Pregnancy and Childbirth
Pregnancy is one of the most common circumstances under which people develop hemorrhoids for the first time — a combination of mechanical pressure, hormonal changes, and the physical demands of labor and delivery, layered on top of each other over a relatively short period.
- An estimated quarter to 40% of pregnant people develop hemorrhoids at some point during pregnancy or shortly after delivery.
- Risk tends to increase as pregnancy progresses, peaking in the third trimester and around delivery itself.
- Vaginal delivery, particularly with prolonged pushing, adds mechanical strain on top of pregnancy-related changes.
- Hemorrhoids that develop this way often improve substantially in the weeks after delivery, though not always completely without some ongoing care.
Why pregnancy specifically raises the risk
Three factors compound during pregnancy:
- Mechanical pressure — the growing uterus increases pressure on the pelvic veins, including those that drain the anal and rectal area, making it harder for blood to return normally and easier for hemorrhoidal tissue to become engorged.
- Hormonal changes — pregnancy hormones (particularly progesterone) relax smooth muscle and vein walls throughout the body, which can make existing hemorrhoidal tissue more prone to swelling and can also contribute to constipation by slowing bowel motility.
- Constipation — partly from hormonal effects on bowel motility, and partly from iron supplementation, which is commonly recommended in pregnancy and can worsen constipation as a side effect.
Why later pregnancy and delivery carry the most risk
Pressure from the uterus increases as pregnancy progresses, which is part of why hemorrhoid symptoms are more common in the third trimester than earlier in pregnancy. Labor and vaginal delivery add a distinct, separate mechanical strain: the sustained pushing involved in the second stage of labor directly increases pressure on the same pelvic and anal veins, on top of whatever pregnancy-related changes were already present. This is why hemorrhoids frequently either appear or noticeably worsen around the time of delivery itself.
Factors that can affect likelihood or severity
- Multiple pregnancies — some data suggests each subsequent pregnancy may carry a somewhat higher likelihood of hemorrhoids, possibly related to cumulative effects on pelvic support tissue, though individual experience varies.
- Prolonged second-stage labor (pushing) — more extended pushing is generally associated with more mechanical strain on the area.
- Pre-existing hemorrhoids — hemorrhoids present before pregnancy are more likely to worsen during it, given the added pressure on already-affected tissue.
- Constipation management during pregnancy — proactive fiber and fluid intake from early pregnancy may help reduce the severity of hemorrhoid symptoms that develop later, though it doesn’t eliminate the risk entirely, since much of the mechanism is structural rather than purely diet-related.
What tends to happen afterward
Most pregnancy-related hemorrhoids improve substantially within the first couple of weeks after delivery, as pregnancy-related swelling and blood volume changes resolve, with continued improvement over the following weeks alongside ordinary self-care. A minority of cases persist longer or need more active management — see Hemorrhoids in pregnancy: safe treatments for what’s generally considered safe to try during pregnancy and while breastfeeding, and when postpartum symptoms need prompt medical attention rather than home care.
A note on distinguishing this from delivery-related tearing
Not everything painful in this area after childbirth is a hemorrhoid — perineal or anal tearing related to delivery itself is a separate injury with its own care needs. If you’re not sure which one you’re dealing with postpartum, that’s a reasonable question for your postpartum visit rather than something to sort out yourself.
This page is for general education and isn’t a substitute for advice from your OB-GYN or midwife.