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Hemorrhoids in pregnancy

Also known as Piles, Pregnancy hemorrhoids, Haemorrhoids. Any trimester, most common in the third trimester and just after birth.

Hemorrhoids, also called piles, are swollen veins in and around the anus and lower rectum, and pregnancy makes them almost predictable. The growing uterus, extra blood volume, hormone-slowed digestion, and straining all raise the pressure in those veins. Between about 30% and 40% of pregnant people get them, most often in the third trimester and the first days after delivery. They are uncomfortable and can bleed a little, but they do not harm your baby and usually improve after birth. This page covers what helps, what is safe in pregnancy, and the signs that mean the bleeding is worth checking rather than assuming it is just piles.

Know the warning signs When to call a provider
How common
About 30% to 40%
Of pregnant people, peaking in the third trimester and just after birth.
When
Any trimester
Most common in the third trimester and the first days postpartum.
Urgency
Routine
Benign and usually managed at home; certain bleeding needs a check.
Outlook
Usually improves after birth
Most settle once the pressure of pregnancy lifts.

Understanding it

What is hemorrhoids in pregnancy?

Hemorrhoids, also called piles, are swollen veins in and around the anus and lower rectum, the same small cushions of tissue everyone has, stretched and engorged until they swell. In pregnancy they are very common, affecting roughly 30% to 40% of pregnant people, and they tend to peak in the third trimester and the first days after delivery.

Pregnancy stacks the deck. The growing uterus and your larger blood volume raise the pressure in the pelvic veins, so blood pools in the vessels around the anus. Progesterone slows the bowel, which leads to constipation, and straining against hard stool pushes still more blood into those veins. Pushing during the second stage of labor can bring hemorrhoids on or make them worse right after birth.

You may notice bright red blood on the toilet paper or on the surface of your stool, itching or soreness around the anus, or a soft lump you can feel. Internal hemorrhoids sit inside the rectum and usually bleed without much pain; external ones form under the skin at the anus and can itch and hurt; a thrombosed hemorrhoid is one where a clot forms, causing a sudden, firm, painful purple lump.

The reassuring part is that hemorrhoids do not harm your baby, and most improve on their own after delivery. Softer stools and less straining are the heart of both prevention and relief, along with sitz baths and pregnancy-safe topical options. One caution: not all rectal bleeding is a hemorrhoid, so bleeding that is heavy, mixed into the stool, or dark deserves a call, since other conditions can bleed too.

Symptoms

What are the symptoms?

Hemorrhoids most often announce themselves with bright red bleeding and itching or soreness at the anus. They are uncomfortable but benign. A few features point away from a simple hemorrhoid and toward something that needs checking.

Early signs

  • Bright red blood on the toilet paper, in the bowl, or on the surface of the stool
  • Itching, aching, or soreness around the anus
  • A soft lump or swelling at the anus, or a bulge that pushes out (a prolapsed hemorrhoid)
  • A feeling of fullness or not fully emptying, sometimes with a little mucus
  • Discomfort when sitting or passing a stool, more so with external hemorrhoids

Emergency signs — call 911

  • Heavy rectal bleeding, or blood mixed through the stool rather than streaked on the surface or the paper
  • Black, tarry, or maroon stools, which point to bleeding higher up and not a hemorrhoid
  • A sudden, very painful, firm lump at the anus, which can be a thrombosed hemorrhoid worth prompt evaluation
  • A lasting change in your bowel habits, unexplained weight loss, or bleeding that keeps returning
  • Signs of anemia from ongoing blood loss: unusual tiredness, dizziness, pale skin, or breathlessness

Why it matters

Risks to you and baby

It does not harm your baby

Hemorrhoids are a comfort problem, not a danger to your pregnancy. They do not reach or affect your baby. The impact is on you: discomfort, itching, bleeding, and occasionally a painful clot.

Discomfort and bleeding

The everyday toll is soreness, itching, and bright red bleeding with bowel movements. It can wear on you, especially late in pregnancy and in the tender early postpartum days, but it responds well to simple measures.

A thrombosed hemorrhoid

Sometimes a clot forms inside an external hemorrhoid, causing a sudden, firm, painful purple lump. It is not dangerous to the pregnancy, but it hurts and is worth having looked at. The pain usually eases over a couple of weeks and can sometimes be relieved sooner.

Rare anemia from bleeding

Hemorrhoid bleeding is usually minor. Rarely, ongoing blood loss can contribute to anemia, which matters more in pregnancy when your iron needs are already high. Persistent or heavy bleeding should be reported and checked.

They usually improve after birth

Most hemorrhoids fade once the pressure of pregnancy lifts. In one series about 45% of people had symptoms resolve within days of delivery, 27% within weeks, and the rest over a few months. Keeping stool soft speeds the recovery.

How it's found

How is it diagnosed?

Hemorrhoids are usually diagnosed from your symptoms and a simple look. No blood tests or scans are needed in a typical case, but atypical bleeding is checked further to be sure of the cause.

Symptom history

The pattern of bright red bleeding on wiping, itching, and a lump at the anus is very suggestive. Your provider will ask about constipation, straining, and exactly how the bleeding looks.

Physical exam

Looking at the anus reveals external and prolapsed hemorrhoids and a thrombosed lump. A gentle digital rectal exam checks for internal ones and for any tenderness.

Anoscopy or further evaluation

If bleeding is heavy, mixed into the stool, dark, or does not fit a hemorrhoid, your provider may look inside with an anoscope or arrange further tests to rule out other causes.

Whenever symptoms are bothersome or bleeding appears. Most pregnancy hemorrhoids need no testing beyond the exam.

Treatment

How is it managed?

Treatment is conservative and aimed at comfort: softer stools, less straining, and soothing measures. Most cases settle with home care and improve after delivery, so procedures are rarely needed and usually deferred.

Treatment paths

Start by keeping stool soft and easy to pass: about 25 to 30 grams of fiber a day, plenty of fluids (roughly 8 to 12 cups), and regular gentle activity. Do not strain or sit on the toilet for long stretches, and go when you feel the urge. For relief, warm sitz baths a few times a day, a cold compress or witch hazel pads, gentle cleaning with moist wipes instead of dry paper, and avoiding long periods of sitting all help.

Medication

Stool softeners such as docusate and bulk-forming fiber are safe and often the most useful medicines, since the real fix is softer stool. Witch hazel pads soothe itching. Ask your provider before using a hemorrhoid cream or suppository so you get one that is safe in pregnancy, and do not reach for strong steroid or numbing products on your own. Avoid castor oil and mineral oil for the constipation side.

Monitoring

Keep an eye on the bleeding. Streaks of bright red on the paper are typical, but bleeding that is heavy, mixed into the stool, dark, or persistent should be reported and checked. A procedure, such as rubber band ligation or, rarely, surgery for a stubborn thrombosed hemorrhoid, is considered only when conservative care has been tried and has not worked, and is usually put off until after birth.

Can it recur?

They can. Because the causes (pressure, hormones, and constipation) come back, hemorrhoids often return in later pregnancies and can flare again after a future delivery. The reassuring side is that they usually improve once the baby is born, and the same stool-softening habits both prevent and treat them.

What you can do

Can it be prevented?

  • Stay ahead of constipation

    The single best prevention is keeping stool soft: roughly 25 to 30 grams of fiber a day from fruits, vegetables, whole grains, and beans, plenty of water, and regular movement. Soft stool means less straining, and less straining means fewer hemorrhoids.

  • Do not strain or linger on the toilet

    Go when you feel the urge rather than holding it, and avoid pushing hard or sitting for long periods, which raises pressure in the anal veins. Keep the phone-scrolling on the toilet short.

  • Manage iron and stay gentle

    If your iron supplement is constipating, ask your provider about adjusting it rather than stopping it. Clean gently with moist wipes, and a warm sitz bath or a cold compress eases soreness before it builds.

Who is more at risk

Risk factors

Constipation and straining
Hard stool and the straining it causes are the leading driver, forcing blood into the anal veins. Preventing constipation is the most effective way to lower your risk.
Constipation raises the risk, up to sixfold after childbirth.
The third trimester
As the uterus reaches its largest and presses hardest on the pelvic veins, hemorrhoids become far more likely, and the first days after birth are another peak.
The third trimester is the most common time, about 61% of cases.
A prior history or earlier pregnancy
If you have had hemorrhoids before, in or out of pregnancy, they are more likely to return, and the odds rise a little with each pregnancy.
About 38% of women have them after a first pregnancy.
Labor and delivery
The intense pushing of the second stage, a long second stage, an assisted (instrumental) delivery, and a larger baby all add pressure that can bring hemorrhoids on or worsen them.
Pushing longer than 20 minutes and a newborn over 3,800 grams (about 8.4 pounds) are linked to hemorrhoids.
Age over 35
The supporting tissue around the anal veins weakens with age, so older pregnant people tend to be affected somewhat more often.
One study found those over 35 were about three times as likely to be affected.

Do not wait

When to call your provider or 911

  • Call for rectal bleeding that is heavy, keeps coming, or is mixed through the stool rather than streaked on the surface or the paper.
  • Be seen for black, tarry, or maroon stools, a lasting change in your bowel habits, or unexplained weight loss, which point away from a simple hemorrhoid.
  • Call for a sudden, very painful, firm lump at the anus, which can be a thrombosed hemorrhoid that is easier to treat early.
  • Report signs of anemia from ongoing bleeding: unusual tiredness, dizziness, pale skin, or breathlessness.
  • Check with your provider before starting any hemorrhoid cream, suppository, or laxative in pregnancy, and reach out if home care is not helping.

Talking to your team

Questions to ask your provider

  • Which hemorrhoid creams or suppositories are safe for me to use in pregnancy?
  • Should I use a stool softener, a fiber supplement, or both, and which do you recommend?
  • Is this bleeding coming from a hemorrhoid, or does it need to be looked into further?
  • What is the best way for me to prevent constipation and straining?
  • What can I do about the pain from a thrombosed or bulging hemorrhoid?
  • Could pushing in labor make these worse, and what will help in the days after birth?
  • If they do not settle, when would a procedure be considered, and can it wait until after delivery?

Keep reading

More on hemorrhoids in pregnancy

All pregnancy guides articles

Good to Know

Hemorrhoids in pregnancy FAQs

Common questions about hemorrhoids in pregnancy, answered.

Are hemorrhoids dangerous for my baby?

No. Hemorrhoids are uncomfortable for you but they do not reach or affect your baby. They are a comfort and quality-of-life problem, and most improve on their own after delivery.

Why did I get hemorrhoids now that I am pregnant?

Pregnancy raises the pressure in the veins around the anus: the growing uterus and extra blood volume, progesterone slowing the bowel and causing constipation, and straining against hard stool. Pushing in labor can add to it right after birth.

What is the fastest safe way to get relief?

Keep stool soft with fiber, fluids, and a stool softener, and avoid straining. For the soreness, try warm sitz baths a few times a day, a cold compress, or witch hazel pads. Ask your provider before using a medicated cream or suppository.

Which creams or medicines are safe in pregnancy?

Stool softeners like docusate and witch hazel pads are gentle and widely used. For a hemorrhoid cream or suppository, ask your provider to recommend one that is safe in pregnancy rather than picking a strong steroid or numbing product yourself.

Is it normal to see blood, and when should I worry?

A streak of bright red blood on the paper or the surface of the stool is typical of a hemorrhoid. Tell your provider anyway, and be seen sooner if the bleeding is heavy, mixed into the stool, or the stool looks black or tarry, since other conditions can bleed too.

Will they go away after I give birth?

Usually. Most hemorrhoids improve once the pressure of pregnancy lifts. In one series about 45% of people had symptoms resolve within days, 27% within weeks, and the rest over a few months. Pushing in labor can flare them briefly right after birth.

How do I know it is a hemorrhoid and not something more serious?

Hemorrhoid bleeding is bright red and on the surface, with itching or a lump at the anus. Blood mixed into the stool, dark or tarry stools, a change in bowel habits, or weight loss are not typical of hemorrhoids and should be checked, so do not assume all rectal bleeding is piles.

Can I prevent hemorrhoids in pregnancy?

Largely, by preventing constipation. Get enough fiber and fluids, stay active, go when you feel the urge, and avoid straining or sitting on the toilet for long. If iron is constipating you, ask about adjusting it rather than stopping it.

Medically Reviewed · Updated

Reviewed by Dr. Grace Lin, MD, FACOG · OB-GYN

Obstetrician-gynecologist focused on reproductive and sexual health for women: pregnancy, BV, yeast, trichomoniasis and HPV/cervical screening. Our editorial guidelines →

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