A woman’s body goes through an immense transformation during pregnancy. It’s common for pregnant women to have gastrointestinal issues, including constipation and haemorrhoids, also known as piles.
Dr Ho Ping Ling, a consultant from the department of obstetrics and gynaecology at KK Women’s and Children’s Hospital, revealed that constipation affects up to 40 per cent of pregnant. It can occur anytime in pregnancy but is more prevalent in the third trimester, when the growing womb places increased pressure on the bowel.
Clinical Associate Professor Winson Tan, who heads the Colorectal Surgery Service at Sengkang General Hospital, said that constipation is often a factor for piles. However, having constipation does not mean you will develop piles.
“Haemorrhoids, or piles, are swollen vascular cushions – tissue containing blood vessels – that form on the inside and outside of the anal canal,” Assoc Prof Tan said. “When these blood vessels become swollen and dilated, piles can present with symptoms of bleeding, pain or swelling.
Up to 40 per cent of pregnant mums in Singapore suffer from constipation, and international studies show that 25 to 35 per cent of pregnant women are affected by piles. (Photo: iStock/GOLFX)
He added that international studies estimate that 25 to 35 per cent of pregnant women are affected by piles. In certain populations, up to 85 per cent of women have haemorrhoids in their third trimester.
Dr Ho explained that the development of haemorrhoids during pregnancy is primarily due to the physiological and physical changes that occur. This includes hormonal effects, as progesterone, an essential pregnancy hormone, relaxes smooth muscles, including those in blood vessels. This results in a weakening of vein walls, making them more susceptible to swelling.
“Progesterone also relaxes the smooth muscle of the intestines or bowel, leading to slow bowel movements,” she told CNA Women. “This allows the body more time for nutrients and water absorption, resulting in hardening of the food waste (stool), making it hard to pass during bowel movements. Straining during bowel movements can worsen or lead to haemorrhoids.”
Additionally, pregnancy significantly increases blood volume to support the growing foetus. This, coupled with the expanding womb and increasing foetal weight, can lead to increased pressure on pelvic veins, causing them to swell further.
Some women may also experience haemorrhoids after childbirth due to the strain of labour and delivery, particularly with prolonged pushing during vaginal childbirth, Dr Ho added.
It’s possible to have piles with no symptoms. However, when they do appear, they range from mild to severe.
Common symptoms are anal itching, irritation, soreness or swelling around the anus; pain or discomfort, especially during bowel movements and/or mucous discharge afterwards; and bleeding during or after bowel movements. Women could also have a lump outside the anus (prolapse haemorrhoid) with or without intense pain, said Dr Ho.
She recommended seeking medical advice if there is severe pain or discomfort, persistent or worsening bleeding, an abnormal lump at your anus area, or prolapsed haemorrhoids that do not reduce on their own.
To reduce the possibility of piles, Assoc Prof Tan offered simple tips such as taking adequate fibre (fruits and vegetables or a fibre supplement) and drinking lots of water to ensure that constipation and straining are avoided during bowel movements.
Regular exercise can also help to reduce the risk of constipation, he added.
Regular exercise can prevent haemorrhoids from developing, both during and after pregnancy. (Photo: iStock/Boyloso)
“Medications like laxatives can be considered to address constipation,” said Assoc Prof Tan. “Constipation is common during pregnancy as medications like iron supplements for pregnant women can often lead to it.”
Dr Ho recommended applying cold compresses gently against the haemorrhoids or using sitz baths – warm water baths for the pelvic region – to reduce swelling and discomfort. Women should also clean the area gently with unscented moist wipes or warm water to avoid further irritation. Pat or wash with clear water and avoid dry toilet paper.
“Over-the-counter creams or ointments containing hydrocortisone or witch hazel can soothe inflammation and reduce the swelling and associated discomfort. Always consult your healthcare provider before use,” Dr Ho advised.
Pregnant women with piles are advised to gently apply cold compresses against the haemorrhoids, avoid using dry toilet paper on the area, and consider taking laxatives to ease constipation. (Photo: iStock/miljko)
Women might look to haemorrhoid pillows for comfort but Assoc Prof Tan said the evidence is limited.
“Haemorrhoid pillows may help alleviate symptoms temporarily when sitting by avoiding direct pressure on the haemorrhoids piles,” he said. “However, given their shape, they provide inadequate support during prolonged sitting and may worsen swelling when used for a protracted period.”
Surgery, called a haemorrhoidectomy, is a treatment option but Assoc Prof Tan said it is usually recommended after the delivery of the baby to minimise any risks to the foetus. “In most cases, pregnant women with piles will experience dramatic relief of symptoms after the baby’s delivery,” he added.
Dr Ho said that haemorrhoids improve after childbirth as pressure on the pelvic veins decreases. However, adopting a healthy lifestyle with balanced nutrition and regular activity after childbirth can prevent recurrence.
While haemorrhoids are rarely serious, Dr Ho pointed out that they can significantly impact a mother’s quality of life, particularly in the later stages of pregnancy.
Ling Ho, who had her three children via vaginal deliveries, suffered from constipation in all her pregnancies. “The relentless pressure, made worse by prolapsed and thrombosed haemorrhoids, left me in constant pain and discomfort,” said the 37-year-old. Thrombosed haemorrhoids is when a blood clot forms in an external haemorrhoid, causing severe pain, swelling and inflammation.
She urged women to seek advice for preventing or easing haemorrhoids as “small steps to ease the pressure can make all the difference in your comfort and well-being”.
A doctor’s advice for pregnant mums with haemorrhoids: Be proactive about prevention, manage symptoms early and do not hesitate to seek help. (Photo: iStock/Nutthaseth Vanchaichana)
Jessica Budiman, 33, had piles for 12 years before her pregnancy in 2023. She started having constipation in her second trimester and the piles became swollen and unbearable in her third trimester. She couldn’t walk, sit, sleep or lie down comfortably.
“At 35 weeks, I faced a dilemma: How much longer could I endure the pain while ensuring a safe delivery for my baby?” she said. “To manage the pain, I used a sitz bath and dextrose solution which provided some relief; I also took paracetamol when required. Additionally, I increased my fruit and vegetable intake, drank three litres of water daily and did pregnancy yoga.”
Budiman’s doctor suggested she consume more fibre and drink more water, and prescribed stool softeners. He also advised her to undergo a haemorrhoidectomy after her baby was born, given how the piles disrupted her daily life.
Dr Ho had the following advice for women experiencing haemorrhoids during pregnancy: Be proactive about prevention, manage symptoms early and do not hesitate to seek help. Postpartum, continue with a healthy diet, ensure adequate hydration and practise good hygiene to support healing.
“Haemorrhoids, though uncomfortable, are typically manageable and rarely lead to serious complications. With proper care and guidance, you can find relief and focus on your pregnancy or postnatal recovery,” she said.
“If you are unsure about your symptoms or need tailored advice, always reach out to your doctor for personalised care.”
CNA Women is a section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg.
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Dr Ho Ping Ling, a consultant from the department of obstetrics and gynaecology at KK Women’s and Children’s Hospital, revealed that constipation affects up to 40 per cent of pregnant. It can occur anytime in pregnancy but is more prevalent in the third trimester, when the growing womb places increased pressure on the bowel.
Clinical Associate Professor Winson Tan, who heads the Colorectal Surgery Service at Sengkang General Hospital, said that constipation is often a factor for piles. However, having constipation does not mean you will develop piles.
“Haemorrhoids, or piles, are swollen vascular cushions – tissue containing blood vessels – that form on the inside and outside of the anal canal,” Assoc Prof Tan said. “When these blood vessels become swollen and dilated, piles can present with symptoms of bleeding, pain or swelling.
Up to 40 per cent of pregnant mums in Singapore suffer from constipation, and international studies show that 25 to 35 per cent of pregnant women are affected by piles. (Photo: iStock/GOLFX)
He added that international studies estimate that 25 to 35 per cent of pregnant women are affected by piles. In certain populations, up to 85 per cent of women have haemorrhoids in their third trimester.
Dr Ho explained that the development of haemorrhoids during pregnancy is primarily due to the physiological and physical changes that occur. This includes hormonal effects, as progesterone, an essential pregnancy hormone, relaxes smooth muscles, including those in blood vessels. This results in a weakening of vein walls, making them more susceptible to swelling.
“Progesterone also relaxes the smooth muscle of the intestines or bowel, leading to slow bowel movements,” she told CNA Women. “This allows the body more time for nutrients and water absorption, resulting in hardening of the food waste (stool), making it hard to pass during bowel movements. Straining during bowel movements can worsen or lead to haemorrhoids.”
Additionally, pregnancy significantly increases blood volume to support the growing foetus. This, coupled with the expanding womb and increasing foetal weight, can lead to increased pressure on pelvic veins, causing them to swell further.
Some women may also experience haemorrhoids after childbirth due to the strain of labour and delivery, particularly with prolonged pushing during vaginal childbirth, Dr Ho added.
FIBRE, WATER AND EXERCISE TO PREVENT PILES
It’s possible to have piles with no symptoms. However, when they do appear, they range from mild to severe.
Common symptoms are anal itching, irritation, soreness or swelling around the anus; pain or discomfort, especially during bowel movements and/or mucous discharge afterwards; and bleeding during or after bowel movements. Women could also have a lump outside the anus (prolapse haemorrhoid) with or without intense pain, said Dr Ho.
She recommended seeking medical advice if there is severe pain or discomfort, persistent or worsening bleeding, an abnormal lump at your anus area, or prolapsed haemorrhoids that do not reduce on their own.
To reduce the possibility of piles, Assoc Prof Tan offered simple tips such as taking adequate fibre (fruits and vegetables or a fibre supplement) and drinking lots of water to ensure that constipation and straining are avoided during bowel movements.
Regular exercise can also help to reduce the risk of constipation, he added.
Regular exercise can prevent haemorrhoids from developing, both during and after pregnancy. (Photo: iStock/Boyloso)
TREATMENT FOR PILES
“Medications like laxatives can be considered to address constipation,” said Assoc Prof Tan. “Constipation is common during pregnancy as medications like iron supplements for pregnant women can often lead to it.”
Dr Ho recommended applying cold compresses gently against the haemorrhoids or using sitz baths – warm water baths for the pelvic region – to reduce swelling and discomfort. Women should also clean the area gently with unscented moist wipes or warm water to avoid further irritation. Pat or wash with clear water and avoid dry toilet paper.
“Over-the-counter creams or ointments containing hydrocortisone or witch hazel can soothe inflammation and reduce the swelling and associated discomfort. Always consult your healthcare provider before use,” Dr Ho advised.
Pregnant women with piles are advised to gently apply cold compresses against the haemorrhoids, avoid using dry toilet paper on the area, and consider taking laxatives to ease constipation. (Photo: iStock/miljko)
Women might look to haemorrhoid pillows for comfort but Assoc Prof Tan said the evidence is limited.
“Haemorrhoid pillows may help alleviate symptoms temporarily when sitting by avoiding direct pressure on the haemorrhoids piles,” he said. “However, given their shape, they provide inadequate support during prolonged sitting and may worsen swelling when used for a protracted period.”
Surgery, called a haemorrhoidectomy, is a treatment option but Assoc Prof Tan said it is usually recommended after the delivery of the baby to minimise any risks to the foetus. “In most cases, pregnant women with piles will experience dramatic relief of symptoms after the baby’s delivery,” he added.
Dr Ho said that haemorrhoids improve after childbirth as pressure on the pelvic veins decreases. However, adopting a healthy lifestyle with balanced nutrition and regular activity after childbirth can prevent recurrence.
‘RELENTLESS PRESSURE... LEFT ME IN CONSTANT PAIN’
While haemorrhoids are rarely serious, Dr Ho pointed out that they can significantly impact a mother’s quality of life, particularly in the later stages of pregnancy.
Ling Ho, who had her three children via vaginal deliveries, suffered from constipation in all her pregnancies. “The relentless pressure, made worse by prolapsed and thrombosed haemorrhoids, left me in constant pain and discomfort,” said the 37-year-old. Thrombosed haemorrhoids is when a blood clot forms in an external haemorrhoid, causing severe pain, swelling and inflammation.
She urged women to seek advice for preventing or easing haemorrhoids as “small steps to ease the pressure can make all the difference in your comfort and well-being”.
A doctor’s advice for pregnant mums with haemorrhoids: Be proactive about prevention, manage symptoms early and do not hesitate to seek help. (Photo: iStock/Nutthaseth Vanchaichana)
Jessica Budiman, 33, had piles for 12 years before her pregnancy in 2023. She started having constipation in her second trimester and the piles became swollen and unbearable in her third trimester. She couldn’t walk, sit, sleep or lie down comfortably.
“At 35 weeks, I faced a dilemma: How much longer could I endure the pain while ensuring a safe delivery for my baby?” she said. “To manage the pain, I used a sitz bath and dextrose solution which provided some relief; I also took paracetamol when required. Additionally, I increased my fruit and vegetable intake, drank three litres of water daily and did pregnancy yoga.”
Budiman’s doctor suggested she consume more fibre and drink more water, and prescribed stool softeners. He also advised her to undergo a haemorrhoidectomy after her baby was born, given how the piles disrupted her daily life.
Dr Ho had the following advice for women experiencing haemorrhoids during pregnancy: Be proactive about prevention, manage symptoms early and do not hesitate to seek help. Postpartum, continue with a healthy diet, ensure adequate hydration and practise good hygiene to support healing.
“Haemorrhoids, though uncomfortable, are typically manageable and rarely lead to serious complications. With proper care and guidance, you can find relief and focus on your pregnancy or postnatal recovery,” she said.
“If you are unsure about your symptoms or need tailored advice, always reach out to your doctor for personalised care.”
CNA Women is a section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg.
Continue reading...