Introduction
Hemorrhoids are commonly known as piles. Hemorrhoids appear as swollen veins occurring in the anus and rectum area. Hemorrhoids appear to be common in pregnancy. It can occur during any period (trimester) of the pregnancy. However, it is mainly seen in the second and third trimesters due to an increase in the size of the fetus leading to pressure over the uterus. Hemorrhoids do not pose any threats to life and is not considered a life-threatening condition. It also does not cause any harm to the health of pregnant women and fetuses. There are two types of hemorrhoids based on their appearance in the location. They are:
- Internal hemorrhoids.
- External hemorrhoids.
Internal hemorrhoids are seen in the rectum, and external hemorrhoids are seen in the area of the anus. People who have experienced hemorrhoids before pregnancy have more chances of having them during pregnancy. Hemorrhoids usually resolve after delivery.
What Are the Causative Factors?
- During the pregnancy, the fetus grows inside the uterus of the woman. As the month progresses, the size of the fetus increases, which puts pressure on the uterus. The pressure of the uterus is transferred to the organs, structures, and blood vessels beneath it. As a result of this pressure present on the blood vessels, the veins become swollen in the rectum and anus area leading to hemorrhoids in pregnancy.
- During pregnancy, the total blood volume increases due to the growing fetus. This extra blood volume causes inflammation over the veins in the anus and rectum area, leading to hemorrhoids in pregnancy.
- If the food intake contains low fiber, it causes difficulty in passing the fecal matter, leading to swelling of veins over that area and hemorrhoids.
- In some pregnant women, taking iron supplements cause difficulty in passing the stools. As a result, straining over the rectus and anal area will lead to swollen veins over the area, leading to hemorrhoids.
- The hormonal change present during pregnancy lead to the formation of hemorrhoids in some patients. The hormone that is increased during pregnancy is progesterone.
- The pregnancy hormones sometimes delay the digestive process and decrease bowel movements. This decrease in bowel movements leads to constipation in pregnancy. In constipation, it is difficult to pass the stools out. The stool becomes hard. Then, extra effort made to pass the fecal matter out lead to swelling of the blood vessels in the anus and rectum, leading to hemorrhoids.
- Long-standing posture or sitting for a prolonged time cause pressure over the anus and rectum area so that swelling appears in the veins over that area can lead to hemorrhoids.
What Are the Symptoms Observed?
Hemorrhoids can be symptomatic and asymptomatic. In some cases, the patient does not experience any difficulty or does not come to know about the situation itself. It is seen in cases of internal hemorrhoids. External hemorrhoids are often symptomatic. The symptoms include:
- Pain around the anus and rectum is felt. It is often referred to as anal pain. The reason for anal pain is that the area has many nerve endings. Pain presents as a dull aching pain or throbbing type.
- The sensation of itching is felt in the anal and rectum area. It initially appears as a small discomfort over the area, leading to an itching sensation. Itching at the anal area is called pruritus ani.
- Pain is present while passing the fecal matter through the anus, where hemorrhoids are present.
- The presence of blood can be identified in the stools, which are passed out through the anus.
- Swelling or a small lump-like area may be noted in the area of the anus.
- Bleeding from the rectus may be observed in some patients. It should be noted well, and appropriate care should be taken immediately.
How Is the Diagnosis Made?
The diagnosis is made based on several pieces of information observed and noted by the healthcare provider:
- The history of the disease stage and the symptoms encountered.
- The doctor would also like to know if the patient has prior history of disease before the pregnancy.
- The doctor physically examines the patient to know the overall status.
- The doctor will check for any swelling or lump present near the anus. After that the doctor will have an examination of the rectum. The doctor inserts gloved fingers into the rectum and observes the changes. For the confirmation of diagnosis, some endoscopic procedures are performed.
These endoscopic procedures may cause slight discomfort in the area of hemorrhoids. Considering the occurrence of hemorrhoids in pregnancy, endoscopic procedures will not be performed. It may be a uncomfortable for pregnant women. If the healthcare provider requires the endoscopic procedure, it will be done using the following:
- Colonoscopy: It is a diagnostic procedure to view the colon, a part of the gastrointestinal tract. In this procedure, the doctor places a long flexible tube into the patient's colon through the anus and rectum. The tube is fitted with a camera at the tip, known as a colonoscope. This colonoscope helps to view the changes in the rectum and anus area. Then, based on the history and physical examination, the doctor concludes the disease.
- Sigmoidoscopy: It helps to view the rectum. This procedure passes a flexible lubricated tube into the rectum through the anus. A camera is present at the tip of the tube, known as a sigmoidoscope. After placing the tube inside, the air is passed into it to visualize the area easily. Sigmoidoscope records the images and sends them to the computer for recreation images for diagnostic procedures.
What Is the Treatment Plan?
The goal of the treatment is to avoid discomfort and pain caused by the hemorrhoids.
- Have a diet with high-fiber content for easy bowel movements and prevention of constipation.
- Do regular exercise, which allows good circulation and ease in bowel movements.
- Pregnant women are advised to avoid standing or sitting in the same position for longer.
- The doctor sometimes recommends stool softeners to prevent strain while passing fecal matter.
- In some cases, according to the opinion of healthcare, laxatives are considered.
- Topical creams to apply over the hemorrhoids are not considered because they are not proven safe during pregnancy.
- Soaking the anus region in a tub of slightly warm water. This method is called a sitz bath. It helps to get relief from the anal pain present. It is considered a home remedy for hemorrhoids.
- Ice cubes or packs can be placed in the area of hemorrhoids as a home remedy.
- Surgery is not considered a treatment option during pregnancy; it will be done after delivery.
Conclusion
Hemorrhoids are swollen veins seen in the anus and rectum area. It is a treatable condition. They do not pose any threat to the life of the mother and fetus. A good fiber-rich diet and exercises help to relieve constipation and straining of the muscles, which helps to prevent discomfort to some extent.
