October 1, 2019

Reviewed by Kimberly Langdon M.D.

One of the most common complaints after childbirth is hemorrhoids, with 28% to 48% of women reporting symptoms at 4 weeks postpartum. They are actually very common during pregnancy as well, thanks to constipation and the extra pressure on your veins in your lower half from your enlarged uterus. If you successfully avoided them during pregnancy, you still might have them after childbirth, due to straining during labor and constipation afterward. If you did have them during pregnancy, they might get worse. Here’s what to expect and what you can do about them.

What are hemorrhoids?

Also called piles, hemorrhoids are sore, swollen veins that are found in your rectum. They can be internal (usually painless) or external (can be very painful). Symptoms include pain, rectal itching, bleeding after having a bowel movement, or a swollen area around the anus. Hemorrhoids occur more frequently after a vaginal delivery than a cesarean.

What’s the difference between hemorrhoids and varicose veins?

Varicose veins are enlarged veins and can be found anywhere on your body. During pregnancy, they occasionally develop on the vulva, and referred to as vulvar varicosities. When varicose veins develop in the rectum, they are referred to as hemorrhoids.

What causes postpartum hemorrhoids?

One of the biggest contributors is constipation. Constipation can lead to straining, which can cause hemorrhoids or make smaller hemorrhoids worse. Thanks to pregnancy hormones, constipation is a common problem during pregnancy.

Also, during labor and delivery, there may be a lot of pushing and straining, which can cause hemorrhoids.

How long do hemorrhoids last after giving birth?

Generally, hemorrhoids will go away on their own by 6 weeks postpartum. However, with treatment, the pain and swelling should decrease dramatically within a few days.

How are postpartum hemorrhoids treated?

If constipation is causing your hemorrhoids, treating that will help the hemorrhoids. The best way to relieve constipation is increasing your dietary fiber intake, drinking more water, and taking a stool softener.

In the meantime, to relieve any pain and itching from hemorrhoids, here are some things you can do at home:

• Sitz baths. Also helpful for pain from perineal tearing, a sitz bath is a basin (you can also use a bathtub with a small amount of water) where you sit to soak your bottom in warm water and epsom salts. The recommendation is 2-4 times a day for 10-15 minutes.
• Witch hazel. Apply witch hazel to the hemorrhoids to cool and soothe. You can apply with cotton balls, or buy pre-soaked pads like Tucks pads.
• Hemorrhoid creams. There are over-the-counter creams, ointments, and sprays designed to provide short-term relief.
• Hemor-rite and Anuice or a bag of crushed ice can be used to get immediate relief from pain and swelling.

If the pain does not go away within a few days, contact your healthcare provider.

What’s the difference between hemorrhoids and anal fissures?

Hemorrhoids and anal fissures are both types of peri-anal disease that are common in the postpartum phase. Hemorrhoids are much more common than anal fissures, and patients often misdiagnose. They both can cause pain and bleeding during bowel movements, however, the pain from anal fissures tends to be more severe. The description commonly used to describe pain from anal fissures is “passing shards of glass.”

An anal fissure is a small tear in the tissue that lines the anus. Trauma caused by childbirth, passing hard bowel movements, and hypertonicity of the internal sphincter (tight sphincter muscles) are the main causes of anal fissures. The treatments at home are generally the same as those of hemorrhoids, addressing any constipation and sitz baths for pain relief, muscle relaxation, and healing.

Anal fissures usually heal on their own within a few weeks, but sometimes they become deep and chronic. For chronic anal fissures lasting 6 weeks or more, treatment options may include pelvic floor physical therapy, a medicated cream, or surgery.

Related: What to expect at a pelvic floor PT appointment

When should I call a doctor?

If the pain is considerable and persists despite treatment at home, talk to your doctor. It may be an anal fissure or a thrombosed hemorrhoid. A thrombosed hemorrhoid means blood clots have developed inside of it, and may require an incision under local anesthesia to remove.

Sources:

University of Rochester Medical Center. Common Conditions. Retrieved on September 27, 2019 from
https://www.urmc.rochester.edu/ob-gyn/obstetrics/after-delivery/common-conditions.aspx

Gjerdingen DK, Froberg DG, Chaloner KM, McGovern PM. Changes in women's physical health during the first postpartum year. Arch Fam Med. 1993 Mar;2(3):277-83. Retrieved from
http://triggered.edina.clockss.org/ServeContent?rft.issn=1063-3987&rft.volume=2&rft.issue=3&rft.spage=277

Anal Fissure and Thrombosed External Hemorrhoids Before and After Delivery. Abramowitz, L., Sobhani, I., Benifla, J.L. et al. Dis Colon Rectum (2002) 45: 650. https://doi.org/10.1007/s10350-004-6262-5. Retrieved from https://link.springer.com/article/10.1007/s10350-004-6262-5

T Poskus et al. Haemorrhoids and anal fissures during pregnancy and after childbirth: a prospective cohort study. (2014). https://doi.org/10.1111/1471-0528.12838 Retrieved from
https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.12838

Mayo Clinic. What causes vulvar varicosities during pregnancy, and how can I relieve the related discomfort? Retrieved on September 27, 2019 from
https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/vulvar-varicosities-during-pregnancy/faq-20419426

Madalinski M. H. (2011). Identifying the best therapy for chronic anal fissure. World journal of gastrointestinal pharmacology and therapeutics, 2(2), 9–16. doi:10.4292/wjgpt.v2.i2.9
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3091162/

Mayo Clinic. Anal Fissure. Retrieved on September 27, 2019 from http://www.mayoclinic.org/diseases-conditions/anal-fissure/home/ovc-20168229

American College of Obstetricians and Gynecologists. (2016). Your Pregnancy and Childbirth: Month to Month, 6th edition.

Cunningham, F. G., & Williams, J. W. (2014). Williams Obstetrics, 24th edition. Stamford, Conn: Appleton & Lange.

Kimberly Langdon M.D. is a retired University-trained obstetrician/gynecologist with 19-years of clinical experience. She graduated from The Ohio State University College of Medicine and then completed her OB/GYN residency program at The Ohio State University Medical Center. Recently, she founded a medical device start-up company that focuses on non-drug treatment for common maladies.