Haemorrhoids are common in the third trimester, treatable, and reported far less often than they occur — for reasons of embarrassment rather than medicine. This page is written to be read without needing to say the word out loud to anybody.
The short answer: increased blood volume, relaxed vein walls, uterine pressure on the pelvic veins and straining from constipation combine in the third trimester. Treating the constipation is the treatment; warm baths, cold packs and short toilet visits are the comfort measures. Some topical preparations are suitable in pregnancy and some are not — ask a pharmacist rather than choosing off a shelf. Severe constant pain with a firm tender lump, or heavy bleeding, needs seeing.
Why it happens
The veins around the anus are normally cushions that help with continence. In pregnancy three separate forces distend them. Blood volume increases by roughly half, so there is simply more to accommodate. Progesterone relaxes the smooth muscle in vein walls, so they stretch more readily under that load. And the uterus sits on the pelvic veins, raising the pressure downstream of it.
Then straining does the rest. Constipation affects a large proportion of pregnancies and is made worse by iron supplements, and every episode of straining pushes the already-distended cushions further down. This is why the two symptoms travel together so reliably, and why treating one without the other never works for long.
What is normal
| Ordinary haemorrhoids | Get it looked at | |
|---|---|---|
| Pain | Discomfort or itching, worse after opening bowels | Severe, constant, unrelated to opening bowels |
| Lump | Soft swelling that reduces | Hard, tender lump that appeared suddenly |
| Bleeding | Bright red, on the paper or the stool surface | Heavy, dark, mixed through the stool, or black and tarry |
| Other | Nothing | Fever, discharge, or a change in bowel habit with weight loss |
What helps
🚽 In order of effect
- Treat the constipation. Fibre, fluid, movement and, if needed, a pregnancy-suitable laxative — see the constipation page. Nothing else on this list changes the cause.
- Do not sit on the toilet for long. Reading there increases pressure on exactly the wrong veins. Go when you need to, and get up.
- Do not strain. A footstool that raises the knees above the hips changes the angle and reduces how much force is needed.
- Warm baths for relief, and a wrapped cold pack for a swollen tender pile.
- Clean gently — water or unscented wipes rather than dry paper, and pat rather than rub.
- Move. Prolonged sitting or standing both make it worse; walking helps venous return.
Call the same day if: the pain is severe and constant with a hard tender lump (a thrombosed haemorrhoid, which is most treatable in the first day or two); bleeding is heavy or does not stop; there is fever or a discharge; or a prolapsed pile cannot be pushed back and is painful.
Do not assume rectal bleeding is piles. Blood mixed through the stool, black tarry stools, a change in bowel habit or unexplained weight loss all need assessing on their own terms, pregnancy or not.
Haemorrhoids in pregnancy — at a glance
A 50% rise in blood volume, progesterone relaxing vein walls, uterine pressure on the pelvic veins and straining from constipation all converge in the third trimester. Treating the constipation is the only intervention that addresses the cause — fibre, fluid, movement and a pregnancy-suitable laxative if needed — while warm baths, wrapped cold packs, gentle cleaning, a footstool to change the angle, and short toilet visits are the comfort measures. Some topical haemorrhoid preparations are considered suitable in pregnancy and others contain ingredients that are avoided, so it is a pharmacist question rather than a shelf decision. Bright red blood on the paper when passing a hard stool is typical; blood mixed through the stool, black tarry stools, heavy bleeding, or a change in bowel habit with weight loss are not, and are assessed on their own terms. Severe constant pain with a hard tender lump suggests thrombosis and is most treatable in the first day or two. Most improve substantially in the weeks after birth, and persistent ones are worth raising at the postnatal check.
Inside Baby Novum: supplements and daily symptoms are logged in one place, which is how an iron prescription in week 28 gets connected to the constipation in week 30 and the piles in week 32 — a sequence that is obvious written down and invisible from memory. Encrypted on the device, no account, no server copy.
Frequently Asked Questions
Why do haemorrhoids happen in pregnancy?
Three things at once. Blood volume rises by around half and progesterone relaxes vein walls, so the veins around the anus distend more easily. The uterus presses on the pelvic veins, raising the pressure inside them. And constipation — extremely common in pregnancy, and worse on iron — means straining, which is what pushes the veins out. The third trimester combines all three, which is why that is when they appear.
What is safe to use for piles in pregnancy?
Most of what helps is not a medicine: warm baths, a cold pack against the area, and not sitting on the toilet for long periods. For products, ask a pharmacist and say how many weeks you are — some topical haemorrhoid preparations are considered suitable in pregnancy and some contain ingredients that are avoided, so it is a question worth asking rather than picking off a shelf. Treating the constipation is the treatment that actually changes the course.
Is it normal for piles to bleed?
A small amount of bright red blood on the paper or on the surface of the stool, when passing a hard stool, is typical of haemorrhoids. What is not: blood mixed through the stool, dark or black tarry stools, heavy bleeding, or bleeding with weight loss or a change in bowel habit. Those are a different question and need seeing — do not assume rectal bleeding in pregnancy is piles just because piles are likely.
Will haemorrhoids go away after birth?
Usually they improve substantially in the weeks after birth as blood volume and pelvic pressure return to normal. Pushing in the second stage of labour can make them temporarily worse first. If they persist beyond the early postnatal weeks, there are effective outpatient treatments — it is worth raising at the postnatal check rather than accepting it as permanent.
When should I see someone about haemorrhoids?
If the pain is severe and constant rather than related to opening your bowels, especially with a firm tender lump — that can be a thrombosed haemorrhoid, which is treatable and is most treatable early. Also if there is heavy bleeding, if you cannot push a prolapsed pile back, or if there is fever or discharge suggesting infection.