Piles in Pregnancy & After Birth
Why pregnancy makes haemorrhoids so likely, what to do about constipation before they appear, what is safe to use, and getting through the first weeks postpartum.
Part of the Complete Haemorrhoids Guide.
Key fact: Constipation is the one factor you can change, and attacking it early does more than treating haemorrhoids later. Most pregnancy-related piles improve substantially in the weeks after birth — but check with your midwife, GP or pharmacist before using any cream or suppository, including over-the-counter ones.
Why pregnancy causes piles
Three things happen at once. Progesterone relaxes the walls of veins and slows the bowel, the growing uterus raises pressure in the pelvis and impedes venous return, and constipation becomes considerably more common. Add the pushing stage of labour and the result is that haemorrhoids are one of the most frequent complaints of late pregnancy and the first weeks after birth.
It is worth saying plainly: this is not a sign you have done anything wrong, and for most women it improves substantially in the weeks after delivery.
Prevention is mostly about constipation
Constipation is the modifiable factor, and it is worth attacking early rather than waiting for haemorrhoids to appear.
- Fluid — requirements rise in pregnancy, and dehydration hardens stool
- Soluble fibre built up gradually — oats, ispaghula, linseed, fruit and vegetables
- Movement — walking and gentle activity help transit
- Do not strain or sit for long; go when you feel the urge rather than putting it off
- Iron tablets constipate — if you are taking them and struggling, raise it at your next appointment rather than stopping them
- Ask about a laxative if stools are hard; bulk-forming and osmotic laxatives are commonly used in pregnancy
Pelvic floor exercises are worth doing for several reasons, and improving venous return in the area is one of them. Sleeping on your side rather than your back also reduces pressure on the pelvic veins.
What is safe to use
Check before treating. Several haemorrhoid preparations are used in pregnancy and breastfeeding, but not all, and the advice differs between products and between trimesters. Ask your midwife, GP or pharmacist before buying anything, including over-the-counter creams and suppositories.
Self-care that carries no such caveat: warm shallow baths, ice packs wrapped in a cloth, keeping the area clean and dry, lying on your side to take pressure off, and paracetamol for pain. Avoid codeine-containing painkillers, which constipate, and check before using ibuprofen in pregnancy.
Where a topical treatment is appropriate, the choice between soothing and steroid-containing products follows the same logic as outside pregnancy — see the creams compared — but the decision should be made with a clinician who knows you are pregnant.
Labour and the days after
The pushing stage commonly brings haemorrhoids out or makes existing ones worse, and the first days postpartum are often the most uncomfortable of the whole episode. What helps:
1
Stay ahead of constipation
The first bowel movement after birth is a common source of dread. Fluid, fibre and a laxative if offered make it far less daunting — ask rather than waiting.
2
Cool and soothe
Ice packs or cooled maternity pads, warm shallow baths, and patting dry rather than rubbing.
3
Get the pain relief right
Paracetamol regularly rather than occasionally. Tell your midwife how bad it is — postpartum haemorrhoid pain is frequently underreported and undertreated.
4
Position
Lie on your side to feed rather than sitting on a hard chair, and use a cushion when sitting.
Most postpartum haemorrhoids improve over the following weeks as pressure and hormones normalise. Those that persist beyond a couple of months, or that keep prolapsing, are worth reviewing — the procedures covered on the main haemorrhoids page are options once you are past the immediate postpartum period.
When to contact your midwife or GP
Contact your midwife, maternity unit or GP promptly if you have severe pain, a sudden very painful lump (a thrombosed haemorrhoid), heavy or persistent bleeding, a fever, or a lump that becomes hot, spreading or discharges pus. Any bleeding in pregnancy that you are unsure of should be checked rather than attributed to piles — see rectal bleeding compared.
Also raise it if pain is stopping you sitting, feeding comfortably or sleeping. It is common, it is treatable, and enduring it silently is not the expectation.
Frequently Asked Questions
Why do you get piles in pregnancy?
Three factors combine: progesterone relaxes vein walls and slows the bowel, the growing uterus raises pressure in the pelvis and impedes venous return, and constipation becomes much more common. The pushing stage of labour then adds to it, which is why haemorrhoids are so frequent in late pregnancy and the first weeks after birth.
Can I use haemorrhoid cream while pregnant?
Some preparations are used in pregnancy and breastfeeding and others are not, and the advice differs between products and trimesters. Ask your midwife, GP or pharmacist before using anything, including over-the-counter creams and suppositories. Warm baths, ice packs, keeping the area clean and dry and paracetamol carry no such caveat.
Will piles go away after the birth?
Usually they improve substantially over the weeks after delivery as pressure and hormone levels normalise, and for many women they resolve. Those that persist beyond a couple of months, or that keep prolapsing, are worth reviewing, and procedural options exist once you are past the immediate postpartum period.
How do I avoid piles getting worse during labour?
You cannot control the pushing stage, but you can control constipation in the weeks beforehand, which is the factor that makes haemorrhoids more likely and more painful. Fluid, soluble fibre built up gradually, movement, not straining and asking about a laxative if stools are hard all help.
What helps with the first bowel movement after birth?
Planning for it rather than dreading it. Fluid, fibre and a laxative if one is offered make it far less daunting, and asking for one proactively is reasonable rather than a fuss. Warm baths and regular paracetamol help with the discomfort around it.
When should I contact my midwife about piles?
Promptly for severe pain, a sudden very painful lump, heavy or persistent bleeding, a fever, or a lump that becomes hot or discharges pus. Also raise it if pain is stopping you sitting, feeding or sleeping — it is common and treatable, and postpartum haemorrhoid pain is frequently undertreated.
References
- NHS. Piles (haemorrhoids). nhs.uk
- NHS. Anal fissure. nhs.uk
- National Institute for Health and Care Excellence. Clinical Knowledge Summary: Haemorrhoids. cks.nice.org.uk
- National Institute for Health and Care Excellence. Suspected cancer: recognition and referral (NG12). nice.org.uk
- National Institute for Health and Care Excellence. Quantitative faecal immunochemical testing to guide referral for colorectal cancer in primary care (DG56). nice.org.uk
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Rectal bleeding should never be assumed to be haemorrhoids without assessment. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.