• Dr Peter Chew

Piles after delivery

Piles or haemorrhoids are swollen veins in the final segment of the large intestine (rectum). When these blood vessels become unusually swollen and engorged with blood, soft lumps may be felt protruding out of the anus. They are very common after a vaginal delivery and can range from the size of a pea to that of a grape.

Symptoms include pain, swelling, itchiness around the anus and rectal bleeding especially after having a bowel movement.

Why are haemorrhoids common during pregnancy?

Haemorrhoids are common during pregnancy for the following reasons:

· The growing womb(uterus) puts pressure on the big veins in the lower abdomen. This pressure slows down the blood flow from the rectum causing the veins to swell

· There is an increase in the levels of pregnancy hormone, progesterone which tends to relax the walls of the veins, allowing them to swell more easily.

· Progesterone also slows down the muscles of the intestinal tract resulting in constipation. This may further cause or aggravate haemorrhoids during a hard bowel movement.

· Haemorrhoids may also be formed when one strains and pushes the baby out of the birth canal during labour.

After delivery, haemorrhoids may get worse because many mothers consume confinement foods which are considered “heaty” in nature. These foods may harden the stools and make the bowels difficult to move

The tears or episiotomy cut at the perineum- the area between the vagina and anus- during delivery may cause pain and soreness. As the skin is still healing, it may hurt when one poops. The fear of moving the bowels may result in further constipation and hardening of stools. This vicious cycle will aggravate the symptoms of haemorrhoids further

What can one do to ease the haemorrhoids?

· Clean the anus gently with wet wipe rather than dry toilet paper,

· Apply ice pack on the haemorrhoids,

· Soak the perineum with sitz bath (a basin filled with warm water and salt). This will soothe and help haemorrhoids shrink,

· Sit on a pillow or air ring to relieve pressure on the haemorrhoids,

· Apply haemorrhoid creams, ointments, suppositories, sprays and painkillers for pain relief,

· Take a stool softener to prevent hard stools,

· Take more dietary fibres by eating fruits e.g., prunes, papaya and vegetables to prevent constipation,

· Drink plenty of water,

· Do Kegel exercises to strengthen the muscles around the perineum,

· Have adequate rest but go for a slow walk every day. Moving the body helps move the bowels,

· Avoid using scented toiletries,

· Avoid sugary and processed foods.

Haemorrhoids are usually experienced during pregnancy. Symptoms usually improve about 6 weeks after delivery. Occasionally, if pain and rectal bleeding persist after that, medical attention including a colonoscopy may be necessary to rule out more serious problems such as tumour in the large intestine.

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