Postpartum hemorrhoids are one of the most common complications of childbirth, affecting roughly a quarter to over a third of women who deliver vaginally. They tend to appear within the first couple of days after delivery, often as painful, swollen lumps around the anus that make an already demanding recovery even harder. Despite how widespread the problem is, it remains strikingly under-discussed in prenatal and postnatal care, and many women are left managing the discomfort on their own without realizing how treatable or preventable it can be.
How Common Postpartum Hemorrhoids Actually Are
The numbers are higher than most people expect. A prospective study following 280 women through pregnancy and the postpartum period found that about 44% developed some form of perianal disease, with hemorrhoids accounting for the overwhelming majority of cases.1PubMed. Haemorrhoids and anal fissures during pregnancy and after childbirth: a prospective cohort study Other estimates put the range at 25% to 35% of pregnant women overall, and in certain populations as high as 85% during the third trimester.2PubMed Central. Hemorrhoids in pregnancy Clinical data consistently show that hemorrhoids cluster around two peak windows: the third trimester and the first day or two after delivery.3PubMed Central. Perianal Diseases in Pregnancy and After Childbirth: Frequency, Risk Factors, Impact on Women’s Quality of Life and Treatment Methods That second window, the immediate postpartum period, is when women are already dealing with perineal soreness, sleep deprivation, and the steep learning curve of newborn care, so hemorrhoids hit at an especially bad time.
Why Childbirth Triggers Hemorrhoids
Hemorrhoids are swollen blood vessels in and around the rectum and anus. They exist in everyone as part of the normal anatomy; the problem starts when those vessels become enlarged, inflamed, or pushed outside the anal canal. Pregnancy and vaginal delivery create the perfect conditions for that to happen through a combination of hormonal shifts and physical pressure.
During pregnancy, increased levels of progesterone relax the walls of blood vessels, making them more prone to swelling. At the same time, the growing uterus puts steadily increasing pressure on the pelvic veins, which slows the return of blood from the lower body. The result is pooling of blood in the rectal veins, much like varicose veins in the legs. Constipation, which is extremely common during pregnancy because of hormonal slowdown of the gut, adds straining on top of that already elevated pressure.4PubMed Central. Hemorrhoids in pregnancy
Then comes delivery itself. The intense, sustained pushing during the second stage of labor puts enormous force on the pelvic floor and anal cushions. For many women who had no hemorrhoid symptoms during pregnancy, this pushing phase alone is enough to cause them. One study found that over 35% of women developed anal lesions during the postpartum period compared to roughly 9% during pregnancy, with the vast majority of thrombosed external hemorrhoids showing up on the very first day after delivery.5PubMed. Anal fissure and thrombosed external hemorrhoids before and after delivery The speed of that onset tells you it is the physical trauma of pushing, not a slow buildup, that triggers the postpartum wave.
Who Is Most at Risk
Not every woman who delivers vaginally develops hemorrhoids, and researchers have identified several factors that raise the odds. A follow-up study examining women through pregnancy and the postpartum period found that higher body mass index, constipation during pregnancy, joint hypermobility, and higher birth weight were all significant predictors of hemorrhoids in both the third trimester and after delivery.6Journal of Women’s & Pelvic Health Physical Therapy. Hemorrhoids, Anorectal Symptoms, and Related Risk Factors in Pregnancy and the Postpartum Period: A Follow-up Study Joint hypermobility is an interesting one that most women would not think to connect. It likely reflects a broader tendency toward connective tissue laxity, which can make the supportive structures around the anus less resilient under pressure.
Parity also matters. Women who have delivered multiple babies are at higher risk than first-time mothers, and hemorrhoid prevalence climbs with age as well.7PubMed. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery Delivering a larger baby increases risk too, as does sustaining perineal tears during delivery.8PubMed. Anal fissure and thrombosed external hemorrhoids before and after delivery The connection between perineal tears and hemorrhoids makes physical sense: both reflect the intensity of stretching and trauma in the same anatomical neighborhood. A prolonged second stage of labor, where you are actively pushing for an extended period, adds to the strain on those tissues.
What Thrombosed Hemorrhoids Look and Feel Like
There is a meaningful difference between a run-of-the-mill hemorrhoid and a thrombosed one, and the postpartum period is particularly associated with the more severe version. A thrombosed hemorrhoid occurs when a blood clot forms inside a swollen external hemorrhoid, creating a firm, bluish-purple lump that is intensely painful. Sitting, walking, and having bowel movements all become much more difficult.
Among women diagnosed with hemorrhoids after delivery, thrombosis rates are strikingly high. One study found that over half of women diagnosed with hemorrhoids during pregnancy or postpartum had thrombosed hemorrhoids.9PubMed Central. Perianal Diseases in Pregnancy and After Childbirth: Frequency, Risk Factors, Impact on Women’s Quality of Life and Treatment Methods Clinical data suggest thrombosed hemorrhoids are far more common immediately after childbirth, at about 20%, than during the last trimester, when about 8% of cases involve thrombosis.10IntechOpen. Hemorrhoids in Pregnancy and Breastfeeding The reason is that the physical force of delivery dramatically increases the odds of a clot forming inside an already swollen vessel. If you notice a hard, painful lump near the anus in the first couple of days after delivery, this is likely what you are dealing with.
Thrombosed hemorrhoids usually peak in pain within the first 48 to 72 hours and then gradually improve as the clot is reabsorbed. The lump itself can take a few weeks to fully shrink. In severe cases, a healthcare provider can perform a small incision to remove the clot, which provides almost immediate relief. This is a simple office procedure and is most effective if done within the first couple of days of symptoms.
How Long Postpartum Hemorrhoids Last
One of the most frustrating aspects of postpartum hemorrhoids is that they do not always resolve quickly. Many women expect them to clear up within a few weeks, but for a substantial number, the problem lingers far longer than anticipated. A study that tracked women from three weeks after delivery to a year and a half later found that about half of those who reported hemorrhoid problems at three weeks still had problems at the 18-month mark.11PubMed. Haemorrhoids – A neglected problem faced by women after birth
That finding runs counter to the reassurance many women receive, which is that hemorrhoids will go away on their own after the baby comes. Some do. Mild hemorrhoids, particularly internal ones that are not thrombosed, often shrink within a few weeks as the hormonal and physical changes of pregnancy reverse. But more severe hemorrhoids, and especially those with repeated flare-ups, can become a chronic issue. The tissue stretching and vein dilation from pregnancy and delivery does not always fully reverse, leaving some women with a permanent tendency toward recurrence. If your hemorrhoids are not improving several weeks after delivery, it is worth raising the issue with your provider rather than assuming they will eventually resolve.
The Toll on Recovery and Well-Being
Postpartum hemorrhoids are not just physically uncomfortable. They can meaningfully interfere with the broader recovery process. Severe cases cause enough pain to restrict mobility, make sitting for breastfeeding sessions difficult, and disrupt bowel movements at a time when regular bowel function is already fragile.12PubMed Central. Effects of Tongyangxiao lotion bidet therapy combined with Ziyu ointment on postpartum hemorrhoidal pain, oedema, anxiety, and depression Women who are afraid of the pain associated with a bowel movement sometimes begin withholding stool, which leads to harder stools and more straining, worsening the hemorrhoids in a self-reinforcing cycle.
There is a psychological dimension as well. Research has linked postpartum hemorrhoid symptoms to reduced quality of life in areas that include physical health, psychological well-being, lactation, baby care, and relationships.13The Iranian Journal of Obstetrics, Gynecology and Infertility. The relationship between severity of hemorrhoid symptoms and quality of life in Postpartum Women with Grade I and II Internal Hemorrhoid Women coping with painful hemorrhoids on top of sleep deprivation, hormonal shifts, and the emotional adjustment to a new baby face a compounding effect. The hemorrhoids are not just an isolated annoyance; they make every other aspect of recovery harder.
What You Can Do to Prevent Them
Prevention starts during pregnancy, and the evidence here is genuinely encouraging. A multicenter randomized clinical trial tested a preventive approach involving dietary guidance, stool softeners, and a topical treatment beginning in early pregnancy. Women in the intervention group had significantly lower hemorrhoid rates at hospital discharge after delivery, with a relative risk reduction of over 60% compared to those receiving standard care.14PubMed Central. Preventing hemorrhoids during pregnancy: a multicenter, randomized clinical trial In the statistical analysis, the intervention was the only factor that independently protected against hemorrhoid development, which gives a lot of weight to the idea that proactive management during pregnancy can make a real difference.
The practical takeaways for prevention are straightforward even without a formal program:
- Fiber intake: Eating enough fiber from fruits, vegetables, and whole grains keeps stools soft and reduces the need to strain. A fiber supplement like psyllium husk can help if dietary intake falls short.
- Hydration: Drinking plenty of water works in tandem with fiber to keep stool consistency manageable.
- Avoiding prolonged sitting: Sitting for long stretches increases pressure on the rectal veins. Getting up and moving regularly helps.
- Addressing constipation early: If constipation develops during pregnancy, treating it promptly with stool softeners (which are generally considered safe during pregnancy) can prevent the repeated straining that leads to hemorrhoids.
- Pelvic floor awareness: Learning to relax the pelvic floor during bowel movements rather than bearing down forcefully reduces the mechanical stress on the anal cushions.
None of these are guaranteed to prevent hemorrhoids entirely, especially given the unavoidable forces involved in vaginal delivery. But they reduce the cumulative pressure that hemorrhoid-prone veins experience over the nine months of pregnancy, which lowers the risk heading into delivery.
Treatment Options After Delivery
Once postpartum hemorrhoids have appeared, treatment focuses on symptom relief and promoting healing. The approach depends on severity.
For mild to moderate symptoms, conservative measures are the first line. Sitz baths, where you sit in a few inches of warm water for 10 to 15 minutes several times a day, reduce swelling and soothe the tissue. Ice packs wrapped in cloth can help with acute pain and inflammation. Over-the-counter topical treatments containing witch hazel or hydrocortisone provide temporary relief from itching and burning. Keeping stools soft with fiber and stool softeners remains important, because a hard bowel movement can re-traumatize healing hemorrhoids.
When over-the-counter options are not enough, prescription treatments come into play. A combination of tribenoside (which reduces inflammation and improves vein tone) and lidocaine (a local anesthetic) has been studied specifically in postpartum women and found to be safe for use during breastfeeding.15PubMed Central. Hemorrhoid management in women: the role of tribenoside + lidocaine Oral medications called phlebotonics, which work by strengthening vein walls and reducing inflammation, have shown effectiveness in decreasing hemorrhoid symptoms like bleeding, itching, and recurrence.16Ewha Medical Journal. Treatment of Hemorrhoid in Unusual Condition-Pregnancy Flavonoid-based phlebotonics in particular have been studied for acute hemorrhoid flare-ups and shown to reduce pain and bleeding.
A Cochrane systematic review looked at rutosides, a specific class of flavonoids, for hemorrhoids during pregnancy and the postpartum period. The review found promising results for symptom relief, but noted that safety data was too limited to make a blanket recommendation.17Cochrane Database of Systematic Reviews. Conservative management of symptomatic and/or complicated haemorrhoids in pregnancy and the puerperium This is a common frustration in postpartum medicine: treatments that appear to work well have not been studied thoroughly enough in breastfeeding women for clinicians to feel fully comfortable prescribing them. If you are breastfeeding, it is worth discussing any medication, even a phlebotonic that sounds mild, with your provider.
Surgery for postpartum hemorrhoids is rare and generally reserved for extreme cases, such as severely thrombosed hemorrhoids that do not respond to conservative care or hemorrhoids with complications like tissue necrosis. For most women, the combination of lifestyle measures, topical treatments, and sometimes oral medications is enough to bring things under control, even if full resolution takes weeks or months.
Why So Many Women Suffer in Silence
Despite how common the problem is, the majority of women with postpartum hemorrhoids do not seek medical care for their symptoms. Research on this gap found that most women simply did not bring it up, and those who did felt that the healthcare system treated their hemorrhoids as a trivial afterthought.18PubMed. Haemorrhoids – A neglected problem faced by women after birth There is an embarrassment factor, certainly, but there is also a broader cultural narrative that postpartum discomfort is just something you endure. Women are often told that hemorrhoids are “normal” in a way that implies no treatment is needed, when what normal actually means is that the condition is common and treatable.
The postnatal checkup, which in many healthcare systems occurs around six weeks after delivery, often focuses on the uterus, the cesarean or perineal wound, mood screening, and contraception. Hemorrhoids rarely come up unless the patient raises them, and by six weeks, a woman who has been dealing with painful hemorrhoids alone for over a month has often either adapted to the discomfort or assumed nothing can be done. Earlier and more routine screening for anorectal symptoms during the immediate postpartum period would catch a lot of women who are struggling unnecessarily.
When Hemorrhoids and Anal Fissures Overlap
Postpartum hemorrhoids do not always appear alone. Anal fissures, which are small tears in the lining of the anal canal, frequently develop alongside or in the wake of hemorrhoids. In the same prospective study that tracked perianal disease after delivery, about 2.5% of women had both hemorrhoids and anal fissures simultaneously, while others developed fissures on their own.19PubMed. Haemorrhoids and anal fissures during pregnancy and after childbirth: a prospective cohort study Fissures tend to show up at a different pace than hemorrhoids: while thrombosed hemorrhoids clustered on the first day after delivery, anal fissures appeared more gradually over the first two months postpartum with no single peak.20PubMed. Anal fissure and thrombosed external hemorrhoids before and after delivery
The distinction matters because the symptoms overlap in confusing ways. Both cause pain with bowel movements and both can produce small amounts of bleeding. But fissures tend to cause a sharper, cutting pain during the bowel movement itself, followed by a burning sensation that can last for hours, while hemorrhoids produce more of a dull ache and pressure. Fissures also respond to slightly different treatments, including topical ointments that relax the internal anal sphincter to allow healing. If your symptoms do not improve with standard hemorrhoid care, or if the pain has a tearing quality, it is worth considering that a fissure might be part of the picture. A quick visual examination by a provider can usually sort it out.
Herbal and Complementary Approaches
Some women turn to herbal remedies for postpartum hemorrhoids, either out of preference or because they are cautious about using pharmaceutical products while breastfeeding. One randomized trial compared a Myrtus communis (myrtle) ointment to a standard anti-hemorrhoid ointment in postpartum women with mild internal hemorrhoids. Both groups saw similar improvement in most hemorrhoid symptoms over eight weeks, though the myrtle ointment was slightly better at reducing anal itching, and women in that group reported higher satisfaction with their treatment.21Journal of Complementary and Integrative Medicine. Comparison of the effect of Myrtus communis herbal and anti-hemorrhoid ointments on the hemorrhoid symptoms and quality of life in postpartum women with grade I and II internal hemorrhoid Quality of life scores did not differ between the groups, which suggests the herbal product performed on par with but not dramatically better than the conventional option.
Witch hazel, aloe vera, and coconut oil are commonly used home remedies, though rigorous clinical trial data for these specific products in postpartum hemorrhoids is sparse. Sitz baths with Epsom salts are another popular option. The evidence base for complementary approaches is thin enough that none can be recommended over established treatments, but for women with mild symptoms who prefer a non-pharmaceutical approach, they are reasonable to try alongside the dietary and lifestyle measures that have better evidence behind them. The key consideration for breastfeeding mothers is whether any topical product contains ingredients that could be absorbed and passed through milk, which is vanishingly unlikely for most plant-based ointments applied externally but worth checking with a pharmacist if you are unsure.