Postpartum Hemorrhoids Happen—Here’s How to Manage Them
Labor and delivery bring plenty of excitement and anticipation for new parents. But for up to 40% of those who give birth, it also brings postpartum hemorrhoids.
Hemorrhoids occur when veins inside or around the anus and rectum become swollen or enlarged. “What they are is just varicose veins, like you would have on the legs, but in the anal canal,” explains Andrei Rebarber, M.D., a board-certified ob-gyn in New York City and clinical professor at the Icahn School of Medicine in the department of obstetrics and gynecology at Mount Sinai Hospital.
Although just about anyone can develop hemorrhoids, pregnancy and childbirth increase your chances of developing them. Unfortunately, they can be painful. Here’s what you should know about the causes and ways to prevent hemorrhoids, as well as how to ease the discomfort if you develop them.
What Causes Postpartum Hemorrhoids?
For some people, hemorrhoids can begin during pregnancy. “It’s common because of the pregnant state itself,” explains Rebarber. That’s because pregnancy can cause the following:
- Increased pressure on the rectum due to the uterus’s growth
- Increased blood volume, creating increased pressure in the veins
- Constipation, which is common in pregnancy
In addition, if you have a prior history of hemorrhoids after childbirth or during pregnancy, you’re more likely to experience them again.
“Hemorrhoids tend to be exacerbated or freshly formed from the birth experience,” adds Jacqueline Kelleher, a Philadelphia-based birth and postpartum doula and the author of Nurturing the Family: A Doula’s Guide to Supporting New Parents. That’s because labor and delivery can involve:
- Pushing for prolonged periods
- Delivering a larger newborn (defined as larger than 8 pounds, 4 ounces)
Symptoms of Postpartum Hemorrhoids
In some cases, hemorrhoids are asymptomatic. But they can cause symptoms such as:
- Feeling or seeing a bump or lump in the rectal area
How to Reduce Your Risk of Postpartum Hemorrhoids
Following certain strategies while pregnant and during labor and delivery can help minimize hemorrhoids after childbirth. Start with these tips:
- Maintain a healthy lifestyle during pregnancy. That includes drinking lots of fluids, eating a fiber-rich diet, and staying active. This can all help prevent constipation, explains Rebarber, which helps prevent straining during a bowel movement—a habit that can lead to hemorrhoids.
- Use medication to treat constipation if necessary. If diet and hydration alone don’t completely relieve your constipation, there are many medication options that are safe in pregnancy. Talk to your provider about options.
- Avoid pushing too soon during labor. While a cervix is dilated enough to deliver a baby at 10 centimeters, you don’t necessarily have to start pushing as soon as yours is that wide. “There's a strategy called laboring down, which is just kind of waiting, because the body will actually expel the baby on its own,” says Kelleher. “And then maybe you have five minutes of pushing or 30 minutes of pushing, but not two hours of pushing. This method is not used by every provider, so be sure to speak to your ob-gyn or midwife about your desire to wait longer before pushing so that they’re on the same page.
- Use upright labor positioning. Talk to your doctor about your desire to use gravity-friendly positioning, like squatting, for pushing, “or just anything that's not working against gravity,” adds Kelleher.
7 Ways to Relieve Postpartum Hemorrhoids
If, despite your best efforts, you still experience postpartum hemorrhoids, try these strategies to find relief.
- Soak in a sitz bath. “The most effective thing people can do is what's called the sitz bath,” Kelleher says. This is a warm, shallow basin you balance on the toilet in order to soak and soothe the perineal area. The American College of Obstetricians and Gynecologists (ACOG) recommends using a sitz bath a few times a day for relief while recovering from childbirth. Though this can be difficult to prioritize when caring for a newborn, notes Kelleher, she recommends baby-wearing so you can keep the baby close.
- Apply medicated pads. Those containing witch hazel, lidocaine, or hydrocortisone can be applied to the affected area to help soothe any discomfort.
- Try OTC products. Certain over-the-counter creams, suppositories, or pain relievers can also help you find relief from postpartum hemorrhoids. Ask your healthcare provider for recommendations about which products might be best suited to your situation.
- Increase your fiber intake. Eating a high-fiber diet—including foods like pears, almonds, beans, and barley—can help you avoid straining during a bowel movement, which is a precursor of hemorrhoids. Most women should aim to get 25 grams of fiber in their diet each day.
- Stay hydrated. “You really need to overhydrate to maintain soft stool,” Rebarber says. Drinking plenty of water also helps the fiber in your diet work its magic. ACOG recommends drinking 8 to 12 cups of water each day while pregnant.
- Don’t force a bowel movement. “The less time you spend bearing down, the less likely you are to have hemorrhoids or exacerbations of hemorrhoids,” Kelleher says. Ask your doctor whether a laxative may be helpful to avoid time spent sitting, pushing, and straining.
No matter which approach—or combination of approaches—you choose, be sure they’re all safe for use if you’re also breastfeeding or healing from a tear.
When to See Your Doctor
Typically, postpartum hemorrhoids aren’t a cause for concern. “They’re short-lived,” says Rebarber, explaining that after delivery, the extra blood volume from pregnancy and the added pressure of the growing uterus immediately start to dissipate.
A good rule of thumb: If symptoms are bothersome after two to three weeks, it may be time to call your doctor.
That way, your doctor can rule out other related issues, such as an anal fissure, an abscess, or genital warts, and confirm that it’s hemorrhoids that you’re dealing with, explains Rebarber. “Visualization, digital examination, and possibly anoscopy are going to be the things that will help to really determine what's going on in that area.” Though rare, surgery may be needed for a more severe hemorrhoid that’s thrombosed (filled with blood) or causing extreme pain, he adds.
“But of course, anytime someone is concerned,” Kelleher says, “they need to bring it to the attention of their clinical care provider.”
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