Giving birth is a major physical feat, and recovery can come with some uncomfortable surprises. One common issue is postpartum hemorrhoids, which can add itching, swelling, pain, or bleeding to an already tender postpartum period.
Postpartum hemorrhoids can affect quality of life during early recovery.1 Fortunately, home care and, when needed, medical treatment can often ease discomfort and support healing.
Here is what causes hemorrhoids after birth, the symptoms to watch for, how to find relief, ways to reduce your risk, and when to contact your healthcare provider.
Key Takeaways
- Postpartum hemorrhoids are swollen veins around the anus or in the lower rectum that may cause pain, itching, swelling, or bleeding.2,3
- Pregnancy-related pressure, constipation, and straining during labor can contribute to hemorrhoids after birth.4,5,6
- Warm sitz baths, cold compresses, softer stools, and certain topical treatments may help relieve symptoms.2,6,7,9,10,14
- Contact your healthcare provider for severe or persistent bleeding, worsening pain, fever, a sudden painful lump, or symptoms that do not improve with home care.3,6,9
What Are Postpartum Hemorrhoids?
Hemorrhoids are swollen, inflamed veins around the anus or in the lower rectum. Internal hemorrhoids form inside the anus or lower rectum, while external hemorrhoids form under the skin around the anus. Symptoms can include itching, burning, swelling, pain, and bleeding. They are similar to varicose veins.2,3
Related: Perineal Care Postpartum: Tips for Healing After Birth
What Causes Postpartum Hemorrhoids?
Postpartum hemorrhoids develop when pressure causes the veins around the anus or lower rectum to swell.15 Pregnancy, constipation, and pushing during labor can all increase pressure in this area.16
Between 40% and 70% of women develop hemorrhoids during pregnancy or postpartum, most often during the third trimester or the first month after delivery.4,5 Contributing factors include:
1. Pressure During Pregnancy
The weight of the growing baby and uterus during late pregnancy can put pressure on the veins in the pelvic area, increasing the risk of hemorrhoids. Hemorrhoids that begin during pregnancy may become more noticeable or worsen during or after childbirth.7
2. Pushing and Straining During Labor
The pushing and straining during labor can put pressure on the rectal area, leading to the development or worsening of hemorrhoids. One study found that pushing for longer than 20 minutes was especially associated with postpartum hemorrhoids.4
Because straining and pushing can cause hemorrhoids, women who have had vaginal births (especially instrumental vaginal births with forceps or a vacuum) are more likely to develop hemorrhoids than women who have had C-sections. In addition to long pushing time, labors that go longer than 12 hours, pregnancies longer than 40 weeks, and birthing a baby larger than 3,800 to 4,000 grams (8 lb 6 oz to 8 lb 13 oz) are associated risk factors for hemorrhoids.6
Hemorrhoids can still develop after a C-section because pregnancy-related pressure, hormonal changes, and constipation can contribute even without vaginal pushing.4,5,6
3. Constipation
One study reported that constipation is the most important risk factor for developing hemorrhoids during pregnancy and postpartum.5 Constipation is common during pregnancy and postpartum recovery due to dietary changes, dehydration, activity level changes, and sometimes iron supplementation.6 Hard stools and the strain required to pass them can increase pressure in the rectum and anus. Postpartum constipation can exacerbate existing hemorrhoids or cause new ones to form.4
4. Pregnancy-Related Hormonal Changes
Pregnancy-related changes in progesterone and estrogen can affect blood vessel strength and elasticity, making rectal veins more prone to swelling. Motilin levels also decrease during pregnancy, which can slow digestion and contribute to constipation. These changes may weaken or enlarge the veins before birth, while labor and postpartum constipation can make symptoms more noticeable afterward.6
What Are the Symptoms of Postpartum Hemorrhoids?
Postpartum hemorrhoid symptoms can vary depending on whether the hemorrhoids are internal or external. Signs may include:3,8,9
- Pain or discomfort in the anal region
- Itching or irritation around the anus
- Swelling or a visible or noticeable lump near the anus
- Bright red bleeding during or after a bowel movement
- Difficulty sitting or discomfort when sitting for extended periods
Could It Be an Anal Fissure?
Hemorrhoids and anal fissures can both cause pain and bleeding with bowel movements, but they are different conditions. An anal fissure is a small tear in the lining of the anus and often causes sharp pain during or after a bowel movement. Because the symptoms can overlap, a healthcare provider may need to examine the area to confirm the cause.6
How Long Do Postpartum Hemorrhoids Last?
Postpartum hemorrhoids often improve gradually during the early postpartum period, but the timeline varies.6,7 Constipation and continued straining can prolong symptoms.2,6
If your symptoms persist or worsen despite a week of home care, contact your healthcare provider to confirm the cause and discuss other treatment options.9
How To Treat Postpartum Hemorrhoids
Postpartum hemorrhoid symptoms can range from uncomfortable to debilitating. The following home treatments may help reduce pain, itching, swelling, and irritation while the area heals:
1. Take a Warm Sitz Bath
A warm sitz bath can help relieve hemorrhoid pain, swelling, and irritation. Soak the affected area in a warm, shallow water bath for about 10 to 15 minutes several times a day to help reduce swelling and relieve discomfort. You can do this in a plastic tub that fits over your toilet or directly in the bathtub filled with a few inches of water.9 Sitz baths improve blood flow to the area, encourage healing, and reduce pressure and pain for hemorrhoids.6
Related: Postpartum Must-Haves for Recovery After a Vaginal Birth
2. Ask About Topical Treatments
Over-the-counter ointments, creams, balms, medicated pads, and suppositories may temporarily relieve itching, inflammation, soreness, or swelling. Products may contain hydrocortisone, witch hazel, or a local numbing ingredient. Ask your healthcare provider or pharmacist which option is appropriate for you, and do not use medicated products longer than directed.7,10
If you are breastfeeding, topical or rectal hydrocortisone and certain other local hemorrhoid treatments are generally considered compatible with breastfeeding when used as directed because systemic absorption is low. Use the lowest effective amount for the shortest necessary time, wash your hands after application, and confirm the active ingredients with your healthcare provider or pharmacist.17,18
3. Apply a Cold Pack
Cold compresses cause vasoconstriction, which helps tighten blood vessels and reduce swelling and pain.10 Wrap the cold pack in a thin cloth rather than applying it directly to the skin. The hospital where I delivered both of my daughters provided ice packs in the postpartum unit. They helped relieve my perineal trauma and were equally soothing for my postpartum hemorrhoids.
4. Prevent or Treat Constipation
Eating fiber-rich foods, including fruits, vegetables, and whole grains, and drinking plenty of water can help bulk and soften stool. This may prevent constipation and reduce pressure and strain in the rectal area.7,14 If constipation continues despite these changes, talk to your doctor about whether a stool softener or laxative could make bowel movements more comfortable.
5. Avoid Straining and Lingering on the Toilet
Avoiding straining can help prevent further irritation. Go to the bathroom when you feel the urge, but avoid sitting on the toilet for extended periods because this can increase pressure on hemorrhoids.2,6
After the birth of my first baby, I would sometimes end up withholding stool because I was in the middle of feeding her, playing with her, or otherwise tending to her. In the immediate postpartum days, I also withheld because I was afraid of the pain of passing stool on my fresh perineal wounds. This only made my constipation and hemorrhoids worse by ignoring the urge to go.
Related: How to Prepare for Your First Poop After Birth
6. Reduce Pressure From Sitting
Increased time sitting is associated with an increased risk of hemorrhoids.11 It can be difficult to get up and move around while you’re healing from birth and tired from having a newborn, but getting off your butt (literally!) can help your hemorrhoids to heal. If you must sit, try sitting on a pillow or donut pillow to relieve pressure from the perineal area.3
7. Clean the Area Gently
Gentle cleaning can help prevent further irritation while hemorrhoids heal. Consider using a gentle, unscented wet wipe or wetting your toilet paper after using the bathroom. Don’t wipe too harshly, as this can exacerbate hemorrhoids. If you have access to a bidet, postpartum is a great time to use it! Otherwise, many hospitals provide a peri-bottle or squirt bottle to rinse your bottom with warm water after using the bathroom. Gently pat yourself dry after rinsing and wiping. Avoid harsh or scented products, soaps, or wipes to prevent irritation or allergic reactions.13
Can Postpartum Hemorrhoids Be Prevented?
Sometimes, hemorrhoids are just an unfortunate side effect of pregnancy and birth. While it may not be possible to prevent postpartum hemorrhoids entirely, certain measures can help reduce the risk of developing them:
1. Avoid “Purple Pushing”
Many providers encourage you to start pushing your baby out as soon as you hit 10 centimeters of dilation. Directed pushing, or “purple pushing,” often involves holding your breath, bearing down, and pushing as hard as you can for eight to 10 seconds at a time, multiple times during a contraction. However, if you wait to push until you experience the fetal ejection reflex, or the sometimes-unstoppable urge to push your baby out, pushing may require less effort and be more comfortable and effective. Even women who have an epidural will experience the fetal ejection reflex if they wait long enough. Waiting to push allows the force of a contraction to help push your baby out and exerts less pressure on your pelvic floor, reducing the risk of hemorrhoids.12
Related: How to Push During Childbirth: Positions and Tips That Help
2. Keep Stools Soft and Avoid Straining
Just as straining to push a baby out can cause or worsen hemorrhoids, straining to have a bowel movement can have a similar effect. Minimize straining to stool by keeping stools easy to pass. Use the bathroom as soon as you have the urge; this way, you’re working with, not against, your body to pass your stool. Avoid constipation, and keep stools soft by consuming plenty of fiber and water, getting daily movement, and using stool softeners as needed with your doctor’s approval.2
When To Call Your Doctor About Postpartum Hemorrhoids
Postpartum hemorrhoids are common and usually heal on their own with home remedies.6 However, if you experience any of the following, be sure to seek medical attention:
- Your symptoms persist or worsen despite home treatment: If you’ve been treating hemorrhoids at home for a week or more with no resolution or relief, it may be time to talk to your doctor about trying other solutions or interventions.9
- Rectal bleeding is severe or persistent: Hemorrhoids may cause a small amount of bright red blood during or after a bowel movement. However, persistent or heavy rectal bleeding needs medical evaluation because hemorrhoids are not the only possible cause. If you are unsure whether postpartum bleeding is coming from the rectum or vagina, contact your healthcare provider.9,16
- You have a fever or worsening pain: Contact your healthcare provider if you develop a fever or intense, persistent, or worsening pain around the anus. These symptoms require medical evaluation and should not automatically be attributed to hemorrhoids.3
- You suspect a thrombosed hemorrhoid: A thrombosed external hemorrhoid occurs when a blood clot forms inside an external hemorrhoid, often causing sudden, severe pain and a firm lump near the anus. Contact your healthcare provider promptly if this occurs.6
Postpartum hemorrhoids are uncomfortable, but measures such as warm sitz baths, cold compresses, softer stools, and avoiding straining may help ease symptoms while your body heals.2,6,7,9,10,14 If pain or bleeding is severe, symptoms worsen, or home treatment is not helping, contact your healthcare provider.
Recovery takes time, especially while you are caring for a newborn. Finding relief from hemorrhoid symptoms can make the postpartum period more comfortable and help you focus on your own healing.
