Why Pregnancy Increases Hemorrhoid Risk

Hemorrhoids are cushions of vascular tissue located in the rectum and around the anus that help with bowel control. They become symptomatic, causing pain, itching, bleeding, or prolapse, when the veins within those cushions become enlarged and swollen. Pregnancy creates several conditions at once that place pressure on that tissue.

Research published in Canadian Family Physician (PMC) estimates that 25 to 35 percent of pregnant women develop hemorrhoids, with some studies placing the rate as high as 85 percent in the third trimester. Contributing factors include:

• Increased abdominal pressure: The expanding uterus presses on the rectal veins, reducing blood flow and causing pooling and swelling in the hemorrhoidal tissue.
• Increased blood volume: Blood volume rises substantially during pregnancy, placing added load on the venous system throughout the body, including the vessels in the anorectal region.
• Hormonal changes: Higher progesterone and estrogen levels slow bowel motility, which can lead to constipation and harder stools, both linked to straining that can aggravate hemorrhoidal tissue.
• Straining during delivery: Vaginal delivery itself raises risk substantially. One study found that childbirth raises the likelihood of hemorrhoids by nearly eight times, and that risk compounds with each pregnancy.
• Prior hemorrhoid history: A 2024 PMC study found that women with a previous hemorrhoid diagnosis were more than five times as likely to develop hemorrhoids again during a later pregnancy.

Note: Many women dismiss hemorrhoid symptoms during pregnancy as a normal part of the experience. While symptoms often improve after delivery, symptoms that persist or get worse are worth a specialist’s attention.

Which Types of Hemorrhoids Affect Women Most?

Pregnancy and the postpartum period make women especially prone to internal hemorrhoids, particularly ones that prolapse. Swollen external tissue can appear too. Higher progesterone relaxes vein walls. The growing uterus adds pelvic pressure. The physical strain of childbirth stretches supporting tissue further. Together, these changes make symptomatic hemorrhoidal disease more common during these reproductive years. A specialist can confirm which type is present and what the right next step looks like.

How Giving Birth Impacts Long-Term Hemorrhoid Risk

The number of times a woman has given birth, referred to clinically as parity, is one of the most well-documented risk factors for hemorrhoidal disease in women. The large Korean cohort study published in Scientific Reports (2022), which looked at nearly 195,000 adults, found that hemorrhoidal disease was meaningfully more common in women who had given birth compared to those who had not. That link held even after researchers adjusted for other lifestyle and metabolic factors.

This suggests that repeated pregnancies and deliveries may cause lasting changes to the pelvic floor and anorectal tissue, adding to a higher baseline risk of symptomatic hemorrhoids later in life. Women who have had multiple vaginal deliveries, a long labor, or a large newborn may be at higher risk.

Note: Body weight distribution and hemorrhoidal disease also appear to be linked differently by sex and parity. Research suggests waist size may be more closely tied to hemorrhoid prevalence in women who have given birth specifically.

Symptoms Women Should Not Ignore

Hemorrhoid symptoms can range from mild irritation to real daily discomfort. Because many women treat these symptoms as normal, especially after pregnancy, it helps to know which signs call for an evaluation. Hemorrhoidal disease can be internal, external, or both, and symptoms often differ by type.

• Rectal bleeding: Bright red blood during or after a bowel movement is one of the most common early signs. Research consistently links fresh blood in the stool with hemorrhoidal disease, though any rectal bleeding should be checked by a clinician to rule out other causes.
• Pain or pressure: Discomfort around the anus, especially during or after bowel movements, may point to internal or external hemorrhoids.
• Itching and irritation: Burning, itching, or mucus discharge are common with hemorrhoidal disease and may get worse with long periods of sitting.
• Prolapse: Internal hemorrhoids that push through the anal opening during or after a bowel movement, or that need to be pushed back in by hand, point to a more advanced stage that calls for prompt evaluation.
• Feeling of incomplete emptying: A lasting sense that the bowel has not fully emptied has been linked to hemorrhoidal disease in research.

Risk Factors Beyond Pregnancy that Affect Women

While pregnancy is the most distinctive risk factor for women, several other contributors to hemorrhoidal disease apply more broadly and matter for women across different life stages.

Several lifestyle and biological factors add to hemorrhoid risk. Long-term constipation is a leading cause. Straining during bowel movements places steady pressure on hemorrhoidal tissue, and hormone shifts across the menstrual cycle and perimenopause can make this worse by disrupting bowel regularity. Low-fiber, low-fluid diets add to the problem by producing harder stools that take more effort to pass. A sedentary lifestyle and prolonged sitting also keep steady pressure on the pelvic region.

Aging plays a role too. The tissue that supports the hemorrhoidal cushions naturally weakens over time, raising the risk of prolapse in both women and men. Family history matters as well: a family history of hemorrhoids is linked to a higher personal risk.

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Hemorrhoid Symptoms: Women vs. Men

Overall lifetime prevalence of hemorrhoidal disease is similar between women and men, but what triggers symptoms, and when those symptoms get reported, often looks different by sex.

For women, pregnancy, hormone shifts, and pelvic floor changes from childbirth are the most distinctive symptom triggers, as covered above. Men more often develop symptomatic hemorrhoids tied to long periods of sitting, heavy lifting, and lower-fiber eating patterns. Research on care-seeking habits also shows that men are more likely than women to put off bringing symptoms to a doctor, which can let hemorrhoids reach a more advanced stage before they are evaluated.

Because the underlying tissue changes behind bleeding, itching, and prolapse are the same regardless of sex, the evaluation a hemorrhoid specialist performs does not differ by gender. What differs is the context: a woman’s evaluation may include questions about pregnancy and childbirth history, while a man’s evaluation may focus more on lifestyle and work-related factors. Either way, symptoms that persist or get worse are worth bringing to a specialist, whether you are asking for yourself or someone you care about.

What Hemorrhoid Treatment Looks Like Today

Many women, and many men, wait longer than they need to before seeking care for hemorrhoid symptoms, often because they are unsure whether treatment exists beyond lifestyle changes or over-the-counter creams. Today, office-based and minimally invasive procedures can address hemorrhoids without general anesthesia or a hospital stay.

USA Hemorrhoid Centers offers Hemorrhoid Artery Embolization (HAE), an outpatient procedure typically completed in under an hour that is designed to help patients return to normal activities quickly. An experienced specialist evaluates the grade and type of hemorrhoids present before recommending the approach that fits. Treatment is tailored to each patient’s anatomy, symptom severity, and medical history, including obstetric history for women.

If symptoms have lasted more than a few weeks, gotten worse over time, or are getting in the way of daily life, an evaluation is the right next step.

Can Internal Hemorrhoids Resolve Without Treatment?

Internal hemorrhoids develop when the vascular cushions inside the rectum become swollen and irritated. Whether they resolve without treatment depends primarily on their grade. Doctors classify internal hemorrhoids on a scale of 1 through 3 based on how far they prolapse – the term for tissue slipping beyond its normal position in the anal canal. Understanding your hemorrhoid grades and stages can help set realistic expectations about what conservative care is likely to accomplish.

Grade 1 and 2 hemorrhoids have a reasonable chance of improving with dietary and behavioral changes. Grade 3 hemorrhoids are less likely to resolve without medical evaluation, as they reflect a structural change in the supporting tissue rather than simple inflammation.

Grade 1 and Grade 2: When Self-Resolution Is Possible

Grade 1 internal hemorrhoids do not protrude outside the anal canal. They are the earliest stage and most likely to improve with consistent lifestyle changes. Adding fiber (typically 25-38 grams per day for adults), increasing water intake, reducing straining during bowel movements, and avoiding prolonged sitting on the toilet can all help reduce swelling in Grade 1 hemorrhoids. Many people see improvement within days to a week.

Grade 2 hemorrhoids prolapse during a bowel movement but return inside on their own. They may respond to the same conservative measures as Grade 1, though improvement tends to be slower and recurrence is more common. If Grade 2 symptoms return repeatedly, a specialist evaluation can help determine whether a longer-term approach is needed.

Conservative measures that may help both grades:

• Increasing dietary fiber gradually to soften stool
• Drinking adequate water throughout the day
• Using a sitz bath (warm water soak) for 10-15 minutes after bowel movements
• Avoiding straining and limiting time spent on the toilet
• Using over-the-counter topical products for short-term symptom relief

These steps address contributing factors and may reduce inflammation, but they do not alter the underlying vascular anatomy of the hemorrhoid.

Grade 3 Hemorrhoids: Why They Rarely Go Away on Their Own

Grade 3 internal hemorrhoids prolapse outside the anal opening during straining and require manual repositioning to return inside. At this stage, the supporting tissue around the hemorrhoid has stretched beyond the point where lifestyle changes alone typically produce lasting improvement. Conservative measures may reduce discomfort and bleeding, but they are unlikely to correct the prolapse itself.

Leaving Grade 3 hemorrhoids unaddressed for extended periods is associated with symptom progression. Prolapse can become more frequent, and repeated protrusion may lead to tissue irritation and a higher risk of bleeding episodes.

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What Happens If Internal Hemorrhoids Are Left Untreated?

When hemorrhoids are left untreated, they may progress over time rather than stabilize or resolve. Grade 1 hemorrhoids may advance to Grade 2, and Grade 2 to Grade 3, particularly if underlying factors such as chronic constipation or straining are not modified. Persistent rectal bleeding, even in small amounts, can contribute to anemia over time. Prolapsed tissue that becomes trapped outside the anal canal may become acutely painful and require urgent evaluation.

While bright red blood from internal hemorrhoid symptoms is common and usually not immediately dangerous, any rectal bleeding should be evaluated by a clinician to confirm its source, since other conditions can produce similar symptoms. If hemorrhoid symptoms have not improved within one week of consistent conservative care, scheduling a consultation is the appropriate next step rather than continued observation.

When to See a Hemorrhoid Specialist To Help Hemorrhoids Go Away

Certain patterns indicate that conservative management is unlikely to be sufficient and that a hemorrhoid specialist evaluation is warranted:

• Bleeding during or after bowel movements that recurs over several weeks
• Tissue that prolapses and does not return on its own
• Discomfort, pressure, or itching that interferes with daily activities
• Symptoms that return quickly after a period of improvement
• Any rectal bleeding in a patient over 45 or with a family history of colorectal conditions, which should always be evaluated

A hemorrhoid specialist can confirm the grade of your hemorrhoids through a physical examination and discuss what options are appropriate based on your specific anatomy and symptom pattern.

Can USA Hemorrhoid Centers Help?

For internal hemorrhoids that have not responded to conservative management, hemorrhoid artery embolization (HAE) is a minimally invasive, image-guided outpatient procedure that addresses the underlying blood flow contributing to hemorrhoid swelling. It is performed by experienced interventional radiologists and is an option for Grade 1 through Grade 3 internal hemorrhoids. Procedures are typically completed in under an hour, with no general anesthesia required and a rapid return to daily activities for most patients.

A consultation is the first step to determine whether HAE may be appropriate for your situation.

Why Pregnancy Causes Hemorrhoids

Hemorrhoids are cushions of vascular tissue in the rectum that help regulate bowel control. They become symptomatic when the veins within that tissue become enlarged and engorged. Pregnancy creates several overlapping conditions that make this likely.

Increased Blood Volume and Pelvic Pressure

Blood volume increases by up to 50% during pregnancy.^[2] The growing uterus also places direct pressure on the inferior vena cava – the large vein that carries blood from the lower body back to the heart – slowing circulation in the pelvic region and allowing blood to pool in rectal veins. As the uterus expands through each trimester, this pressure intensifies.

The Role of Progesterone

Higher progesterone levels during pregnancy cause the walls of veins to relax, making them more prone to swelling.^[3] This hormonal effect begins early in the first trimester and persists throughout pregnancy. It also slows digestion, which contributes directly to constipation.

Constipation and Straining

Slower digestion leads to harder stools and more frequent straining during bowel movements. Straining increases pressure in the rectal veins significantly. One study found that nearly 46% of pregnant women experience constipation at some point during pregnancy.^[4] Iron supplements prescribed during pregnancy can worsen this.

Hemorrhoids in the First Trimester

Many women do not expect hemorrhoids this early, but the conditions are already in place. Progesterone levels rise sharply in the first trimester, blood volume begins climbing, and constipation often sets in as digestion slows. For women who had existing internal hemorrhoid symptoms before becoming pregnant, those can worsen quickly.

First-trimester hemorrhoid symptoms that are considered common include mild itching, occasional spotting of bright red blood on toilet paper, or a sense of fullness or pressure in the rectal area. Symptoms this early are worth mentioning at a prenatal appointment, but they are not typically a reason for alarm.

Hemorrhoids in the Second Trimester

The second trimester often brings some physical relief from first-trimester nausea, but the uterus continues to grow and pelvic pressure increases. For many women, hemorrhoid symptoms remain mild or even temporarily improve if constipation eases. For others, the additional uterine pressure intensifies symptoms.

If bleeding is noticed for the first time during the second trimester, or if existing symptoms worsen significantly, it is reasonable to raise this at your next prenatal visit. Any rectal bleeding during pregnancy should be evaluated – not because bleeding from hemorrhoids is dangerous, but because it is important to confirm that hemorrhoids are the source.

Hemorrhoids in the Third Trimester

The third trimester is when most pregnancy-related hemorrhoids develop or become most noticeable. Research identifies week 28 and beyond as the peak period.^[5] At this stage, the uterus is at its largest, exerting maximum pressure on pelvic blood vessels. The combination of weight, pressure, progesterone, and accumulated constipation creates the highest-risk environment for hemorrhoid development and worsening.

Symptoms that are common in the third trimester include bright red blood after a bowel movement, itching, pressure or heaviness in the rectal area, and occasional prolapse – where the hemorrhoid temporarily extends outside the anal opening. Mild prolapse that retracts on its own is not uncommon at this stage.

Symptoms that warrant a call to your OB or midwife include bleeding that does not stop after a bowel movement, significant pain that is not relieved with position changes or sitz baths, a hard and acutely painful lump near the anus (which may indicate a thrombosed hemorrhoid) or prolapse that does not retract on its own.

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After Delivery: What to Expect with Hemorrhoids

Delivery itself can intensify hemorrhoid symptoms. Prolonged pushing during the second stage of labor places significant strain on rectal veins. One study found that roughly 35% of women have hemorrhoids or anal fissures in the postpartum period, with the highest rates appearing within the first day after delivery in women who had longer or more strenuous labor.^[6]

For most women, postpartum hemorrhoids improve substantially within six to twelve weeks after delivery as hormone levels normalize, blood volume returns to baseline, and pelvic pressure resolves. Continuing with sitz baths, a high-fiber diet, and adequate hydration during the postpartum period supports recovery.

Hemorrhoids that persist beyond three months postpartum, cause ongoing bleeding, or significantly affect daily comfort deserve a formal evaluation rather than continued self-management.

When to See a Hemorrhoid Specialist

Most hemorrhoids during pregnancy can be managed conservatively with dietary adjustments and comfort measures. However, there are clear indicators that a specialist evaluation may be appropriate – particularly after delivery, once the pregnancy-related pressure has been resolved.

Consider speaking with a hemorrhoid specialist if you experience any of the following:

• Bleeding that occurs regularly, not just after bowel movements
• Persistent pain that does not improve with sitz baths or position changes
• Prolapsed tissue that does not retract
• Hemorrhoids that persisted through pregnancy and have not improved within a few months postpartum
• A thrombosed hemorrhoid that causes significant, unmanageable pain

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For women with internal hemorrhoids that persist or recur after delivery, hemorrhoid artery embolization (HAE) may be worth exploring as an option. HAE is a minimally invasive, image-guided procedure performed by experienced interventional radiologists on an outpatient basis. It works by reducing blood flow to the affected hemorrhoidal tissue, which shrinks the hemorrhoids without cutting, banding, or general anesthesia.

HAE is not a pregnancy treatment – it is appropriate for women with persistent internal hemorrhoids after delivery, evaluated case by case. The first step is a consultation with a hemorrhoid specialist to review your symptoms and determine whether you are a candidate.