Medically reviewed by
USA Clinics Medical Review Team
Reviewed August 2026
Hemorrhoids affect an estimated 25% to 40% of pregnant women, making them one of the most common – and least-discussed – physical changes that come with carrying a baby.[1] They can appear at any stage of pregnancy, but the timing, severity, and what they signal often shift from trimester to trimester. Understanding what to expect at each stage, and recognizing when symptoms cross from normal into something worth discussing with your care team, can make the experience significantly less stressful.
We will cover why pregnancy creates the conditions for hemorrhoids, how symptoms tend to change across each trimester and into the postpartum period, and the warning signs that indicate it is time to speak with a specialist.
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.
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
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.
Treatment option: hemorrhoid treatment
Pregnancy hemorrhoids are common. Persistent ones after delivery do not have to be.
Managing hemorrhoids through pregnancy is largely about comfort and symptom control. Most improve after delivery. But for women whose hemorrhoids persist or recur after pregnancy, self-management eventually reaches its limits.
USA Hemorrhoid Centers offers minimally invasive, outpatient treatment performed by experienced interventional radiologists. Procedures are completed in the office, typically in under an hour, with no general anesthesia required and a rapid return to daily activities for most patients. The first step is a consultation to evaluate your symptoms and discuss your options.