Hemorrhoidal disease is more frequent in the age group ranging from 50 to 65 years; It is estimated that about half of people over 50 have suffered from it in some way. Probably due to the type of diet and sedentary lifestyle, the populations of industrialized countries are more at risk of suffering from this disorder.
Men and women are affected equally, but women are more vulnerable due to the greater propensity for chronic venous insufficiency. Even the period of pregnancy can increase the risk, both for hormonal factors, which can favor or worsen constipation, and for the weight gain of the pregnant woman and for the pressure that the uterus exerts on the veins of the area as the fetus grows.
What are hemorrhoids in pregnancy
Hemorrhoids are blood vessels located inside the canal. From the anatomical point of view these are three pads (left side, right front and right rear) located in the submucosal tissue that function as “valves”. Thanks to the inflow and outflow of blood, which regulate the opening of the canal, they have the role of contributing to fecal continence.
These are therefore venous structures that, under normal conditions, are not felt, but which can evolve towards hemorrhoidal pathology, characterized by swelling, inflammation, discomfort and blood loss. In common language this pathological condition is always referred to as hemorrhoids.
Hemorrhoids can be internal or external. Internal hemorrhoids are localized at the end of the rectum intestine; They often do not cause a visible lump or pain, but can bleed, generally during evacuation. The external ones are painful and appear spontaneously after intense effort, for example related to a problem of constipation.
In severe cases, hemorrhoids can prolapse, that is, leak from the canal. In this case, blood loss caused by erosion of the superficial part of the mucosa is accompanied by chronic local inflammation.
How hemorrhoids are classified
Hemorrhoidal disease can be classified according to a scheme that provides for four degrees of severity. First-degree hemorrhoids are completely internal to the canal. They can bleed, but there are no signs of protrusion, even during evacuation.
Those of the second degree have a greater volume due to increased venous pressure, may prolapse following excessive efforts, for example during evacuation or delivery, but return spontaneously.
Third-degree hemorrhoids, on the other hand, prolapse spontaneously outside and manual intervention is necessary for them to return.
Finally, in the fourth degree, the most painful, they are completely prolapsed and cannot be repositioned inside the anus.
Hemorrhoids can undergo complications such as thrombosis, which consists of the formation of a blood clot inside them. This prevents the normal passage of venous blood back to the heart and causes an acute inflammatory crisis.
Another possible complication concerns anemia, which can arise as a result of bleeding that lasts over time, even in a subtle way.
The causes
Hemorrhoids are caused by an increase in venous pressure of the anorectal area. It can be caused by pregnancy, lifting weights or repeated efforts during defecation.
Constipation, especially if prolonged, is one of the major risk factors for the development of hemorrhoidal disease: the stool remains in the intestine longer than normal and therefore dehydrates and hardens to cause trauma to the wall. The diet poor in fiber and the poor physical movement are in this sense of the causes.
In favoring the development of the disease, however, other factors also intervene, such as the individual predisposition to varicose veins and the physiological aging process are conditions that alter the venous state and facilitate prolapse.
Or a job that forces you to spend many consecutive hours sitting can hinder blood circulation: stagnation at the level of the and rectal veins, consequently, tends to dilate the hemorrhoidal vessels. Even the intensive practice of sports such as cycling, horse riding, motorcycling, due to the continuous stresses caused, can weaken the hemorrhoidal tissues.
Another important aspect is being overweight, not only during pregnancy. In general, this also predisposes to varicose veins: a weight gain of 20% compared to the ideal weight, in fact, increases the risk of chronic venous insufficiency by 3 to 15%.
Finally, it can happen that an acute hemorrhoidal crisis occurs due to nutrition: habitually eating spicy foods or foods rich in spices, cocoa, sausages, crustaceans or abusing alcohol can, in some subjects, irritate the mucous membrane of the rectum.
Symptoms
Hemorrhoidal disease can give various symptoms, from pain that appears in particular at the time of evacuation or in a sitting position, to bleeding that is generally observed after defecation due to the rupture of blood vessels.Other typical symptoms are itching, burning, feeling of weight and swelling. Soft bodies may be felt to the touch in the area outside the anus.
Rectal bleeding can also be caused by fissures. These are small ulcerations that form in the skin during evacuation and that are caused by the effort that constipation entails.
Although very annoying and painful, hemorrhoidal disease does not generally involve health risks; in the presence of bleeding, however, it is advisable to consult a doctor, who may prescribe any diagnostic tests to rule out other more serious diseases that can cause similar symptoms.
Hemorrhoids in pregnancy
If there are numerous factors that predispose to the development of hemorrhoidal disease, pregnancy is the most important among those that can trigger them. It is estimated that on average two out of three women suffer from hemorrhoids during gestation.
The growing uterus causes pressure on the pelvic veins and inferior vena cava, which, due to the slowed return of blood from the lower half of the body, swell and dilate. The venous walls are thus weakened. The effects can manifest themselves already at the first pregnancy, but the risk of hemorrhoids increases with the subsequent ones by 20-30%.
In the first period, up to the 23rd week, it is mainly hormonal changes that favor hemorrhoids. The progressive increase in progesterone slows down all physiological activities of the body, including intestinal transit, thus worsening a pre-existing constipation or causing its appearance in women who did not suffer from it. In addition, the end of the intestine is compressed by the weight of the fetus, a condition that worsens as pregnancy progresses.
From the 24th week onwards, hormonal factors are associated with weight gain of the pregnant woman and in many cases a reduction in physical activity, which gradually become more important.
Disorders related to hemorrhoidal disease are significantly worsened by natural childbirth. In women who suffered from hemorrhoids during pregnancy, labor and delivery can aggravate the pathology, also in relation to the size of the baby. After childbirth, moreover, especially if it has been difficult, there is an increased risk of hemorrhoidal thrombosis and the frequent appearance of fissures.
Annoying presences to counteract
Hemorrhoids are not a serious disorder, but it is good to fight them immediately, both to alleviate the annoying symptoms, and to prevent them from creating complications during labor and delivery.
If we do not wait for them to get worse, simple behavioral rules can reduce inflammation and restore elasticity to the venous walls.
And they can also be useful as preventive measures.
How to keep an eye on weight and constipation
During pregnancy it is advisable to take care of the diet to keep constipation under control, practice regular physical movement and introduce an adequate amount of fluids (at least one and a half liters a day). The diet must be rich in fiber derived from whole grains, legumes, fruits, vegetables to regularize intestinal transit as much as possible, in favor of a reduction in pressure on the internal veins and to soften the stool.
Particularly useful are all foods that contain substances that can strengthen the walls of the vessels and reduce inflammation, such as blueberries and berries.
Herbal teas (such as those of mallow, marshmallow, horsetail and spirea) can also help. But be careful, better to inquire: not all herbs are indicated in pregnancy.
If lifestyle changes did not bring sufficient results, you can resort to a laxative. This must be osmotic, i.e. based on substances that retain water and increase fecal mass favoring its expulsion, without being metabolized or, if the problem persists in the period immediately following delivery, taken by the child during breastfeeding.
The physiological weight gain must also be kept within certain limits; Not buying extra pounds is also a way to prevent the onset of hemorrhoids. The Guidelines for physiological pregnancy of the Ministry of Health indicate, in relation to the weight of the woman before becoming pregnant, as adequate an increase of six kilos for obese women, 12-18 kilos for underweight women and 11-16 kilos for normal weight women.
Sometimes it happens, in women who experience severe nausea and have difficulty eating, to lose weight during the first trimester. In the following period the nutritional requirement increases: a normal-weight woman needs every day, compared to normal, about 300 additional Kcal in the second trimester and 450 in the third. In order not to exceed with the extra pounds, however, it is advisable to avoid the so-called “empty” calories, which do not provide nutrients: foods rich in sugars and fats, drinks, sweets, fried foods, alcohol.
Leave the armchair
Moving is an obligation. With common sense. No violent efforts, but regular exercise is good for you, throughout your pregnancy.
It stimulates intestinal motility, promotes circulation and, therefore, the return of venous blood to the heart. And it helps to keep weight under control, which is no small matter!
Bodyweight activities are a real panacea for the cardiovascular system and to keep the muscles in tone. Swimming, pilates or stationary bikes, for example, are fine, as are long walks in the fresh air.
Soap and water
As long as the water temperature and pH of the detergent are adequate, several washes a day with warm water and acid soaps can provide relief, especially if hemorrhoids have already appeared.
And, in any case, it is advisable to make a bidet every time you go to the bathroom, to speed up healing and avoid the risk of infection.
Dry by dabbing, without rubbing, as well as using emollient wet wipes instead of toilet paper will avoid irritating the area.
Altolà in the cold: washing with icy water is absolutely contraindicated because they induce contraction of the muscles that could cause the choking of hemorrhoidal nodules.
Treatment of hemorrhoids in pregnancy
In milder cases, to counteract hemorrhoids, it may be sufficient to change your lifestyle and diet, possibly also using drugs with local action.
Other interventions, surgical and not, necessary for more serious situations that occur during pregnancy, are however postponed until after the birth of the child, when it is very likely that most of the disorders have decreased, if not disappeared.
The ointments based on corticosteroids and local anesthetics normally used cannot be used in pregnancy. To cope with the symptoms, it is therefore better to use products based on substances such as zinc oxide, calendula, bismuth or hamamelis which, thanks to a soothing and astringent action, reduce the feeling of discomfort. Among the possible remedies that can give relief and alleviate pain, also to immerse yourself in warm water for 10-15 minutes, taking care then to dry the part to avoid humidity.
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
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