in the toilet bowl

Although bleeding is often caused by haemorrhoids, do not assume that it is always the case. Other sinister conditions can also cause rectal bleeding and should be investigated.

Are Bleeding Haemorrhoids During Pregnancy Dangerous?

A small amount of bleeding from haemorrhoids is usually not dangerous. However, you should arrange a medical review if:

• The bleeding is heavy or does not stop
• You pass blood clots
• Your stool is black or sticky
• You feel faint, dizzy or unusually weak
• You have severe pain
• Your bowel habits have changed unexpectedly
• You are unsure whether the blood is coming from the anus or vagina

Vaginal bleeding during pregnancy requires a separate medical assessment and should not be assumed to be caused by haemorrhoids.

How to Relieve Haemorrhoids During Pregnancy?

The main goals of treatment are to reduce pressure on the veins, prevent constipation, and relieve discomfort.

Simple measures often help.

1. Eat a Moderate Amount of Dietary Fibre

Fibre helps keep stools soft and easier to pass. Good sources include:

• Fruits and vegetables
• Beans and lentils
• Oats and wholegrain cereals
• Brown rice
• Wholemeal bread
• Nuts and seeds

2. Drink Enough Water

Adequate hydration helps keep stools soft and easier to pass.

3. Stay Active

Gentle movement can help your bowels work more regularly. Walking may be helpful during pregnancy, unless your doctor has advised you to reduce physical activity.

4. Avoid Straining

Try not to push too hard when passing a stool. You can also:

• Go to the toilet when you feel the urge
• Avoid sitting on the toilet for too long

5. Try a Warm Bath

Sitting in a shallow bath of warm water may help relieve soreness and itching. Avoid scented soaps or bubble baths, as they may irritate the skin.

6. Use a Cool Compress

A cool cloth or cold pack may help reduce swelling and discomfort. Wrap the cold pack in a cloth before placing it on the skin.

7. Clean the Area Gently

Clean the area with water or soft, damp and fragrance-free toilet tissue after passing a stool. Pat the skin dry instead of rubbing it. Avoid scented wipes and soaps.

8. Check Before Using Medicines

Some creams, suppositories, laxatives, or stool softeners may help. However, not all products are suitable during pregnancy. Speak to your doctor, midwife, or pharmacist before using any medicine or supplement.

Can Haemorrhoids Be Prevented During Pregnancy?

It may not be possible to prevent every case, particularly as the baby grows. However, healthy bowel habits may reduce the risk of haemorrhoids becoming worse.

Helpful habits include:

• Eating fibre-rich foods every day
• Drinking enough fluids
• Staying active when medically appropriate
• Avoiding straining
• Avoiding long periods on the toilet
• Speak to your healthcare professional if constipation continues or if you think an iron supplement is making it worse. Do not stop taking prescribed supplements without medical advice.

When Should You See a Doctor?

Arrange a medical assessment if:

• This is the first time you have experienced rectal bleeding
• Bleeding continues or keeps returning
• Pain or swelling is severe
• A lump becomes suddenly painful
• Symptoms do not improve with self-care
• Your bowel habits change unexpectedly
• You are unsure whether haemorrhoids are causing your symptoms

Bleeding, pain, and anal lumps can have several possible causes. An examination can help confirm the diagnosis and rule out other conditions.

Finding Relief Safely

Haemorrhoids are a common part of pregnancy for many women, but they do not have to be something you simply tolerate.

Most cases can be managed by keeping stools soft, eating more fibre, drinking enough water, staying active, and avoiding straining. Medicines should only be used after checking that they are suitable during pregnancy.

At Ten Surgery Singapore, our general and colorectal surgeons assess haemorrhoids and other possible causes of rectal bleeding. Depending on your symptoms and stage of pregnancy, your doctor can advise whether lifestyle changes, medicines or further treatment may be appropriate.

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