Hemorrhoids affect women at every stage of life, but pregnancy and childbirth push the prevalence dramatically higher than in the general population. Roughly 40% of pregnant women and new mothers develop hemorrhoids or related perianal conditions, most often during the third trimester or within the first couple of days after delivery.1Frontiers in Surgery. Perianal Diseases in Pregnancy and After Childbirth: Frequency, Risk Factors, Impact on Women’s Quality of Life and Treatment Methods That pregnancy connection dominates the conversation, and rightly so, but it also obscures the fact that women who have never been pregnant get hemorrhoids too, and the causes, complications, and treatment decisions can look quite different depending on what is driving the problem.
Why Pregnancy Is the Single Biggest Risk Factor for Women
Hemorrhoids during pregnancy are not a mystery. Three things converge at once: physical pressure, hormonal shifts, and constipation. As the uterus grows, it compresses the veins draining the pelvis and lower body. Blood has a harder time returning to the heart, which means the veins around the rectum and anus stay fuller and under more pressure than usual. That alone is enough to stretch those veins into swollen hemorrhoidal cushions.
On top of the mechanical pressure, rising progesterone levels relax the walls of veins throughout the body, making them more prone to swelling and pooling blood. Estrogen contributes as well by altering vascular tone and widening veins further.2IntechOpen. Hemorrhoids in Pregnancy and Breastfeeding Think of a garden hose that has been softened in the sun: the same water pressure now bulges the walls outward. This hormonal effect is systemic, which is why varicose veins in the legs and vulvar varicosities often appear during the same pregnancies that produce hemorrhoids.
The third contributor is constipation. Iron supplements, shifting dietary patterns, reduced physical activity, and the slowing of gut motility by progesterone all make hard stools more likely. Straining on the toilet raises pressure in the hemorrhoidal veins each time it happens. In a prospective study following women through pregnancy, constipation during pregnancy and a straining phase lasting more than 20 minutes were both independently associated with developing hemorrhoids.3Frontiers in Surgery. Perianal Diseases in Pregnancy and After Childbirth: Frequency, Risk Factors, Impact on Women’s Quality of Life and Treatment Methods
When Hemorrhoids Are Most Likely to Appear
Timing matters both for prevention and for reassurance. A prospective cohort study that followed 280 pregnant women found that perianal disease developed in about 44% of them. Only a small fraction, around 1.6%, had symptoms in the first trimester. The overwhelming majority, about 61%, developed hemorrhoids during the third trimester, when the uterus is heaviest and venous compression is at its peak. Another 34% first noticed symptoms after delivery itself, and a small group of about 3% developed them a month postpartum.4PubMed. Haemorrhoids and anal fissures during pregnancy and after childbirth: a prospective cohort study A second study broadly confirmed this pattern, with about two-thirds of cases appearing in the third trimester and a smaller proportion after delivery.5Journal of Pharmaceutical Research International. Occurrence of Hemorrhoids and Anal Fissures through Pregnancy and Postpartum
This timeline is useful because it tells you what to expect. If you are in your first or second trimester and feeling fine, the risk window has not really opened yet. If you are in your third trimester or the first days after delivery, that is precisely when to be most aggressive about soft stools, adequate fluid, and good toilet habits. Hemorrhoids that show up in the first two days postpartum are largely the result of the pushing phase of labor. Instrumental deliveries and babies weighing more than about 3,800 grams (roughly 8.4 pounds) were specifically linked to higher hemorrhoid risk.6Frontiers in Surgery. Perianal Diseases in Pregnancy and After Childbirth: Frequency, Risk Factors, Impact on Women’s Quality of Life and Treatment Methods
Outside of Pregnancy
Pregnancy gets the spotlight, but the underlying mechanics of hemorrhoids are the same for anyone: sustained pressure on the veins of the anal canal causes them to swell, stretch, and sometimes bleed or prolapse. Women who have never been pregnant develop hemorrhoids from chronic constipation, prolonged sitting, heavy lifting, obesity, and simply aging, just as men do. The difference is that the conversation around female hemorrhoids tends to be funneled so narrowly toward pregnancy that women dealing with the condition outside of that context may not realize how common it is or may feel less comfortable seeking help.
Constipation is particularly worth examining here. A systematic review and meta-analysis found that functional constipation and a specific pattern called dyssynergic defecation, where the muscles that should relax during a bowel movement instead tighten up, are more common in people with hemorrhoids than in healthy controls.7European Journal of Gastroenterology & Hepatology. Functional constipation in patients with hemorrhoids: a systematic review and meta-analysis This matters because it means treating hemorrhoids without addressing the underlying constipation is treating the symptom rather than the cause. The same analysis suggested that successfully treating the constipation pattern could reduce recurrence of hemorrhoids long-term.
Women appear to be particularly vulnerable to dyssynergic defecation. An American College of Gastroenterology guideline noted that in one study, failure to properly relax the anal canal muscles during straining was found in over a third of healthy women and over half of women with chronic constipation.8American Journal of Gastroenterology. ACG Clinical Guideline: Management of Benign Anorectal Disorders This is significant because it means a large number of women may be straining inefficiently every day without realizing it. Biofeedback therapy, which retrains those muscles, has been shown to help and could reduce the strain that feeds hemorrhoid development.
Conservative Treatment During Pregnancy
The good news is that most hemorrhoids in pregnant women can be managed without procedures. The standard approach focuses on dietary fiber, stool softeners, increased fluid intake, and better toilet habits. The goal is soft stools that pass without straining. That may sound unglamorous, but it works for most women.9PubMed Central. Hemorrhoids in pregnancy
Topical treatments are commonly used too: creams and suppositories containing local anesthetics, low-dose corticosteroids, or anti-inflammatory agents. None of these have been formally studied for safety in pregnancy with the rigor that, say, a blood pressure medication would be. However, a review in a family medicine journal concluded that the constituent ingredients are unlikely to harm a third-trimester baby, given the small amounts absorbed and the short durations typically used.10PubMed Central. Hemorrhoids in pregnancy That said, extended use of steroid-containing creams can thin the skin, so these are best used in short bursts rather than as a daily habit for months.
Sitz baths, warm soaks of the anal area for 10 to 15 minutes a few times a day, provide relief and are completely safe during pregnancy. Ice packs wrapped in cloth can also reduce swelling and numb pain. Many women find alternating between warm and cold most effective. The fiber advice is not just about supplements; getting fiber from whole foods like fruits, vegetables, legumes, and whole grains also adds fluid and bulk to stool in a way that a fiber pill alone may not.
When Conservative Measures Are Not Enough
Most pregnancy-related hemorrhoids resolve within a few weeks after delivery as venous pressure normalizes and hormone levels return to baseline. For hemorrhoids that persist or for women who develop severe hemorrhoids outside of pregnancy, office-based procedures become an option. Rubber band ligation, in which a small elastic band is placed around the base of an internal hemorrhoid to cut off its blood supply, is the most commonly performed office procedure for internal hemorrhoids.
One concern specific to women is whether rubber band ligation is safe during pregnancy. A study that compared outcomes in pregnant women, people with HIV, people with hemophilia, and healthy controls found encouraging results. Pregnant women needed an average of about 1.15 banding sessions per patient to get relief, which was not significantly different from the 1.28 sessions needed by matched healthy controls.11PubMed Central. Rubber band ligation of hemorrhoids: is the procedure effective for the immunocompromised, hemophiliacs and pregnant women? The procedure appeared to work well and without the complications some clinicians might worry about during pregnancy. Even so, most guidelines still recommend deferring elective procedures during pregnancy when conservative treatment is managing symptoms, simply because the condition often resolves on its own after delivery.
Surgical hemorrhoidectomy, the full surgical removal of hemorrhoidal tissue, is reserved for severe cases: large prolapsing hemorrhoids that cannot be pushed back in, hemorrhoids that keep bleeding significantly despite other treatments, or situations involving blood clots in external hemorrhoids that do not respond to drainage. Surgery is generally avoided during pregnancy unless there is an emergency, and most clinicians prefer to wait until the postpartum period to evaluate whether surgery is truly needed, since many hemorrhoids shrink on their own by then.
Exercise, Weightlifting, and Pelvic Floor Considerations
Women who exercise regularly sometimes notice hemorrhoid symptoms during or after workouts, and the type of exercise matters. A study surveying athletes found that cycling, horseback riding, and bodybuilding were all associated with higher rates of hemorrhoid symptoms. Among men, these associations reached statistical significance. Among women in the same study, the trend was similar but did not reach statistical significance, likely because the number of female participants in each sport category was smaller.12PubMed Central. Sport practice and hemorrhoidal disease: results from a self-assessment questionnaire among athletes
The mechanism with weightlifting is intuitive: holding your breath and bearing down during a heavy lift (the Valsalva maneuver) spikes intra-abdominal pressure in the same way that straining on the toilet does. For women who lift heavy weights, a cross-sectional survey found that a history of constipation or hemorrhoids was among the factors significantly associated with symptoms of pelvic organ prolapse.13PubMed. Symptoms of pelvic organ prolapse in women who lift heavy weights for exercise: a cross-sectional survey This does not mean lifting causes prolapse or hemorrhoids in isolation, but it does suggest that women who already have risk factors, such as previous pregnancies, chronic constipation, or a family history of pelvic floor issues, should pay attention to breathing technique during lifts and avoid chronic breath-holding under load.
The pelvic floor is the connective tissue between these issues. Hemorrhoids, pelvic organ prolapse, and dyssynergic defecation are not the same condition, but they share an anatomical neighborhood and some of the same mechanical stresses. Strengthening the pelvic floor through targeted exercises can improve support for all three. Conversely, a weak or damaged pelvic floor, as can happen after vaginal delivery, may make all three more likely.
How Hemorrhoids Affect Quality of Life
The physical symptoms of hemorrhoids, bleeding, itching, pain, the sensation of something bulging from the anus, are manageable for many women. But the impact on daily life, especially during the already demanding periods of late pregnancy and early motherhood, can be significant. Research has specifically noted that perianal conditions reduce quality of life for both pregnant and postpartum women.14Frontiers in Surgery. Perianal Diseases in Pregnancy and After Childbirth: Frequency, Risk Factors, Impact on Women’s Quality of Life and Treatment Methods
Part of this is the discomfort itself, but part of it is the embarrassment and reluctance to seek help. Hemorrhoids are not a glamorous topic, and many women endure symptoms for weeks or months before mentioning them to a healthcare provider. This is particularly true for symptoms that overlap with other conditions, like rectal bleeding, which can seem alarming even when it has a benign cause. The fear of what bleeding might mean sometimes keeps women from bringing it up at all, paradoxically delaying the reassurance they need.
Pain during bowel movements can create a cycle of avoidance: fearing pain leads to delaying going to the bathroom, which leads to harder stools, which leads to more straining, which worsens the hemorrhoids. Breaking that cycle early, usually with stool softeners and fiber, is one of the most effective things you can do regardless of what type of hemorrhoid you have or when it appeared.
Toilet Posture and Prevention
A question that comes up frequently is whether using a squatting position or a footstool helps prevent or relieve hemorrhoids. A scoping review examining the health effects of toilet posture found that squatting may reduce digestive strain and improve bowel evacuation compared to standard sitting.15BMC Public Health. Sitting vs. squatting: a scoping review of toilet postures and associated health outcomes The idea is that squatting straightens the anorectal angle, allowing stool to pass with less muscular effort and therefore less straining. Footstools placed under the feet while sitting on a standard toilet approximate this posture.
The evidence is encouraging but not definitive enough to guarantee prevention. What the posture change does reliably accomplish is reducing the time and effort spent straining, and since prolonged straining is a well-established risk factor for hemorrhoids, the logic is sound even if large randomized trials have not been conducted specifically on hemorrhoid prevention. For pregnant women, who are already dealing with constipation and limited mobility, a footstool is a low-risk, low-cost intervention worth trying.
Other prevention strategies that apply broadly include staying physically active (walking counts), staying hydrated, avoiding sitting on the toilet for extended periods scrolling through your phone, and responding promptly to the urge to have a bowel movement rather than delaying it. These are not revolutionary recommendations, but they are the ones that reduce hemorrhoid risk across every population studied.
When Hemorrhoid Symptoms Mimic Something Else
One underappreciated issue for women is that hemorrhoid symptoms can overlap with symptoms of other conditions, leading to diagnostic confusion in both directions. A case report highlighted a 37-year-old woman who presented with what appeared to be hemorrhoids: an anal mass and bloody stools that had been going on for three years. On examination, she did have hemorrhoids, but a digital rectal exam also revealed a mass under the rectal lining about 8 centimeters from the anus. That mass turned out to be rectal endometriosis.16BMC Women’s Health. Endometriosis in the rectum accompanied by hemorrhoids leading to diagnostic pitfalls: a rare case report
Rectal endometriosis is rare, but the case illustrates a broader point: rectal bleeding in women has a differential diagnosis that includes conditions men do not share. Endometriosis, colorectal malignancy, inflammatory bowel disease, and anal fissures can all produce bleeding, pain, or a sensation of prolapse. If hemorrhoid symptoms do not improve with standard conservative treatment, or if bleeding is accompanied by weight loss, changes in stool caliber, or pain that worsens with menstruation, further evaluation is warranted. A clinician who assumes the obvious diagnosis without examining thoroughly may miss what is actually going on.
The flip side is also true. Women with known endometriosis who develop rectal symptoms may attribute everything to endometriosis and delay evaluation for hemorrhoids, which are far more common and far more treatable. The safest approach is a proper physical examination rather than self-diagnosis in either direction.
Recurrence After Previous Pregnancies
If you had hemorrhoids during a first pregnancy, the odds of getting them again in a subsequent pregnancy are higher. Having perianal disease during a previous pregnancy and childbirth was identified as an independent risk factor for developing hemorrhoids in a later pregnancy.17Frontiers in Surgery. Perianal Diseases in Pregnancy and After Childbirth: Frequency, Risk Factors, Impact on Women’s Quality of Life and Treatment Methods This makes sense biologically: once the hemorrhoidal veins have been stretched and weakened, they are more susceptible to swelling again when the same mechanical and hormonal stresses return.
For women planning another pregnancy who had significant hemorrhoid problems the first time around, addressing residual symptoms before conceiving is a reasonable strategy. That might mean rubber band ligation for internal hemorrhoids that never fully resolved, working with a pelvic floor therapist to improve defecation dynamics, or simply establishing a fiber-rich diet and good hydration habits well before the next pregnancy begins. Starting from a better baseline makes it less likely that the next round of venous pressure will produce the same result.
Treating constipation proactively from the first trimester rather than reactively in the third also appears to help. Women who maintain soft, regular bowel movements throughout pregnancy are less likely to develop the chronic straining pattern that feeds hemorrhoid growth. Iron supplements, which are often prescribed in pregnancy and are notorious for causing constipation, can sometimes be swapped for better-tolerated formulations if the constipation they cause is worsening hemorrhoid symptoms. That is a conversation worth having with your prescriber rather than just toughing it out.