For most women in their third trimester, seeing blood in the toilet bowl would trigger panic. For Callie Brenshaw,* it was more like annoyance. The Brampton, Ont., woman had been suffering from pregnancy-related constipation and had read that it can sometimes lead to hemorrhoids, which can bleed. “When you read about hemorrhoids, you think, It won’t happen to me,” she says. Until it does. Up to 35 percent of pregnant women suffer from hemorrhoids.
Know the signs
Hemorrhoids develop when the veins in and around the anus become swollen due to the pressure caused by the weight of your pregnant uterus. The most common symptoms are anal itching and burning, and pain when you poo. Internal hemorrhoids will bleed when a hard bowel movement passes over the swollen veins. External hemorrhoids appear as swollen, bluish-coloured lumps on the outside of the anus and are painful but usually don’t bleed.
Hemorrhoids tend to show up either in your first trimester or your last. “In the first couple of months of pregnancy, women tend to become constipated due to hormonal changes. They strain, and we know straining is a risk factor for the development of hemorrhoids,” says Arthur Zaltz, chief of obstetrics and gynaecology, and head of the Women and Babies program at Sunnybrook Health Sciences Centre in Toronto. In the final trimester of pregnancy, he says, your heavy uterus puts pressure on nearby veins, causing tiny clumps of blood vessels in and around the rectum to bulge.
Focus on prevention
One way to prevent hemorrhoids is to minimize straining. That includes avoiding heavy lifting, like picking up your three-year-old. To alleviate the strain of constipation, Toronto-based registered dietitian Cassandra Reid recommends changing your diet. Along with hormonal fluctuations, she says, constipation in pregnancy can also be caused by a lack of fibre. “Eating during pregnancy can be hard,” says Reid. “Hormonally, you might be going for more of your wants versus what you really need, which is a balanced diet.” Along with foods that are rich in fibre, Reid also suggests drinking plenty of water and taking probiotics.
Chat with your doc
If you suspect you have hemorrhoids, mention it at your next ob/gyn or midwife appointment. Don’t be embarrassed—they’ve seen this many times. It’s crucial to raise the issue if you’ve seen blood, says Zaltz, because “there can be other, more serious causes of bleeding.” Want to know sooner? Grab a mirror. If they’re the external kind, you’ll be able to see them around the opening of your anus. Internal hemorrhoids should be looked at by a doctor. Treat the symptoms Though hemorrhoids can’t be cured, the symptoms can be treated until the hemorrhoids go away on their own. Brenshaw’s case appeared seven months into her pregnancy, and she was told to manage her symptoms until after delivery. For most women, that’s the case. “They probably won’t completely disappear until after the baby is born,” warns Zaltz.
If you’re still struggling with discomfort once you’ve increased your fibre and water intake, Ottawa-based pharmacist Shelita Dattani suggests talking to your doctor about using an over-the-counter (OTC) hemorrhoid product containing pramoxine, which relieves pain. Soaking in a bath with witch hazel or Epsom salts will ease discomfort. An OTC stool softener may also help.
Discussing hemorrhoids isn’t fun—so even if the topic doesn’t come up in your prenatal class, know that a few of the women in the group are probably struggling too. “It’s not a subject people openly talk about,” says Brenshaw. “They probably prefer to talk about their kid’s poops, not their own.”
Hemorrhoids during labour
Many women develop hemorrhoids during labour, as the straining caused by pushing the baby out forces the veins in the anus and perianal region to swell. Talk to your nurse, midwife or doctor about meds, but if the hemorrhoids don’t bother you, it’s OK to ignore them until they go away on their own.
*Name has been changed