Pregnancy is clearly a very challenging time for the body and many women will notice as well as their pregnancy developing they may be prone to develop or get worse symptoms from other conditions – this article will focus on haemorrhoids and hernias which can be problematic in this group.
Haemorrhoids during pregnancy
Haemorrhoids are probably the most common ailment and they can be irritating not only during but also after pregnancy. These are dilated cushions of tissue with a rich blood supply that can protrude or remain outside the anus and typically cause itching, bleeding and discomfort. The increased pressure in the pelvis and enriched blood supply and venous congestion caused by the pregnancy almost certainly make this condition worse in many women.
The good news is that many will get a lot better or completely resolve postpartum as this pressure is removed. Simple measures like eating a balanced diet with fibre and plenty of water or using topical therapies may alleviate the symptoms – for those whose haemorrhoids remain long term, many can be treated by simple outpatient measures such as injection or banding, but those unsuitable may need surgical treatment by excision or suturing if their symptoms dictate.
The question is frequently asked if it is better to get these treated after completing their family, and there is not really a right or wrong answer here – it all boils down to how much of a nuisance they are at that particular time – clearly sometimes other conditions may need exclusion such as fissure, fistulae, perianal haematoma or colorectal pathology such as polyps, cancer and colitis. Luckily in most cases treatment is simple and successful although there can be a recovery period.
Hernias occurring during pregnancy
Hernias are protrusions through a wall that normally contains them – they are most commonly found as lumps in the groin or through or around the umbilicus (belly button). People can be born with hernias (or weakness) and times of pressure or straining can cause something to protrude (rupture) through the weakness (hole), manifesting as a hernia. This can thus occur in everyday life but particularly while straining, lifting or during pregnancy, all of which stress the abdominal wall more.
Hernias can present with little or no symptoms though occasionally as an emergency where something has become trapped or strangulated in the hole. This can make patients very unwell and need emergency surgery. Thankfully this is rare in pregnancy as the uterus normally occludes the hernia (hole) preventing significant bowel from protruding, particularly around the groin. Hernias can be confused with dilated veins which look similar sometimes and lymph glands.
Hernias ideally need repaired unless they are wide necked and have no symptoms as the risk of strangulation is always there – they usually become bigger with time which can cause discomfort and they can become unsightly.
There are a host of different surgical techniques to fix hernias, increasingly using minimally invasive or keyhole surgery to minimise scarring, meshes are used to strengthen the weak tissue where the hernia protrudes and women who have large abdominal wall hernias associated with striae or stretch marks may wish to undergo combined surgical and plastic correction of both the hernias and the skin on the abdominal wall.
Whilst these conditions are common, they are usually treatable and in the vast majority quality of life is dramatically improved by treatment with a low risk of significant side effects. It is well worth seeing a specialist either before, during or after your pregnancy if you believe you are troubled by one of these conditions to understand the most bespoke option for your circumstances.
Article by Gordon Buchanan, Consultant General and Colorectal Surgeon, Lister Hospital, London, UK