Why does it worsen during pregnancy?
Everyone has cavernous plexuses; they are involved in retaining the contents of the intestine. They become a problem when they become filled with blood and become distended. During pregnancy, this is facilitated by several factors that add up to each other. From the second trimester, the uterus compresses the veins of the small pelvis and impedes the outflow of blood. Progesterone slows down peristalsis, which causes constipation, and straining sharply increases the pressure in the nodes. Weight gain, inactivity and taking iron supplements, which often harden the stool, all contribute.
- Compression of the pelvic veins by the growing uterus
- Slow bowel movements and constipation
- Straining during defecation
- Increased circulating blood volume
- Taking iron supplements
- Sedentary lifestyle
How it manifests itself
Most often, the first symptom is discomfort and the sensation of a foreign body in the anus, followed by itching and pain during bowel movements. Blood is usually scarlet and appears in drops on toilet paper or on top of stool without mixing with it. With external nodes, the woman herself feels the painful formations at the edge of the anus. A separate situation is node thrombosis: the pain becomes sharp, constant, intensifies when sitting, the node is dense and cyanotic. This is a reason to see a doctor within 24 hours, rather than endure it.
- Itching and burning in the anus
- Pain during and after defecation
- Scarlet blood on paper or on top of stool
- Feeling of incomplete emptying
- Loss of knots when straining
- Dense painful node due to thrombosis
Examination: what is important to exclude
Blood from the anus during pregnancy cannot automatically be considered hemorrhoids. The same complaints are caused by anal fissure, and occasionally by polyps and inflammatory bowel diseases. The proctologist conducts an examination and digital examination, and, if necessary, an anoscopy; these procedures are safe during pregnancy. Sigmoidoscopy and colonoscopy are prescribed only for serious indications and are usually postponed until the postpartum period. With regular bleeding, hemoglobin is monitored, because anemia during pregnancy is already common.
- Examination and digital examination of the rectum
- Anoscopy for unclear picture
- Sigmoidoscopy strictly according to indications
- Complete blood test to monitor hemoglobin
- Exclusion of anal fissure and polyps
Treatment during pregnancy
The main direction is to make the stool soft and regular, because without this no candles will help. The diet is supplemented with vegetables, fruits, bran and enough water; if necessary, the doctor prescribes mild laxatives, which are allowed during pregnancy. Local remedies in the form of suppositories and ointments are selected by the doctor: not all components are acceptable, especially in the first trimester. Cool sitz baths, washing with cool water instead of hard paper, and avoiding prolonged sitting on the toilet help. Minimally invasive methods and surgery are not performed during pregnancy, except in emergency cases.
- Soft regular stool as the basis of treatment
- Adequate amounts of fiber and water
- Mild laxatives as prescribed by your doctor
- Local suppositories and ointments allowed during pregnancy
- Cool sitz baths and water hygiene
- Planned interventions - only after childbirth
Postpartum and prevention
The first days after childbirth, the nodes often look scary, but with proper care, the swelling decreases within one to two weeks. During this time, it is important to avoid constipation, move more and continue local treatment agreed with the doctor if the woman is breastfeeding. If complaints persist two to three months after birth, minimally invasive methods are discussed: ligation with latex rings, sclerotherapy, and in case of pronounced nodes, hemorrhoidectomy. Prevention in the next pregnancy begins in advance, with normalization of stool and treatment of existing nodes.
- Preventing constipation in the first weeks after childbirth
- Early activation and walking
- Medication reconciliation during breastfeeding
- Assessment by a proctologist 2–3 months after birth
- Minimally invasive methods for persistent complaints
- Treatment of hemorrhoids before planning the next pregnancy
