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Hemorrhoids and Varicose Veins in Pregnancy

ABOUT CAUSES DIAGNOSIS TREATMENT NEXT STEPS

What are hemorrhoids and varicose veins?

Hemorrhoids and varicose veins might seem to be two different, unrelated problems, but they're actually quite similar. And many women, especially those in the third trimester of pregnancy, have them.

Both hemorrhoids and varicose veins are swollen, twisted veins. These veins are often in the legs, but they also can form in other parts of your body. When they form in the rectum, they're called hemorrhoids.

What causes hemorrhoids and varicose veins in pregnancy?

Normally, veins have one-way valves to help keep blood flowing toward the heart. Pressure or weakening of these valves allows blood to back up and pool in the veins. This causes them to enlarge and swell. Hemorrhoids result when rectal veins enlarge. Varicose veins occur when veins of the legs swell.

Many changes in pregnancy can increase the risk of hemorrhoids and varicose veins, such as:

• Increased blood volume, which enlarges the veins
• The heavy weight of the growing baby, which presses on the large blood vessels in the pelvis, altering blood flow
• Hormone changes affecting blood vessels, which can slow the return of blood to the heart and cause the smaller veins in the pelvis and legs to swell

Hemorrhoids can get worse with pushing or straining, especially with constipation. Being overweight and having hemorrhoids before pregnancy can also make them worse. Pushing during delivery tends to worsen hemorrhoids, too.

Varicose veins tend to run in families. Sitting or standing in one position for a long time may force the veins to work harder to pump blood to the heart. This can result in swollen, varicose veins and can also worsen existing hemorrhoids. Varicose veins can also occur in a woman's genital area.

What are the symptoms of hemorrhoids and varicose veins in pregnancy?

Hemorrhoids can be internal, forming inside the rectum, or external, located on the outside, around the anal opening. Internal hemorrhoids can sometimes bulge out through the anal opening. The most common symptom is bright red blood passed with a bowel movement. External hemorrhoids can be painful or itch and may bleed if irritated by straining or wiping.

Varicose veins often look like large, twisted, raised blue or purple veins on the legs–often on the backs of the calves or inside the legs. They may cause mild swelling in the ankles and feet or aching, heaviness, or throbbing in the legs. They can also cause leg cramps. If varicose veins occur in the genital area, they also appear as large, twisted, raised veins.

How are hemorrhoids and varicose veins in pregnancy diagnosed?

Your healthcare provider will examine your legs or rectal area to check for varicose veins or hemorrhoids.

How are hemorrhoids and varicose veins in pregnancy treated?

Hemorrhoids in pregnancy are a short-term problem, and they get better after your baby is born. Still, there are some things you can do to relieve the discomfort:

• To relieve pain, sit in a tub or sitz bath several times a day in plain, warm water for about 10 minutes each time. When you use a tub bath, don’t fill the tub all the way. Just put in enough warm water to sit in. That will direct blood flow to your rectum.
• Use ice packs or cold compresses to reduce swelling.
• Ask your healthcare provider about creams or other medicines, such as stool softeners, that are safe to use during pregnancy.

It’s important to prevent constipation by including lots of fiber and fluids in your diet.

Also try not to strain with bowel movements, and avoid sitting for a long time. Regular Kegel exercises can help improve muscle tone, These exercises involve squeezing and relaxing the muscles in your vaginal and rectal area.

Most varicose veins that develop during pregnancy get better within the first year after birth. But for now, limit standing or sitting for a long time without a break, and try not to cross your legs. Also try to raise your legs and feet whenever you’re sitting or lying down.

Avoid tight clothing around your waist, thighs, and legs, as it can worsen varicose veins.

Be sure to check with your provider if your symptoms worsen or you have excessive bleeding from hemorrhoids. And remember that these problems are usually short-term and get better after delivery with time and treatment.

What can I do to prevent hemorrhoids and varicose veins in pregnancy?

The best way to help prevent hemorrhoids during pregnancy is to prevent constipation. If you're constipated, don't strain during bowel movements.

Steps to help prevent varicose veins are the same as those used to decrease symptoms:

• Don't stand still or sit for long periods of time.
• Prop your feet up whenever possible.
• Don't wear tight clothes.

Key points about hemorrhoids and varicose veins in pregnancy

• Both hemorrhoids and varicose veins are swollen, twisted veins. These veins are often in the legs, but when they form in the rectum, they're called hemorrhoids.
• Many normal changes in pregnancy can increase the risk for hemorrhoids and varicose veins.
• Hemorrhoids and varicose veins in pregnancy are a short-term problem, and they get better after your baby is born.
• You can do things to ease the discomfort they can cause. These include sitz baths, ice packs, or cold compresses to reduce swelling and creams or other medicines, such as stool softeners, your healthcare provider may recommend.
• The best way to help prevent hemorrhoids during pregnancy is to prevent constipation. If you're constipated, don't strain during bowel movements.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.

Medical Reviewer: Irina Burd MD PhD

Medical Reviewer: Donna Freeborn PhD CNM FNP

Medical Reviewer: Heather M Trevino BSN RNC

© 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

Varicose veins during pregnancy - what to do and how to treat

Veins are actively involved in the complex 9-month pregnancy process, and their changes are significant. Even with complete medical supervision, there is a risk of developing venous insufficiency.

Pregnancy is accompanied by profound changes throughout the female body. One of the first effects of pregnancy is an increase in the load on the veins of the pelvis and lower extremities. Therefore, many pregnant women develop varicose veins, which sometimes disappear after childbirth. This varicose vein is accompanied by discomfort, a feeling of heaviness, pain when walking, but women are mainly concerned with noticeable skin changes and varicose coloration of the legs and ankles, which remain after pregnancy. nine0003

From sickness to sickness

Many pregnant women are familiar with the feeling of malaise, accompanied by discomfort in the lower extremities. Functional chronic venous insufficiency is the first stage of venous disease with a feeling of heaviness in the lower extremities, sometimes with itching, paresthesias and, in some cases, convulsions, often nocturnal.

The possibility of thrombosis in pregnant women is 3-5 times higher than in other women. Sometimes blockage of the veins leads to their inflammation - thrombophlebitis. Blood clots that form in this case in the veins can cause a serious and dangerous disease - pulmonary embolism. In addition, the risk of developing thrombosis remains for another 1.5 months after childbirth, especially if they are severe. nine0003

Should I go to the doctor?

There are five groups of factors that affect the body of a pregnant woman, which explain the need for observation by a phlebologist.

Mechanical factor

An enlarged uterus is a barrier to blood circulation, as it compresses the inferior vena cava, pressing it against the spinal column and iliac muscle. This is of particular importance at rest, when a sharp decrease in venous outflow can lead to postural shock, well known to gynecologists. The anatomical structure of the iliac vein, which crosses the right iliac artery, explains the high incidence of thrombosis of the left limb (Cocket's syndrome). nine0003

Circulatory factor

An increase in blood volume and outflow of blood from the heart leads to an increase in the load on the vessels, especially veins, and their expansion. This is especially important for the veins of the lower extremities and the vaginal area.

Hormonal factors

Progesterone, due to its relaxing effect on smooth muscle fibers, leads not only to a decrease in the tone of the venous wall, but also to a decrease in the tone of the urethra, bladder and small intestine. nine0003

Hemostatic factors

Changes in the hemostasis system always occur in the direction of increased coagulability (increased fibrinogen and factor III levels, increased platelet activity and decreased fibrinolytic activity).

Hemorheological factors

Blood viscosity increases despite a decrease in hematocrit.

Other contributing factors

In addition to the above factors associated with pregnancy, there are other contributing factors such as family history, sedentary lifestyle, immobile posture while working, driving, too low or high thin heels, obesity, underfloor heating, hot baths, and multiple pregnancies with short intervals between them. nine0003

How to prevent illness?

Pregnant women, regardless of risk factors and venous manifestations, always need lifestyle modification: avoidance of standing still, sitting in a low chair, hot baths and sunbathing, adaptive exercises such as easy walking, leg movement when sitting, contrast showers, elevated the position of the lower extremities in a state of rest.

And in any case, at the first signs of the disease (spider veins and dilated veins, in the later stages - swelling and pain), it is necessary to contact a phlebologist who can adequately assess the condition of the veins and prescribe the correct therapy. nine0003

Varicose veins during pregnancy - what to do and how to treat varicose veins in the legs

Varicose veins are persistent and irreversible enlargement resulting from pathological changes in the walls and valves of blood vessels. The superficial veins in the legs most often expand, since they have increased pressure when standing and walking. Varicose veins during pregnancy is one of the diseases that can appear or progress during the period of gestation. Because of this, women get sick 4 times more often than men. nine0003

Causes

The following reasons contribute to the occurrence of varicose veins during pregnancy:

• Violation of the outflow of blood from the veins of the lower extremities. This is because the growing uterus presses on the inferior vena cava - a large abdominal vein that collects blood from the lower half of the trunk and lower extremities.
• During pregnancy, the blood is more viscous, flows more slowly, this also contributes to venous congestion.
• An increase in body weight during gestation increases the load on the legs. nine0056

The development of varicose veins is promoted by wearing high-heeled shoes, prolonged work in a standing position, lifting weights, and overweight.

Symptoms

The first symptom is a visible increase in the vessels of the lower extremities. The veins are blue or purple, tortuous, protrude above the surface of the skin, may be serpentine or knobby (nodular) in shape. At the initial stage of the disease, a woman is only concerned about a cosmetic defect. nine0003

Other complaints follow. Edema appears, increasing in the evening and decreasing or completely disappearing after rest and a night's sleep. At night, convulsions may disturb. When walking, rapid fatigue is observed, there may be a feeling of fullness and pain.

Varicose veins of the lower extremities are observed in 50% of pregnant women, but not all of them suffer from true varicose veins, when irreversible changes appear in the venous wall. For most, the disease is functional in nature, that is, it is temporary, and after childbirth, when the factors that prevent normal venous outflow are eliminated, the tubes return to normal. This usually happens within a year. nine0003

Regression does not occur if the predisposition is independent of pregnancy. In this case, close relatives usually have varicose veins, or the woman herself had some symptoms even before conception.

Diagnostics

As you know, the “gold standard” for diagnosing pathology is ultrasound duplex scanning (USDS) of the veins of the lower extremities. This is a safe procedure for the expectant mother. Experienced obstetricians and gynecologists strongly recommend that pregnant women visit a phlebologist in the early stages of pregnancy, which contributes to the early prevention of complications of varicose veins in the postpartum period. nine0003

Stockings against varicose veins during pregnancy

During pregnancy, it is recommended to wear special compression (anti-varicose) tights and stockings. They need to be put on in a prone position, slightly lifting the leg up. There are 4 compression classes (pressure levels):

1. 18-21 mmHg
2. 23-32 mmHg
3. 33-48 mmHg
4. over 49 mmHg

During pregnancy, it is recommended to use compression class 1-2. The third class of compression hosiery is used for the late stage of leg varicose veins, the fourth class - only for severe congenital anomalies of the venous system. nine0003

Tights should be specially designed for expectant mothers so that they do not put pressure on the growing belly, but support it.

How much to wear?

After 20 weeks, you need to wear a bandage. It supports the uterus and reduces pressure on the large vessels of the abdominal cavity, thereby improving the outflow of blood from the lower half of the body.

Compression underwear and a bandage should be bought in pharmacies, it is important to choose the right size for them.

Exercises

It is recommended to attend gymnastics for pregnant women or do exercises at home. Particularly good prevention of varicose veins are classes in the pool. Sports strengthen the walls of blood vessels and improve blood flow. In addition, gymnastics is the prevention of excess weight.

A contrast shower on the calf muscles is useful.

If you think you have a predisposition to varicose veins, you should avoid saunas and thermal treatments. nine0003

As often as possible, try to give your legs an elevated position. Don't sit cross-legged for long periods of time.

Wear comfortable shoes with small heels.

You can use creams for pregnant women "to relieve fatigue from the legs", such creams usually contain plant substances that, with regular use, strengthen the walls of superficial veins.

Treatment

Treatment of true varicose veins is surgical. During pregnancy, surgical treatment is carried out only for emergency indications, in view of the development of complications (thrombophlebitis). nine0003

A modern method of treatment is sclerotherapy, when a chemical substance is injected into the lumen of the vein, which leads to sclerosis and closure of its lumen. Endovasal methods are also minimally invasive treatments performed on an outpatient basis (described in the relevant sections of our website).

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