Managing Severe Hemorrhoids During Pregnancy: Tips for Smooth Bowel Movements

Hello, what should I do if I have severe internal and external hemorrhoids during pregnancy that are causing difficulty with bowel movements?

Hello, Dr.
Ko.
I developed severe external and internal hemorrhoids during childbirth at the age of 38.
Both the internal and external hemorrhoids swell during bowel movements.
Doctors have prescribed suppositories and stool softeners for me, and it has been nearly four years.
I am now preparing for pregnancy and planning to undergo in vitro fertilization.
However, I am concerned that my severe internal and external hemorrhoids will worsen during pregnancy.
My main worry is experiencing constipation and difficulty with bowel movements.
What methods can I use to ensure smooth bowel movements? Thank you.

Ms. Chen, 40~49 year old female. Ask Date: 2016/01/20

Dr. Ke Fangxu reply Surgery

Hemorrhoids caused by pregnancy are generally larger in size.
If there is constipation or if a woman becomes pregnant again, the condition of the hemorrhoids may worsen.
During pregnancy, we usually do not recommend taking medications; however, stool softeners are mostly not contraindicated during pregnancy.
If one prefers not to rely on medication, it is still advisable to increase the intake of vegetables and fruits, drink plenty of water, and engage in regular exercise.
Aside from these common recommendations, there are no particularly special suggestions.

Reply Date: 2016/01/20

More Info

Managing severe hemorrhoids during pregnancy can indeed be a challenging situation, especially for women who have a history of hemorrhoids. The pressure from the growing uterus, hormonal changes, and the increased blood volume during pregnancy can exacerbate existing hemorrhoids or lead to new ones. Here are some strategies to help manage this condition and promote smoother bowel movements.

Dietary Adjustments
1. Increase Fiber Intake: A high-fiber diet is crucial for preventing constipation, which is a significant contributor to hemorrhoids. Aim for at least 25-30 grams of fiber daily. Foods rich in fiber include fruits (like berries, apples, and pears), vegetables (such as broccoli, carrots, and leafy greens), whole grains (like oats, brown rice, and whole wheat bread), and legumes (beans and lentils).

2. Stay Hydrated: Drinking plenty of water is essential. Aim for at least 8-10 glasses of water a day. Proper hydration helps soften stool, making it easier to pass.

3. Consider Probiotics: Incorporating probiotics, either through supplements or foods like yogurt and kefir, can help maintain a healthy gut flora and improve digestion.

Lifestyle Modifications
1. Regular Exercise: Engaging in regular, moderate exercise can help stimulate bowel function. Activities like walking, swimming, or prenatal yoga can be beneficial. However, always consult your healthcare provider before starting any new exercise regimen during pregnancy.

2. Establish a Routine: Try to set a regular time each day for bowel movements. This can help train your body to have more predictable bowel habits.

3. Avoid Straining: When you feel the urge to have a bowel movement, don’t delay. Straining can worsen hemorrhoids. If you find yourself straining, consider using a stool softener or a fiber supplement, but consult your doctor before starting any medication.

Positioning and Techniques
1. Proper Toilet Position: Elevating your feet while sitting on the toilet can help. You can use a small stool to raise your feet, which can change the angle of your rectum and make it easier to pass stool.

2. Don’t Sit Too Long: Avoid sitting on the toilet for extended periods, as this can increase pressure on the hemorrhoids.

Medical Management
1. Topical Treatments: Over-the-counter creams and ointments can provide relief from itching and discomfort. However, consult your healthcare provider to ensure they are safe during pregnancy.

2. Suppositories and Laxatives: If dietary changes are not enough, your doctor may recommend stool softeners or laxatives that are safe for use during pregnancy. Always consult your healthcare provider before taking any medication.

3. Consult a Specialist: If your hemorrhoids are severe and not responding to conservative measures, consider consulting a colorectal specialist. They can provide additional options, including minimally invasive procedures that may be safe during pregnancy.

Postpartum Considerations
After delivery, many women find that their hemorrhoids improve significantly. However, it’s essential to continue with a high-fiber diet and hydration to prevent recurrence. If hemorrhoids persist or worsen postpartum, further evaluation and treatment may be necessary.

Conclusion
Managing severe hemorrhoids during pregnancy requires a multifaceted approach that includes dietary changes, lifestyle modifications, and possibly medical interventions. By focusing on a high-fiber diet, staying hydrated, and maintaining regular bowel habits, you can help minimize the discomfort associated with hemorrhoids. Always keep an open line of communication with your healthcare provider to tailor a management plan that suits your specific needs and ensures the health of both you and your baby.

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