Piles (Haemorrhoids) During and After Pregnancy: A UK Guide

Haemorrhoids, commonly known in the UK as piles, are swellings containing enlarged blood vessels found inside or around the bottom (the rectum and anus). While anyone can develop piles, they are particularly common during pregnancy and the immediate postnatal period. According to NHS data, a significant portion of expectant mothers will experience them, usually during the third trimester or while pushing during labour.

There are two main types: internal piles, which develop inside the rectum and are usually painless but may bleed, and external piles, which develop under the skin around the anus. In pregnancy, these can become particularly uncomfortable due to the increased volume of blood in the body and the physical pressure of the growing baby on the pelvic veins.

Hormonal Changes

During pregnancy, the body produces high levels of the hormone progesterone. While essential for a healthy pregnancy, progesterone relaxes the walls of your blood vessels, making them more prone to swelling. It also slows down the digestive system, which frequently leads to constipation—a primary trigger for piles.

Physical Pressure

As your baby grows, the uterus puts increasing pressure on the pelvic veins and the inferior vena cava (the large vein that carries blood from the lower limbs). This pressure can slow the return of blood from the lower half of the body, increasing the pressure on the veins in the rectal area.

Straining

Constipation is a common side effect of pregnancy and certain prenatal iron supplements. Straining to pass hard stools increases the pressure in the anal canal, causing the veins to bulge. Additionally, the intense straining during the second stage of labour can cause new piles to form or existing ones to enlarge.

Symptoms of piles during pregnancy can range from a mild nuisance to significant discomfort. Common signs include:

• Bright red blood: You may notice small amounts of fresh blood on the toilet paper after a bowel movement.
• Itching and soreness: The skin around the anus may feel irritated, itchy, or inflamed.
• Lumps: You may feel a soft lump hanging outside the anus, which might need to be pushed back in after a bowel movement.
• Pain or discomfort: This is often worse during or immediately after passing a stool.
• Mucus discharge: Occasionally, you may notice slime on the toilet paper or in your underwear.

Following NICE (National Institute for Health and Care Excellence) guidelines, the initial management of piles in pregnancy focuses on lifestyle modifications to soften stools and reduce straining.

Dietary Adjustments

Increasing your intake of fibre is crucial. Aim for plenty of wholemeal bread, cereals, fruit, and vegetables. Fibre adds bulk to the stool and helps it retain water, making it easier to pass. It is equally important to drink at least 1.5 to 2 litres of water a day to ensure the fibre can work effectively.

Soothing the Area

To relieve local discomfort, you can try:

• Using moist toilet wipes instead of dry paper to clean the area.
• Taking a warm (not hot) bath to soothe itching.
• Applying a cold compress or an ice pack wrapped in a towel to Reduce swelling.
• Gently pushing external piles back inside using a lubricated finger.

Medication

If self-care isn't enough, various ointments, creams, and suppositories are available in the UK. Many products contain a local anaesthetic to numb the pain or a mild corticosteroid to reduce inflammation. While many are available over-the-counter, pregnant women should always consult a healthcare professional before use to ensure the specific product is safe for their stage of pregnancy.

If you are struggling with piles during pregnancy, you do not have to suffer in silence. Speaking to a UK online GP is a convenient way to get a diagnosis and access stronger treatments without leaving home. You should arrange a consultation if:

• Lifestyle changes like increasing fibre and fluids have not improved your symptoms after two weeks.
• The pain is making it difficult to sit, walk, or sleep.
• You are experiencing persistent bleeding from the bottom.
• You are concerned about the safety of over-the-counter treatments while pregnant or breastfeeding.

An online doctor can review your symptoms, provide a private prescription for stronger haemorrhoid creams or stool softeners, and offer a sick note if the discomfort effectively prevents you from working.

For many women, piles that developed during pregnancy will improve or disappear entirely within a few weeks of delivery as hormone levels stabilise and pelvic pressure is removed. However, the early weeks of motherhood can still be a high-risk time due to dehydration (especially if breastfeeding) and the fear of pain during bowel movements after a perineal tear or episiotomy.

Continue to prioritise hydration and avoid 'holding it in.' Ignoring the urge to go can lead to harder stools and further straining. If your piles persist beyond your six-week postnatal check, your GP may discuss further options, though surgical interventions are rarely considered until at least six months postpartum to allow for natural healing.