Hemmroids during pregnancy. Hemorrhoids During Pregnancy: Causes, Symptoms, and Effective Treatments
What causes hemorrhoids during pregnancy. How to identify hemorrhoid symptoms. Which treatments are safe and effective for pregnant women. When to seek medical attention for hemorrhoids. How to prevent hemorrhoids during pregnancy.
Understanding Hemorrhoids in Pregnancy
Hemorrhoids, also known as piles, are a common condition affecting approximately 1 in 3 pregnant women. These swollen varicose veins located in the rectum and anus can cause discomfort and concern for expectant mothers. But what exactly are hemorrhoids, and why are they so prevalent during pregnancy?
Hemorrhoids are classified into two main types:
- Internal hemorrhoids: Located inside the rectum and not visible from the outside
- External hemorrhoids: Swollen veins visible on the outside of the anus
Some individuals may experience both types simultaneously. Understanding the difference can help in identifying the condition and seeking appropriate treatment.
Recognizing the Symptoms of Pregnancy-Related Hemorrhoids
Identifying hemorrhoid symptoms early can lead to faster relief and prevention of complications. What are the telltale signs of hemorrhoids during pregnancy?
- Rectal bleeding during bowel movements
- Pain or burning sensation when passing stools
- Itching around the anal area
- Visible swollen veins around the anus (in the case of external hemorrhoids)
It’s important to note that internal hemorrhoids generally don’t cause pain but may result in minor bleeding. External hemorrhoids, on the other hand, are more likely to cause noticeable symptoms and discomfort.
The Link Between Pregnancy and Hemorrhoid Development
Why do hemorrhoids seem to be more common during pregnancy? Several factors contribute to this increased prevalence:
- Increased pressure on rectal veins due to the growing uterus
- Hormonal changes that can cause blood vessels to dilate
- Constipation, which is common during pregnancy
- Increased blood flow in the pelvic area
These factors combine to create an environment conducive to hemorrhoid formation, especially during the second and third trimesters when the baby’s size and weight increase significantly.
Are Some Women More Susceptible to Pregnancy Hemorrhoids?
While any pregnant woman can develop hemorrhoids, certain factors may increase the likelihood:
- Previous history of hemorrhoids
- Family history of hemorrhoids
- Chronic constipation
- Prolonged sitting or standing
- Obesity
Understanding these risk factors can help expectant mothers take proactive steps to prevent or manage hemorrhoids during pregnancy.
Safe and Effective Treatments for Hemorrhoids During Pregnancy
Managing hemorrhoids during pregnancy focuses on alleviating symptoms and preventing further complications. What treatment options are safe and effective for pregnant women?
Lifestyle Modifications
Simple changes in daily habits can significantly impact hemorrhoid symptoms:
- Increasing fiber intake to soften stools and reduce straining
- Staying well-hydrated by drinking plenty of water
- Avoiding prolonged sitting or standing
- Practicing good toilet habits, such as not straining during bowel movements
Topical Treatments
Over-the-counter remedies can provide relief from hemorrhoid symptoms:
- Ice packs to reduce swelling and discomfort
- Sitz baths to soothe the affected area
- Hemorrhoid creams or ointments (consult with a healthcare provider before use)
Medications
In some cases, medications may be necessary to manage hemorrhoids during pregnancy:
- Stool softeners to prevent constipation
- Pain relievers like acetaminophen (always consult with a doctor before taking any medication during pregnancy)
It’s crucial to consult with a healthcare provider before starting any new treatment regimen during pregnancy to ensure safety for both mother and baby.
When to Seek Medical Attention for Hemorrhoids in Pregnancy
While many cases of hemorrhoids can be managed at home, certain situations warrant medical attention. When should pregnant women consult their healthcare provider about hemorrhoids?
- Severe pain or discomfort that interferes with daily activities
- Persistent bleeding during bowel movements
- Symptoms that don’t improve with home remedies
- Large or painful external hemorrhoids
- Any unusual changes in bowel habits
Seeking prompt medical attention can help rule out more serious conditions and ensure appropriate treatment for severe hemorrhoids.
Preventing Hemorrhoids During Pregnancy
Prevention is often the best approach when it comes to hemorrhoids during pregnancy. What steps can expectant mothers take to reduce their risk of developing this uncomfortable condition?
Dietary Considerations
A balanced diet plays a crucial role in preventing hemorrhoids:
- Consume a high-fiber diet rich in fruits, vegetables, and whole grains
- Stay hydrated by drinking at least 8-10 glasses of water daily
- Avoid foods that may cause constipation, such as processed foods and excessive dairy
Exercise and Movement
Regular physical activity can help prevent hemorrhoids by promoting healthy circulation and bowel function:
- Engage in prenatal-approved exercises like walking, swimming, or prenatal yoga
- Avoid prolonged periods of sitting or standing
- Practice Kegel exercises to strengthen pelvic floor muscles
Toilet Habits
Proper bathroom habits can significantly reduce the risk of hemorrhoid development:
- Avoid straining during bowel movements
- Don’t delay when you feel the urge to have a bowel movement
- Use soft, unscented toilet paper or moistened wipes
The Impact of Hemorrhoids on Pregnancy and Delivery
Many expectant mothers worry about how hemorrhoids might affect their pregnancy and delivery. What should women know about the potential impact of hemorrhoids on these crucial stages?
During Pregnancy
Hemorrhoids during pregnancy can cause discomfort but generally don’t pose a risk to the baby. However, they may impact the mother’s quality of life by causing:
- Difficulty sitting for extended periods
- Discomfort during daily activities
- Anxiety or stress related to symptoms
During Delivery
Hemorrhoids may become more pronounced during labor due to increased pressure. However, they typically don’t interfere with the delivery process. In some cases:
- Existing hemorrhoids may become more swollen or painful
- New hemorrhoids may develop due to pushing during delivery
- Rarely, severe hemorrhoids may require special consideration during delivery
Healthcare providers are accustomed to managing hemorrhoids during delivery and can take appropriate measures to minimize discomfort and complications.
Post-Pregnancy Hemorrhoid Care
What happens to pregnancy-related hemorrhoids after delivery? For many women, hemorrhoids improve or resolve on their own within weeks after giving birth. However, some may require ongoing care or treatment.
Postpartum Hemorrhoid Management
To promote healing and prevent complications, new mothers should:
- Continue with dietary and lifestyle measures that prevent constipation
- Use ice packs or sitz baths to reduce swelling and discomfort
- Avoid straining during bowel movements
- Follow up with a healthcare provider if symptoms persist or worsen
When to Consider Further Treatment
In some cases, postpartum hemorrhoids may require additional intervention:
- Persistent symptoms beyond 6-8 weeks postpartum
- Severe pain or bleeding
- Large external hemorrhoids that don’t respond to conservative treatment
Treatment options for persistent hemorrhoids may include more aggressive topical treatments, minimally invasive procedures, or in rare cases, surgical intervention.
Understanding the causes, symptoms, and management of hemorrhoids during pregnancy can help expectant mothers navigate this common but often uncomfortable condition. By taking proactive steps to prevent and manage hemorrhoids, women can focus on the joys of pregnancy and minimize discomfort. Remember, open communication with healthcare providers is key to ensuring appropriate care and addressing any concerns throughout pregnancy and the postpartum period.
Haemorrhoids during pregnancy | Pregnancy Birth and Baby
Haemorrhoids during pregnancy | Pregnancy Birth and Baby
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Key facts
- Haemorrhoids (also known as ‘piles’) are swollen varicose veins located in the rectum and anus (back passage).
- Haemorrhoids are common in pregnancy, with about 1 in 3 pregnancies affected.
- Haemorrhoids can cause symptoms including bleeding, pain or burning when passing a bowel motion (making a poo).
- If you have symptoms, your doctor can confirm the diagnosis and rule out more serious causes.
- The best way to treat and prevent haemorrhoids is by avoiding constipation by drinking plenty of water and eating a high-fibre diet.
What are haemorrhoids?
Haemorrhoids (also known as ‘piles’) are swollen varicose veins located in the rectum and anus (back passage). Haemorrhoids are a common condition in pregnancy, affecting around 1 in 3 pregnancies.
There are two main types of haemorrhoids:
- Internal haemorrhoids are not visible from the outside. Your doctor may see them while performing a visual or digital rectal examination (where the doctor examines your anus with a gloved finger).
- With external haemorrhoids, the veins swell and become visible from the outside.
Some people have both types of haemorrhoids at the same time.
What are the symptoms of haemorrhoids?
Haemorrhoids can cause symptoms including:
- bleeding from the rectum or anus
- pain or burning when having a bowel motion
- itching
External haemorrhoids are more likely to cause symptoms. Internal haemorrhoids generally don’t cause pain, but at times can cause minor bleeding.
When should I see my doctor?
If you have pain when passing stools or see blood on the toilet paper or on your faeces (stool or poo), you should see your doctor. It might be the result of haemorrhoids, but it could be a sign of a more serious condition.
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What causes haemorrhoids during pregnancy?
During pregnancy, haemorrhoids can be triggered by an increase in pressure on your rectal veins. This can result from your growing uterus and pressure from your growing baby, and increased blood flow in the area.
Straining on the toilet because of constipation can also trigger or worsen haemorrhoids.
Haemorrhoids are generally more common in females during their reproductive years.
Sometimes pregnancy can trigger symptoms from internal haemorrhoids, even if they previously did not cause symptoms.
When am I more likely to experience haemorrhoids during my pregnancy?
Pressure on the veins around your anus may get worse as your pregnancy progresses. This is due to your growing uterus and your baby’s increased size. This is why haemorrhoids are more common in the second and third trimesters of pregnancy.
Am I more likely to experience haemorrhoids if I had them before pregnancy?
Not everyone with haemorrhoids has symptoms. If you first experience haemorrhoids during pregnancy, you might not be able to tell if this is new, or if you have had haemorrhoids in the past that did not cause symptoms.
If you know you had haemorrhoids before your pregnancy, take extra care, as they may get worse during pregnancy.
How are haemorrhoids managed during pregnancy?
Because constipation worsens haemorrhoids, treatment options centre around preventing or managing constipation. Another goal of treatment is to reduce the pain associated with haemorrhoids.
Treatment options include the following:
- Lifestyle changes — including a diet high in fibre and drinking lots of water will help ensure you don’t need to strain on the toilet. External haemorrhoids can be treated by placing an icepack on the affected area to reduce swelling. Taking a warm bath may also help to reduce the pain.
- Laxatives — help ease any straining associated with constipation. They help you pass bowel movements (poo) more easily.
- Pain relief medicines — paracetamol can help reduce pain associated with sore, swollen veins, and can be taken during pregnancy. Be sure to follow the directions for use.
- Haemorrhoid creams — help reduce itchiness, pain or inflammation, and contain active ingredients such as corticosteroids or local anaesthetics.
Check with your doctor or pharmacist before using medicines or creams while pregnant.
Could haemorrhoids be a sign of something more serious?
If you think you might have haemorrhoids, it is important to tell your doctor.
This is because symptoms such as bleeding from your bowel or anus can be a sign of more serious conditions.
Will haemorrhoids affect my baby?
Some people are concerned that haemorrhoids might affect their pregnancy or their baby. There is no evidence to support this.
However, there is some concern that the pushing stage of labour and birth can worsen your haemorrhoids. Speak to your midwife if you are concerned about haemorrhoids during your pregnancy or birth.
Will haemorrhoids continue after I’ve had my baby?
In most cases, haemorrhoids go away within a few days after your baby is born.
Minimising constipation by drinking plenty of water and eating a diet high in fibre will help your haemorrhoids improve.
If you find your haemorrhoids do not get better, even a short time after giving birth, speak to your doctor about further treatment.
Can haemorrhoids be prevented?
Avoiding constipation is the best way to reduce your chance of haemorrhoids. A healthy gut will prevent the need to strain during a bowel movement. Eat a diet high in fruit, vegetables and wholegrains, and drink plenty of water.
Resources and support
If you have more questions about haemorrhoids during your pregnancy, you can consult with:
- your doctor or midwife
- an obstetrician
- an accredited dietitian
Sources:
NSW Health
(Haemorrhoids in Pregnancy and Breastfeeding),
Royal Australian and New Zealand College of Obstetricians and Gynaecologists
(The first few weeks following birth),
Australian Government – Department of Health and Aged Care
(Pregnancy care guidelines – Haemorrhoids),
Frontiers in Surgery
(Perianal Diseases in Pregnancy and After Childbirth: Frequency, Risk Factors, Impact on Women’s Quality of Life and Treatment Methods)
Learn more here about the development and quality assurance of healthdirect content.
Last reviewed: March 2023
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Hemorrhoids during pregnancy | BabyCenter
Hemorrhoids – small swollen vessels in your rectal area – are very common during pregnancy, especially in the third trimester. One way to prevent hemorrhoids while you’re pregnant is to reduce constipation; a high-fiber diet and good hydration habits help. Most hemorrhoid treatments are safe for pregnant women, including at-home remedies like ice packs and sitz baths. If you’re experiencing very painful hemorrhoids during pregnancy, talk to your healthcare provider, who can prescribe topical medication. Hemorrhoids typically go away after your baby is born.
What are hemorrhoids?
Hemorrhoids are swollen blood vessels in and around the rectal area. They typically range in size from as small as a pea to as large as a grape, and they can develop inside the rectum or protrude out through the anus. They’re caused by an increase in pressure on the anus and the rectum, the last several inches of your large intestine.
While it’s possible to have hemorrhoids without experiencing any symptoms, they can often be itchy, sore, and mildly uncomfortable – or downright painful, especially when you’re straining during a bowel movement. In some cases, hemorrhoids cause rectal bleeding or blood in the stool during pregnancy.
It’s not uncommon to develop a “thrombosed” hemorrhoid, which is a blood clot that forms inside the hemorrhoid, leading to a large and swollen lump. This type of hemorrhoid can be quite painful and make it hard to walk, sit, or have a bowel movement.
What causes hemorrhoids during pregnancy?
Your growing uterus, constipation during pregnancy, and an increase in the hormone progesterone all make it more likely you’ll develop hemorrhoids during pregnancy (as well as varicose veins in the legs and sometimes even in the vulva). And you’re not alone – up to half of pregnant women have hemorrhoids while they’re pregnant.
Hemorrhoids are especially common in the third trimester, as your expanding 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. As a result, these veins can slow the return of blood from the lower half of your body, which increases the rectal pressure on the veins below your uterus and makes them dilate or swell.
Constipation can also cause or aggravate hemorrhoids because you tend to strain when having a hard bowel movement, and that pushing force encourages the development and growth of hemorrhoids.
During pregnancy, the hormone progesterone relaxes the walls of your veins, which allows them to swell more easily. Progesterone packs a double punch by also contributing to constipation by slowing down your intestinal tract.
Some women get hemorrhoids for the first time while they’re pregnant. And if you’ve had them before, you’re unfortunately more likely to have hemorrhoids during pregnancy too.
You may also develop hemorrhoids during labor while you’re pushing. Discomfort or bleeding from hemorrhoids is also a common complaint during the early postpartum period. In most cases, however, hemorrhoids that developed during pregnancy go away soon after you give birth, especially if you’re careful to prevent postpartum constipation.
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How to prevent hemorrhoids during pregnancy
Here are some ways to prevent hemorrhoids while you’re pregnant:
- Reduce constipation by eating a high-fiber diet (that includes plenty of whole grains, legumes, fruits, and vegetables), staying well-hydrated by drinking about ten 8-ounce cups of water a day, and getting regular exercise during pregnancy, as long as your healthcare provider says it’s okay. If you’re already constipated, ask your healthcare provider about taking a fiber supplement or using a stool softener.
- Don’t wait when you feel the urge to have a bowel movement, and try not to strain.
- Don’t sit on the toilet longer than necessary; this puts pressure on your rectal area.
- Do Kegel exercises daily. Kegel exercises increase circulation in the rectal area and strengthen the muscles around the anus, reducing 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.
- Don’t sit for long stretches of time. If you’re pregnant at work and sitting at a desk all day, get up and move around for a few minutes every hour or so. At home, lie on your side when sleeping, reading, or watching TV to take the pressure off your rectal veins and increase blood return from the lower half of your body.
Remedies and treatments for pregnancy hemorrhoids
There are several remedies you can try to get rid of hemorrhoids during pregnancy:
- Use cold. Cold therapy may reduce swelling and discomfort. Apply an ice pack (with a soft covering) to the affected area several times a day. Some women also find cold compresses saturated with witch hazel soothing.
- Use heat. Soak your bottom in a tub of warm water for 10 to 15 minutes a few times each day. If you don’t have a tub, you can buy a sitz bath, a small basin that you fill with water and position over your toilet so you can sit and submerge your rectal area.
- Alternate cold and hot. Use cold treatments first, then warm, and repeat.
- Keep clean. Clean the affected area gently but thoroughly after each bowel movement. Use soft, unscented toilet tissue, which is less irritating than other varieties. Many women prefer to use unscented wipes rather than toilet tissue. You can also buy wipes moistened with witch hazel specifically for treating hemorrhoids.
- Medicate. Ask your healthcare provider about taking medication for hemorrhoids during pregnancy. They may recommend a topical anesthetic or medicated suppository that’s safe to use. Talk to your provider if you need to use these products for more than a week. (Using some of these products for extended periods of time can cause side effects such as skin irritation or thinning.)
Do I need to see a doctor about pregnancy hemorrhoids?
Most of the time, you can find hemorrhoid relief with home remedies or by making sure you’re doing what you can to address and avoid constipation issues. Reach out to your healthcare provider if those preventive efforts and home treatments aren’t helping, or if you have very painful hemorrhoids during pregnancy or rectal bleeding.
Sharp rectal pain during bowel movements may be a symptom of anal fissures, a less common but routinely seen pregnancy complication. There are effective treatments for anal fissures, but they’re different from what you may be doing to treat hemorrhoids.
It’s always a good idea to check in with your healthcare provider before taking any over-the-counter hemorrhoid medications, or any other medications during pregnancy.
In some cases, you may need to see a specialist for treatment to shrink your hemorrhoids. Minor surgery may be necessary, but that’s rare, and most healthcare providers will recommend waiting until after you’ve given birth to discuss surgery options.
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causes, symptoms, price of treatment in Moscow
Hemorrhoids in pregnant women are manifested in half of women, and after childbirth, more than 80% experience this disease. The disease is associated with changes in the venous network and the formation of nodes. With the progression of the disease, hemorrhoids become inflamed, bleed, fall out and cause many other suffering to a person. Causes and symptoms of the disease
Pregnancy is a natural physiological process, which cannot be the basis for the onset of the disease. However, the characteristics of the body and its transformation in a pregnant woman can lead to the occurrence or exacerbation of hemorrhoids.
Hereditary predisposition and the age of the pregnant woman are important factors contributing to the onset of the disease. Other causes of the disease include malnutrition, excessive physical activity, etc.
Symptoms of hemorrhoids during pregnancy
When hemorrhoids occur during pregnancy, its symptoms are quite obvious:
- Unpleasant sensations: pain, burning, feeling of heaviness in the area of the rectum. Weakly expressed at rest, when walking, sitting and other vigorous activity, they appear more clearly.
- The appearance of nodes, most often observed after a chair and may be accompanied by pain, of varying degrees. The nodes cause discomfort and pain when touched and exercised and can be of various sizes and densities.
- Bloody discharge from the rectum occurs during bowel movements. Their intensity may vary depending on the degree of development of the disease. This is the most dangerous situation, if hemorrhoids bleed during pregnancy, then there is a risk of developing anemia and other diseases that adversely affect the development of the fetus.
Treatment of hemorrhoids in pregnant women
Hemorrhoids during pregnancy, the treatment of which will be carried out untimely, can cause other serious diseases. The greatest danger is external hemorrhoids due to the increased risk of infection. Therefore, treatment must begin from the moment the disease is diagnosed. During therapy, mainly conservative methods are used, and only in cases that pose a threat to the life of the mother or child, they turn to surgical intervention.
In any case, even hemorrhoids in early pregnancy require the attention of a specialist. It is highly not recommended to self-medicate, any mistakes can affect the health of the child. This is due to contraindications to many drugs during pregnancy and the general blood flow of the mother and child.
It is very important to prevent hemorrhoids during pregnancy, which will avoid the disease or reduce the severity of the consequences. The most effective preventive measures include:
- Increase physical activity whenever possible;
- Exclusion from the diet of food (smoked, salty, sweet), provoking constipation;
- Limiting the use of toilet paper and replacing it with wet wipes or washing;
- Use of laxatives recommended by a physician.
Benefits of treating hemorrhoids during pregnancy at the Miracle Doctor Clinic
You should not delay the visit to a specialist, because the sooner treatment begins, the lower the risk of comorbidities and disease progression. Our medical center is ready to provide the services of highly qualified specialists who have repeatedly and effectively treated hemorrhoids during pregnancy. Proctologists are able to offer the most effective methods of therapy, combining traditional and the latest techniques. In addition to extensive practical experience, the doctors of our clinic constantly improve their theoretical knowledge, which allows them to successfully treat even advanced cases, for example, chronic combined hemorrhoids.
The problem of any patient who comes to us is solved strictly individually. Therapeutic methods are selected taking into account the physiological characteristics of the expectant mother and the presence of personal contraindications. The techniques used in our clinic allow pregnant women not to give up their usual way of life.
Hemorrhoids during pregnancy: treatment, diagnosis, symptoms
Venous blood flow disorders are one of the common problems that women face during pregnancy. An increase in hemorrhoids during pregnancy is due to physiological reasons associated with bearing a child. In most cases, a few months after childbirth, the pathology resolves on its own. During pregnancy, specialists prescribe symptomatic treatment of pathology, to eliminate unpleasant symptoms and prevent complications of the disease.
Why does hemorrhoids develop during pregnancy?
Conception starts the process of serious hormonal changes in the woman’s body to maintain and successfully resolve the pregnancy. One of the side effects of hormonal changes is a violation of the intestines, in particular constipation. Irregular bowel movements lead to the formation of hard feces and injuries to the anus and rectum, which leads to inflammation of the hemorrhoids.
The circulatory system experiences tremendous stress, because the volume of circulating blood increases by 50%, which increases the load on the heart and blood vessels. Stagnation of blood in the veins of the lower extremities, edema also contribute to the development of hemorrhoids. The growing uterus puts pressure on the pelvic organs and blood vessels, causing a violation of the blood supply in the venous vessels. Hemorrhoids can develop inside the rectum (internal hemorrhoids) or outside the anus (external hemorrhoids).
Symptoms of hemorrhoids
Inflammation of hemorrhoids in a pregnant woman is characterized by the following symptoms:
- Pain in the anus, pain during defecation. Depending on the size and location of the inflamed node, the pain can be sharp, sharp, dull, pressing.
- Discharge with blood impurities during bowel movements.
- Prolapse of a hemorrhoid from the anus. At the exit, you can feel a small painful formation.
- Cutting and itching in the anus.
- With an exacerbation of internal hemorrhoids, the symptoms are less pronounced. A woman is worried about discomfort in the anus and blood during bowel movements.
As inflammation progresses, pain may become permanent. Blood marks may remain on the linen, in especially severe cases, severe bleeding occurs during bowel movements.
Diagnosis of hemorrhoids
If pathological symptoms appear, you should immediately consult a proctologist. The doctor will determine the presence of pathology by palpation of the anus or during sigmoidoscopy. To determine the severity of the pathology, the presence of an inflammatory process and a decrease in hemoglobin levels due to blood loss, you will need to take a general and biochemical blood test.
Treatment of hemorrhoids in pregnancy
The use of drugs for the treatment of inflammation of hemorrhoids in pregnant women is limited. Recommended for pregnant patients:
- Special diet. A woman needs to exclude fatty, fried, salty, pickled and smoked dishes. Eat more foods rich in fiber and have a laxative effect. It is important to exclude foods that provoke constipation – muffins, fatty foods, rice, semolina, etc.
- Carrying out hygiene procedures. After defecation, you can not use toilet paper and napkins, but wash the anus with warm water or chamomile infusion.
- Motor mode. With an exacerbation of hemorrhoids, it is undesirable to sit for a long time, it is better to be in a reclining position. To activate the venous blood supply, it is important to walk more.
In addition, anti-inflammatory, analgesic suppositories and ointments are used, which the doctor prescribes based on the duration of pregnancy and the severity of the pathology. Surgical treatment of hemorrhoids is contraindicated during pregnancy and lactation. If, 6 months after childbirth, a woman is concerned about inflamed nodes in the rectum or anus, then a minimally invasive operation to remove the node is recommended.
To prevent exacerbation of hemorrhoids during pregnancy, it is important to carefully monitor nutrition and regular defecation. It is recommended to walk more and engage in feasible physical culture in order to prevent blood stasis in the pelvis and activate intestinal motility.