Let's talk Butt Stuff! Hemorrhoids in pregnancy & after! | Bowling Green, KY Birth Doula, Educator
What did you think we were talking about?
You have to have a sense of humor to talk about hemorrhoids and literal pains in the butt. There's literally nothing funny about actual hemorrhoids except the way it's spelled. It's hard for some folks to admit or accept, but I'm willing to make a fool of myself and have a photo of my own butt on the internet holding up a help sign, FOREVER, so that you can have a laugh and also so you don't have to suffer through without knowing the basics and how to soothe the pain in your behind.
Again, we're talking about hemorrhoids, not your nosy neighbor.
(If you don't care about knowing what they are or how they got there and want to skip my somewhat comedic description along with the anatomy project .. scroll down to the next red heading .. HOW TO FIX THEM!)
So ... What EXACTLY are hemorrhoids?
Hemorrhoids are swollen, inflamed, (and usually) SORE veins in the area of your rectum and anus.
Essentially they are varicose veins. You may have even heard them called piles by your Great Granny. If you have, they are the same thing. If you haven't .. you should totally call them piles, just for funsies.
There are two types of hemorrhoids, internal and external.
Internal hemorrhoids are found inside your rectum. They are said to be painless ..(let's say less painful because anything that is in or around your anus and rectum that is swollen, inflamed and possibly bleeding does indeed cause some level of pain, even if it's on an emotional level). Internal hemorrhoids are said to cause less pain because of the lack of nerve endings inside the rectum.
Symptoms that you might experience with internal hemorrhoids are:
Painless bleeding on the toilet paper or in the toilet. (Bright red blood)
Pressure in your vaginal area ( I know .. if you're here, there's probably a baby in there or has been recently and that's all kindsa of pressure, but it needed to be said because I rarely see it in articles and you may be reading this postpartum)
Pain (I thought they said painless??) during or after emptying your rectum. (going #2)
When you experience the pain of internal hemorrhoids, it might be because you've experienced a prolapse or that hemorrhoid has slipped through the anus to the outside of your body. It can be scary .. BUTT .. I mean but, (sorry .. I had to at least once) it will typically go back from whence it came on it's own. If not, you can gently coax it back in.
External hemorrhoids are the ones that you find in the area of your anus, better known as the "outside". More crudely put, they are protruding from your butthole. They develop in the skin surrounding your anus. If your care provider doesn't happen upon them during an exam and ask you if you're experiencing pain, you typically find them BECAUSE you are experiencing pain or bleeding and you cautiously try to explore the area to see what's up, down there. I mean everyone has likely heard a hemorrhoid joke or two in their lifetime but I don't think any of us are prepared for what it's like to actually have a hemorrhoid .. or 4.
If you found them with a mirror, by accident .. I'm here to talk.
Symptoms that you might experience with external hemorrhoids might be:
Pain. This can range from mild to OMG I CAN'T SIT DOWN BUT I'M FOR SURE NOT WALKING.
Itching around your anus. (Was your mom furious because you went through a shower strike as a kid to the point that you had itchy butt? No? My kids did! It's like that .. but a shower doesn't fix it.)
Bleeding. Bright red blood. Either on the toilet paper into the toilet or sometimes randomly in your underthings.
Swelling and orb like protrusions from the anus.
One last note on external hemorrhoids. There's a thing ... its called a thrombosed hemorrhoid. It causes extreme pain .. I know ... I know .. insult to injury.
Trust me, it hurts to even talk about it. But you need to know about it. It's essentially a blood clot that has formed in the vein. While it's not considered to be dangerous or life threatening as we tend to think of when we think of a blood clot, it is incredibly uncomfortable. An external hemorrhoid in the anus that is thrombosed will feel more solid as if it has a lump in it, it may be purple or blue, upon visual inspection. This complication can heal on it's own but there are procedures available, of course with risks and benefits to consider, to drain and remove the clot with local anesthetic. For best results, its recommended that these procedures are done within 3 days of the clot forming. Consult with your health care provider for more information.
You may be wondering why I'm using the words rectum and anus as if they aren't the same thing? Well, it's because they aren't. You probably already knew that .. but just in case you didn't .. now you do. The fact that it was so incredibly difficult to find a diagram of a fetus in utero that was LABELED with a rectum and anus, tells me that it's probably not a thing that we talk about enough.
So now that you know WHAT they are ... let's talk about the WHY?
Why? ... I promise I'll make this part short.
(and not as funny)
Just because ... I know .. that sounds silly but some people just get them. I don't really like to rely on percentages because, in my opionion, they are typically made up (at least I think so), inaccurate or conflicting, or used to incite fear. But here I am, citing them as an explanation. According to healthline .. THREE OUT OF EVERY FOUR people will have at least one hemorrhoid in their lifetime. (See .. you're not alone!)
Pregnancy and Birth. If you take a peek at the diagram above, you can see that the pressure of the uterus alone is enough to put strain on the rectum. Constipation in pregnancy is also a leading factor. In a research article about Changes in women's health in the first postpartum year it was cited that 28%-48% of women reported hemorrhoids as a complaint in the 4 weeks immediate postpartum.
Sitting for long periods of time on the toilet. (quit watching tik toks in there .... I'm serious)
Chronic digestive upset like diarrhea or constipation.
Straining during bowel movements
Lack of fiber in your diet.
Regular heavy lifting.
Age. Its thought that as you age that the tissue is more prone to weaken and stretch.
Obesity.
I have to add this because it makes me giggle. It's a wives tale or maybe anecdotal is a more accurate description, but makes me think of my mama, who told me this during my first pregnancy.
"Sitting on concrete causes hemorrhoids."
Again, this isn't research based .. but hey .. maybe don't sit on concrete, just in case?
Now to the part that we've all been waiting for ... in red, as promised!
HOW TO FIX THEM!!!
You can and should ALWAYS call your care provider with any concern that you have! That's what they are there for!
Here's an example script in case you're shy:
Them: Ring Ring .. So and so's office
You: Hi this is (your name), I'm calling for guidance as I'm having some issues/pain in my bottom and I suspect that I have hemorrhoids.
Alternative script:
Them: Ring Ring ... So and so's office
You: Hi! I just had a baby, I'm home now, my butt hurts, please help.
ORRRRR you can use my line.
Postpartum Nurse: Hey there mama! How are you feeling? Are you having any pain?
Me: Yes, my butt really hurts.
Now on to the other stuff.
Try to avoid getting them in the first place. (Which may be impossible even with your best efforts) This is probably deserving of it's own blog post.
Sitz baths or a warm soak in the tub. (I know .. who has time for the warm soak part?) What tha heck is a sitz bath? Just trust me .. you'll thank me later.
This little contraption is a sitz bath and sits in the top of your toilet to hold warm water to soothe your sore bum. Some people like to add herbal soaks intended for this purpose or 1/2 cup UNSCENTED epsom salt (we don't need the lavender and chamomile for this part) to aid in the soothing and healing. It's also great for perineal soaks to aid in comfort when used, like the sitz bath with plain warm water as many times a day as you would like.
Stool softeners postpartum, taken as directed by the lovely postpartum staff.
High fiber diet. Eat more whole grains along with fruits and veggies. If you are struggling with this part there are products on the market that can help you. Benefiber was a great fiber supplement for me postpartum because it was flavorless and diluted well in water.
OTC topical treatments ... this deserves multiple sub headings and explanations.
Creams and suppositories
There's a variety of topical creams and suppositories like Preparation H, containing hydrocortisone and sometimes lidocaine that can be used to reduce swelling and relieve pain. Follow the directions on the packaging.
Tucks or witch hazel pads
We're going to get personal here ..
because the instructions say "Apply externally to the affected area up to 6 times a day or after each bowel movement." If you've sat on a toilet looking at these tiny circles wondering exactly how you apply them then you'll appreciate this tip. You can use these to assist in cleansing the area (if you're postpartum, AFTER you've used your peribottle) THEN .. don't be shy, grab two or three of them and arrange them as I have these circles in the picture below.
Once you've laid them on top of one another .. and have enough to cover your intended area (external hemorrhoids) then wrap these witch hazel pads around them and LEAVE THEM THERE, right between your cheeks to get the full effect. Change them out as needed if they dry out or at your next trip to the potty.
As always, I'm not a doctor. I am not offering medical advice. I'm simply talking about a subject that I feel like we NEED to talk more about. There is nothing on this website or in this post that is intended to replace the advice of a MEDICAL PROVIDER who can evaluate, diagnose and treat any concerns that you might have.
We're looking for all the tips and tricks ... if you have something to add that will help, comment below!