Piles (Hemorrhoids) in Pregnancy: Causes, Symptoms & Safe Treatment

In short: Piles are common in pregnancy because the growing uterus increases pressure on the blood vessels around the anus. Symptoms are bright red blood after a bowel movement, itching, and pain with external piles. To prevent and treat them: eat more fibre, drink 8 or more glasses of water a day, walk for 20 minutes a day, and sit in warm water for 15–20 minutes. See the doctor for heavy bleeding or black stools.

Many pregnant women notice discomfort around the anal area at some point during pregnancy — this is often due to piles, also known as hemorrhoids. To understand why this happens, it helps to know a little about the normal anatomy of this area. There are numerous blood vessels — arteries and veins — supplying the anal and rectal region, which play an important role in regulating bowel motion and helping control stool continence by protecting the anal sphincter from high pressure (in fact, about 15% of anal closure pressure at rest comes from these blood vessels).

Within that area are special blood vessels called sinusoids. Unlike typical arteries and veins, they don’t have muscle tissue in their walls. Together with connective tissue and smooth muscle, this network is called the hemorrhoidal plexus.

Under normal circumstances, these plexuses are not noticeable. But when there’s increased pressure in the anal area or abdomen, they can dilate, become tortuous, and eventually become noticeable or palpable — this is what we call hemorrhoids.

Piles are a very common problem — it’s estimated that about half of people may experience some symptom of hemorrhoids by the age of 50.

Causes of Piles - Hemorrhoids:

Several conditions can increase pressure on these vessels and lead to hemorrhoids, including:

• Pregnancy: the enlarging uterus increases pressure on these veins.
• Straining caused by chronic constipation.
• Straining during bowel movement.
• Prolonged sitting on the toilet.
• Obesity.
• Liver cirrhosis, liver failure, or chronic liver disease.
• Aging, as supporting connective tissue weakens with age.
• Lack of exercise.
• Nutritional factors (low-fiber diet).
• Increased intra-abdominal pressure caused by ascites, an intra-abdominal mass, prolonged straining, or pregnancy.
• Genetic factors.
• A rare factor related to absence of valves in hemorrhoidal veins.
• Prostate hypertrophy in male patients, making them more prone to piles - hemorrhoids.
• Anal intercourse.

Types of Piles - Hemorrhoids:

There are two types of hemorrhoids according to their anatomical position:

• Internal Piles: Hemorrhoids located in the lower rectum above the dentate line; they lack pain receptors.
• External Piles: Hemorrhoids located under the skin around the anus, covered by skin that is sensitive to pain and temperature.

Internal Piles - Hemorrhoids are subdivided into four grades according to the degree of prolapse:

• Grade 1: No prolapse, just prominent, dilated, and tortuous blood vessels.
• Grade 2: They prolapse with bearing down but spontaneously reduce on their own.
• Grade 3: They prolapse with bearing down but need manual reduction.
• Grade 4: Piles - Hemorrhoids become irreducible at this grade.

Symptoms of Piles - Hemorrhoids:

Hemorrhoid symptoms usually depend on their location. The most common sign is painless bleeding, either fresh blood after a bowel movement or streaks of blood on toilet paper.

• Painless bleeding, usually bright red rectal bleeding.
• Rectal pain: For internal hemorrhoids, although they lack pain receptors, if they swell and prolapse they can become strangulated by the anal sphincter muscle, or their blood supply may be cut off, causing pain.
• For external Piles - Hemorrhoids, they can become painful if a blood clot (thrombosis) forms; the pain usually resolves in 2-3 days, though swelling may take a few weeks to settle.
• Perianal mass: a feeling of a lump at the anus, which may be a prolapsed internal hemorrhoid, a skin tag from a previous thrombosis, or dilated skin over an external pile.
• Anal itching and irritation: when a hemorrhoid protrudes, it can trap small amounts of mucus and microscopic stool particles that cause irritation.
• Mucous discharge.
• Fecal incontinence.

Diagnosis of Piles - Hemorrhoids:

Diagnosis is usually made through a medical history and a simple physical examination. A visual examination of the anus and surrounding area can identify external or prolapsed hemorrhoids.

A rectal exam may also be performed, in which the doctor gently inserts a gloved, lubricated finger into the rectum to feel for any masses. A small lighted scope may also be used to look inside the anal canal or lower rectum (endoscopy), performed as a simple office procedure that doesn’t usually require sedation. Depending on your medical history, medications, and overall health, further testing may be recommended.

Things you should pay attention to

Rectal bleeding is never something to ignore — although it is often due to hemorrhoids, other conditions can sometimes cause similar symptoms, so it’s always worth getting it checked.

• If rectal bleeding is associated with marked changes in bowel habit.
• If passing black, tarry stool.
• If there is associated abdominal pain — hemorrhoids don’t typically cause abdominal pain.
• If there is a family history of colorectal cancer.
• If the patient is above 50 years old.
• If there is significant blood loss causing anemia.
• If the patient is taking anticoagulant medication.

Differential Diagnosis of Piles - Hemorrhoids:

• Rectal polyp.
• Anal fissure.
• Fistulae.
• Abscesses.
• Rectal varices.
• Colorectal cancer.
• Inflammatory bowel diseases.
• Diverticular disease.
• Angiodysplasia.
• Anal warts, which might be mistaken for skin tags resulting from external hemorrhoids.
• Rectal prolapse.

Management of Piles - Hemorrhoids:

The most important approach is prevention and conservative management. If conservative treatment doesn’t help, or complications develop, surgical intervention may be considered.

Conservative Management of Hemorrhoids:

• Add more fiber to your daily diet; fiber-rich foods (such as lettuce, bran, or fiber supplements) help prevent constipation, which in turn lessens pressure on the rectum and anus.
• Increase fluid intake, aiming for at least 8 cups of water a day.
• Stool softeners may help, though if hemorrhoids are already present, loose stool can sometimes cause irritation or inflammation of the anus.

These three steps together help reduce pressure on the hemorrhoids, decrease bleeding and inflammation, and reduce irritation from small bits of stool trapped around the blood vessels.

• Exercise helps relieve constipation and reduce pressure — even a brisk 20-30 minute walk a day can help stimulate healthy bowel function.
• Try to have a bowel movement as soon as the urge arises; delaying it can lead to constipation and straining.
• Warm baths for the buttocks and hips can relieve itching, irritation, and spasms of the sphincter muscles. A 15-20 minute sitz bath after each bowel movement, plus twice daily, is often recommended.
• Try to avoid sitting for long periods, or consider using an air or rubber cushion, available at most pharmacies.

Medication for Piles - Hemorrhoids:

Over-the-counter treatments such as topical creams containing local anesthetic can help soothe pain.

Creams and suppositories containing hydrocortisone can also be effective and are considered safe for short courses in pregnancy, but they shouldn’t be used for more than a week at a time, as they may cause skin thinning (atrophy) with prolonged use. During pregnancy, please check with your doctor or pharmacist before using any pile cream or suppository.

Surgical treatment of Piles - Hemorrhoids:

• Coagulation (infrared, laser, or bipolar): uses heat to cause small, controlled bleeding so the hemorrhoid eventually hardens and shrivels; this method has few side effects but a relatively high recurrence rate.
• Sclerotherapy: injecting a chemical solution into the hemorrhoid tissue to shrink it; causes little to no pain but tends to be less effective long-term.
• Rubber band ligation: the most commonly used procedure in the United States, in which a small elastic band is placed around the base of a hemorrhoid; the surrounding tissue scars as it heals, holding the hemorrhoid in place.

It typically takes 2-4 sessions, spaced 6-8 weeks apart, to fully treat the hemorrhoid this way. Complications are rare but can include mild pain or tightness, bleeding, and infection.

• Hemorrhoidectomy: a surgical procedure performed under local or general anesthesia in which the whole hemorrhoid is removed.
• Stapling: a newer surgical technique in which the abnormally lax, expanded supporting tissue that allows the hemorrhoid to prolapse is removed; it tends to be less painful than traditional hemorrhoidectomy, and patients often return to normal activities sooner.

Regardless of the type of surgery, sitz baths and a high

During pregnancy, these procedures are usually postponed until after delivery, because piles often improve by themselves in the weeks after birth. In pregnancy we rely on diet, fluids, gentle stool softeners and safe creams. A procedure is considered only for severe problems, such as a very painful thrombosed (clotted) external pile, which can be treated with a minor procedure under local anaesthetic.-fiber diet are recommended afterward to support healing.

If you’re pregnant and experiencing symptoms of piles or any other concerns during your pregnancy, our team at Dr. Najeeb Layyous’s clinic is here to help guide you with compassionate, experienced care.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist