Most expectant mothers enjoy sharing the joyful news of a pregnancy. However, many uncomfortable side effects of pregnancy and childbirth often go unmentioned. These include hemorrhoids, which occur in about half of all (expectant) mothers. In this article, we explain what hemorrhoids actually are, why they frequently occur during pregnancy or after childbirth, and why you shouldn't feel embarrassed talking about them.

What are hemorrhoids?

Hemorrhoids are well-perfused vascular cushions located in the mucous membrane at the end of the intestine. Together with the sphincter muscle, they seal the anus and contribute to stool continence. Although everyone has hemorrhoids, you usually don’t notice them. That changes only when they cause problems. So, when people talk about hemorrhoids, they usually mean the condition in which these vascular cushions become enlarged and may protrude outside the anus. These “varicose veins around the anus” can lead to symptoms such as itching, pain, bleeding after bowel movements, or soiling. Beyond these physical symptoms, hemorrhoids can also be emotionally burdensome for many people.

Hemorrhoids are classified into four grades of severity:

What are the causes of hemorrhoids during pregnancy and childbirth?

Hemorrhoids can affect anyone, but they often occur in women during or after pregnancy. About half of all expectant mothers experience hemorrhoids, often only Grade 1 or 2. They most commonly appear in the last third of pregnancy, due to several factors: The hormone progesterone causes tissues, blood vessels, the pelvic floor, and muscles to relax and soften to make room for your growing baby. The vascular cushions in the anus are also affected and are therefore more likely to protrude. In addition, your steadily enlarging uterus puts pressure on the hemorrhoidal cushions. As a result, blood flow in this area becomes less efficient and may stagnate. Pregnant women are also frequently affected by constipation. The increased straining during bowel movements puts additional pressure on the blood vessels and further promotes hemorrhoids. Even if you don’t develop hemorrhoids during pregnancy, they may occur afterward due to pushing during childbirth.

In general, the likelihood of hemorrhoids increases with age and the number of pregnancies. A genetic predisposition to weak connective tissue and being overweight can also promote the development of hemorrhoids. They can be quite uncomfortable and painful, but one concern we can ease: hemorrhoids have no effect on your baby.

How can hemorrhoids be treated and symptoms alleviated?

In most cases, the vascular cushions naturally regress within a few weeks after birth. For example, eight weeks after birth, 30 percent of women are still affected by hemorrhoids, and after 24 weeks, that number is still 13 percent. Even though hemorrhoids usually disappear on their own during this time, they can feel very uncomfortable. If you have hemorrhoids, you can always contact your midwife or gynecologist without feeling embarrassed. They know how many women deal with these bothersome symptoms during pregnancy and postpartum and can best assess which treatment is most suitable for you. In addition to seeing a doctor, there are several things you can do to prevent, treat, and relieve hemorrhoids.

Prevention

1. Verstopfung vermeiden

During pregnancy, digestion is usually slower, and you may experience constipation. This often leads to straining during bowel movements and can promote hemorrhoids. With a balanced, high-fiber diet and adequate fluid intake (one liter more than usual each day), you can support digestion and help prevent constipation. You can find out which foods are especially good for you right now in the article ". If you do experience constipation, take laxatives during pregnancy only after consulting your doctor, and only if absolutely necessary.

2. Viel bewegen und langes Sitzen vermeiden

Another way to stimulate your somewhat sluggish bowel activity during pregnancy is regular exercise. You don’t have to do competitive sports; even a daily walk can work wonders. You can also easily incorporate movement into your workday: for example, if you spend most of your day sitting, try to stand up once an hour and take a walk around the office, or use your lunch break for a walk.

3. Entspannung auf der Toilette

To avoid putting additional strain on the vascular cushions in your intestine, it’s important to avoid straining during bowel movements and, ideally, to relax only the pelvic floor. It helps to take your time and sit in a squatting position if possible. A low stool—or even two thick books—can be a useful aid, allowing you to place your feet on them while sitting on the toilet. In addition, you can make bowel movements easier by applying a fatty cream to the area around the anus beforehand.

4. Beckenbodentraining

The pelvic floor muscle network surrounds not only the uterus and bladder, but also the rectum. With pelvic floor training, you strengthen muscles that are particularly challenged during pregnancy and childbirth, which can help prevent severe hemorrhoids. Even after birth, you can continue to strengthen these muscles, but be sure to give your body enough rest during the postpartum period and allow your pelvic floor a break at first.

Treat and relieve

1. Ärztlich behandeln lassen

If you suspect you have hemorrhoids, discuss it with your gynecologist/doctor. They can determine whether hemorrhoids are actually causing your symptoms. This is important because symptoms such as blood in the stool can be caused by serious illnesses, and itching in the genital area can be caused by eczema or fungal infections. An anal vein thrombosis can also cause pain around the anus. If your doctor diagnoses an anal vein thrombosis, it can be treated easily in the practice. If hemorrhoids are the cause, your doctor can advise you on further treatment and, for example, prescribe an anti-inflammatory medication in the form of suppositories or an ointment. For persistent complaints such as severe pain, bleeding, or fecal incontinence, they will likely refer you to a proctology practice that specializes in bowel problems. After childbirth and the postpartum period, additional treatment options are available there, such as sclerotherapy, cryotherapy, or surgical removal of hemorrhoids. But don’t worry: these procedures are only necessary in rare cases; most hemorrhoids can be managed with other treatments or disappear on their own after childbirth.

2. Kühlen

For pain relief, you can cool the affected areas. Simply wrap a cooling pack (from the refrigerator, not the freezer) in a clean cloth and hold it against the anus two to three times a day. Be sure not to hold an ice pack or ice directly against the anus, as the cold can damage sensitive tissue. Alternatively, you can also use a quark compress or a cooled black tea bag. Both also have anti-inflammatory effects.

3. Auf Hygiene achten

After bowel movements, clean your intimate area with lukewarm water and gently pat dry with fragrance-free toilet paper to avoid irritation and inflammation. If you are using a cream for treatment, reapply it after each rinse. In addition, regular sitz baths can have a soothing effect. It’s best to use a bath additive containing tannins, such as an oak bark extract from the pharmacy. This has anti-inflammatory and anti-itching properties and helps the blood vessels constrict. You can take a lukewarm sitz bath daily for ten to fifteen minutes. If you still have fresh birth injuries, consult your midwife beforehand to ensure the wound does not soften too much. The injuries should also not come into contact with fatty creams used for hemorrhoid treatment.

4. Mit Creme behandeln

With external hemorrhoids, friction pain is common, especially during movement. You can ease this uncomfortable sensation with fatty ointments—either for external use or, in the case of internal hemorrhoids, as suppositories. Most are special hemorrhoid ointments available at the pharmacy, which may include witch hazel,
oak bark, witch hazel, or borage. The natural active ingredients have anti-inflammatory effects, relieve itching, and support wound healing.
You can also get an extra cooling effect by storing the cream in the refrigerator.

5. Schmerzfrei sitzen

For acute pain when sitting, a Sitzring or a special hemorrhoid cushion can provide relief. However, be careful not to use it for too long at a time, as sitting on the ring can impede blood circulation, which can slow the healing process.

Even if it feels difficult to talk about intimate issues like hemorrhoids, you absolutely do not need to feel embarrassed. If these bothersome vascular cushions are causing you trouble, consider confiding in your doctor or midwife. They are familiar with these issues and can help you best. The earlier hemorrhoids are diagnosed, the more effectively symptoms can be treated and uncomfortable complications avoided. We wish you all the best!