What Causes Hemorrhoids During Pregnancy?

Pregnancy hemorrhoids are soft venous clusters formed by the expansion and flexion of the venous plexus under the mucosa at the distal end of the rectum and under the skin of the anal canal. Pregnant women are a high-risk group of hemorrhoids. Its occurrence is related to the increase in arterial blood flow in the pelvic cavity of pregnant women during pregnancy, and the increase of uterine pressure and abdominal pressure, which oppress the pelvic cavity. The main clinical manifestations are bleeding in the stool, or prolapsed with hemorrhoids, and severe cases are accompanied by anal bloating and anemia. The diagnosis can be confirmed by clinical manifestations, visual inspection, digital examination, and anoscopy. Hemorrhoids during pregnancy are generally treated conservatively, and surgery is feasible when necessary. The prevalence of hemorrhoids during pregnancy is high, and attention should be paid to prevention.

Basic Information

Visiting department

Obstetrics and Gynecology

Multiple groups

Pregnant woman

Common locations

anus

Common causes

Pregnant women are sedentary during pregnancy, which affects blood circulation throughout the body, insufficiency of pregnant women's movements, slowed bowel movements, fetal growth, and increasing uterus, etc.

Common symptoms

Anal swelling, itching, soreness, erosion, necrosis, blood in the stool, even suppuration, secondary anal fistula, etc.

Causes of hemorrhoids during pregnancy

1. Pregnant women are sedentary during pregnancy, which affects blood circulation throughout the body, slows blood flow in the pelvis and congestion of internal organs in the abdominal cavity, causing excessive filling of venous veins, varicose veins, bulges, and decreased venous wall tension.

2. Insufficient movement of pregnant women, slowed bowel movements, long stay of feces in the intestinal cavity, excessive absorption of water in the feces causes dry stools, clusters of fecal masses thereby compressing the veins and causing local congestion and blood reflux disorders.

3. With the growth of the fetus, the uterus gradually increases, and pressure on the inferior vena cava is formed, which hinders the blood flow in the pelvic cavity and stagnates the blood in the perianal venous plexus.

4. Affected by endocrine hormones during pregnancy, can cause pelvic vasculature and rectal vasodilation.

5. Increased abdominal pressure during childbirth can cause local anal hemorrhoidal vein reflux disorders, and even cause damage to hemorrhoidal veins leading to thrombotic external hemorrhoids and inflammatory external hemorrhoids.

6. After delivery, due to the emptiness of the abdominal cavity, the sense of stool becomes dull, and there is often no stool for several days. In addition, the bed is prolonged and the defecation is weak, which makes the feces stay in the intestine for too long and becomes highly indurated.

Clinical manifestations of hemorrhoids during pregnancy

Internal hemorrhoids performance

Mainly manifested as bleeding during stool, or with prolapse of hemorrhoids. Generally no pain, severe cases may have anal swelling, itching, such as prolapse incarceration of hemorrhoid nucleus, can cause swelling and pain, erosion, necrosis, and even suppuration, secondary anal fistula and other symptoms. Generally there are no systemic symptoms, anemia may be secondary to those with a large amount of bleeding, difficulty in stool, and difficulty in emptying urine.

2. External hemorrhoid manifestations

May have red, swelling, heat, pain and other inflammatory manifestations, and anal subcutaneous swelling, anal marginal fibrosis, connective tissue hyperplasia and other manifestations.

Hemorrhoid examination during pregnancy

Inspection

External hemorrhoids can see hemorrhoidal bumps or skin tags on the anal margin.

2. Referral

Simple internal hemorrhoids are not easy to touch. Larger internal hemorrhoids can feel vertical folds and raised hemorrhoidal nodules above the tooth line. Thrombosis internal hemorrhoids in the center of the hemorrhoid body can touch the oval blood clots, hard, mobile, tenderness.

3. Auxiliary inspection

(1) Anoscopy is the main method for diagnosing hemorrhoids. Can see the site, size and shape of internal hemorrhoids. The primary internal hemorrhoids are usually located in the front right, rear right, and left middle, and the location of secondary internal hemorrhoids often varies.

(2) Suction checker For patients with prolapsed hemorrhoids in the middle and late stages, the suction device can be used to attract the hemorrhoid body outside the anus for observation. Patients can also be instructed not to observe after defecation.

Diagnosis of hemorrhoids during pregnancy

Hemorrhoids are first divided into internal, external, and mixed hemorrhoids.

1. Diagnosis of internal hemorrhoids

Stage : Asymptomatic, with blood only in the stool, nodular protrusions of the mucosa were seen above the dentate line during anal examination.

Stage : Intermittent blood, drip or ejection during defecation, internal hemorrhoids prolapse, and they will be self-contained after defecation.

Stage III: Internal hemorrhoids prolapse during defecation and cannot be accepted.

2. Diagnosis of external hemorrhoids

Inflammatory external hemorrhoids: After skin injury or infection of the anal margin, the folds and protrusions are red, swollen, hot, and painful.

Thrombotic external hemorrhoids: Thrombosis in the anal venous plexus, subcutaneous bulge, and pain.

Connective tissue external hemorrhoids: Repeated stimulation of chronic inflammation causes fibrosis of the skin of the anal margin, connective tissue hyperplasia, and formation of skin tags, also known as skin extrahemorrhoids.

Varicose external hemorrhoids: When squatting or attracting for a long time, the anus is swollen subcutaneously, and varicose veins can be seen, which cannot be dissipated immediately.

3. Diagnosis of mixed hemorrhoids

The rectum (inner hemorrhoidal venous plexus) and anus (external hemorrhoidal venous plexus) venous plexus in the same position above and below the dentate line expand, flex, and anastomosis, and the sphincter sulcus disappears, so that the upper and lower forms a whole.

Prevention of hemorrhoids during pregnancy

1. Develop good eating habits

Eat more fresh vegetables and fruits, especially should eat more foods containing crude fiber; do not eat or eat spicy foods and condiments; develop a habit of drinking plenty of water, it is best to drink light saline or honey water It is beneficial to soften and lubricate the stool and prevent constipation.

2. Develop good bowel habits

The bowel time should be relatively fixed, and once the bowel habits are formed, do not change easily. At the time of bowel movements, even if you have no bowel movements, you should insist on going to the toilet to cause bowel bowel reflexes, and you can form a habit for one week; Long, generally not more than 10 minutes; do not read and read newspapers in the toilet; if the stool is dry, when the stool is difficult, you can use some intestinal laxative drugs such as Ma Ren Run Chang Wan Wanguo tablets.

3. Reasonable physical activity and anal health

Prevent sedentary movements, and promote reasonable outdoor activities, such as walking, doing exercises, and Tai Chi; etc. You can do anal contraction exercises twice a day, 30 to 40 times each morning and evening; Wash the anal hot towel and press the anus, and massage the anus 15 times clockwise and counterclockwise each to improve local blood circulation.

Hemorrhoids treatment during pregnancy

For the treatment of hemorrhoids during pregnancy, corresponding treatment methods should be adopted according to the different pregnancy and different conditions of the patient. Generally speaking, it is divided into two categories: conservative treatment and surgical treatment. Conservative treatment is generally advocated during pregnancy. No treatment is required for asymptomatic patients. The conservative treatment method is as follows:

1. Do not eat spicy and irritating food, eat less digestible food, eat more fiber-containing food.

2. Fumigation and bathing: Use rhubarb, cork, yellow cedar, sophora flavescens or wormwood, peppercorns, locust horn or locust flowers, purslane, figs, arborvitae leaves, decoction, twice daily, or morning and evening. Wash the affected area first after fumigating with heat, 15-20 minutes each time. Drugs such as hemorrhoids ning suppository can be used after defecation sitting bath.

3. Reduce the time of standing or sitting for a long time, and make blood circulation smoother.

4. Pregnant women can also do some exercises to promote local blood circulation in the anus: contract the anus by itself for 1 minute, relax and then contract, 3 times in a row, 3 to 7 times a day.

For patients with severe symptoms, recurrent attacks, and ineffective conservative treatment, patients with unbearable pain, it is recommended to terminate pregnancy and surgical treatment in a timely manner. If surgery is performed during pregnancy, it is safer to choose to become pregnant during pregnancy.