Hemorrhoids

What are hemorrhoids?

Hemorrhoids are varicose veins — blood vessels that have become unusually swollen — that show up in the rectal area. Hemorrhoids typically range from the size of a raisin to the size of a grape. They can be merely itchy or downright painful, and sometimes they can even cause rectal bleeding, especially during a bowel movement.

Sometimes the enlarged veins protrude through the anus. When this happens, you'll feel a soft, swollen mass.

Hemorrhoids are relatively common during pregnancy. Some women get them for the first time while they're pregnant — and if you've had them before pregnancy, you're quite likely to have them again now. They may also develop during the second stage of labor, while you're pushing. Either way, they often go away on their own — or with the help of some simple measures mentioned below — soon after you give birth.
Why are they more common during pregnancy?

Pregnancy makes you more prone to hemorrhoids, as well as to varicose veins in the legs and sometimes even in the vulva, for a variety of reasons. Your growing uterus puts pressure on the pelvic veins and the inferior vena cava, a large vein on the right side of the body that receives blood from the lower limbs. This can slow the return of blood from the lower half of your body, which increases the pressure on the veins below your uterus and causes them to become more dilated or swollen.

Constipation, another common problem during pregnancy, can also cause or aggravate hemorrhoids. That's because straining leads to hemorrhoids, and you tend to strain when having a hard bowel movement.

In addition, an increase in the hormone progesterone during pregnancy causes the walls of your veins to relax, allowing them to swell more easily. Progesterone also contributes to constipation by slowing down your intestinal tract.


What can I do to get relief?

• Apply an ice pack (with a soft covering) to the affected area several times a day. Ice may help decrease swelling and discomfort. Some women find cold compresses saturated with witch hazel to be soothing.

• Soak your bottom in warm water, in a tub or a sitz bath. A sitz bath is small plastic basin that you fill with water and position over your toilet, allowing you to submerge your rectal area simply by sitting down.

• Try alternating cold and warm treatments. Start with an ice pack followed by a warm sitz bath.

• Gently but thoroughly clean the affected area after each bowel movement using soft, unscented, white toilet tissue, which causes less irritation than colored, scented varieties. Moistening the tissue can help, too. Many women find using pre-moistened wipes more comfortable than using toilet tissue. You can buy medicated wipes (such as Tucks) made specifically for people with hemorrhoids.

• Ask your healthcare practitioner to recommend a safe topical anesthetic or medicated suppository. There are many hemorrhoid-relief products on the market, but consult your practitioner before trying one on your own. Most of these products should be used for a short course of treatment only (a week or less). Continued use can cause even more inflammation.


How can I avoid getting hemorrhoids?

Though you're more susceptible to hemorrhoids when pregnant, they're not inevitable! Here are some ways to ward them off — or get rid of them if you do get them:

• Avoid constipation: Eat a high-fiber diet, drink plenty of water (eight to ten glasses a day), and get regular exercise, even if you only have time for a short, brisk walk. If you're constipated, ask your practitioner about using a fiber supplement or stool softener.

• Don't wait when you have the urge to have a bowel movement, try not to strain when you're moving your bowels, and don't linger on the toilet, because it puts pressure on the area.

• Do Kegel exercises daily. Kegels increase circulation in the rectal area and strengthen the muscles around the anus, decreasing the chance of hemorrhoids. They also strengthen and tone the muscles around the vagina and urethra, which can help your body recover after you give birth.

• Avoid sitting or standing for long stretches of time. If your job involves sitting, get up and move around for a few minutes every hour or so. At home, lie on your left side when sleeping, reading, or watching TV to take the pressure off your rectal veins and help increase blood return from the lower half of your body.


When should I call my practitioner?

If your own preventive and relief efforts don't help — or if you notice bleeding — consult your doctor or midwife. (Any rectal bleeding should be checked by your practitioner.)

For most women, hemorrhoids will get better after delivery with the help of the measures discussed above. In some cases, you may need to see a specialist for treatment to help shrink your hemorrhoids. Rarely, minor surgery is required to correct the problem.