I am 27 and have had hemorrhoids for more then five years. When I was pregnant with my first baby, they used to prolapse and cause me a lot of discomfort. Now, I'm frightened that if I get pregnant again, they will give me even more trouble. If hemorrhoids thrombose during pregnancy, what can be done?

E.

Hemorrhoids are enlarged veins located just under the skin in the lower rectum and anus. The enlargement of these veins is sometimes related to constipation, but in most cases there is no obvious cause for the hemorrhoids. In some patients, it is thought that the loosening of the tissues surrounding the hemorrhoids may lead to their increase in size. Clearly, pregnancy is associated with an increase in hemorrhoid size and symptoms. This is likely related to pressure changes that occur near the rectum when a woman is carrying a fetus or in labor. The symptoms of hemorrhoids include itching, bleeding, severe pain related to inflammation of the veins (thrombosis), and prolapse, a situation in which hemorrhoids in the lower rectum protrude through the anal sphincter. Simple measures used to treat hemorrhoids include topical formulas to combat the inflammation and surgical clipping to treat bleeding, prolapse and thrombosis.

Unfortunately, you are correct that your hemorrhoids are likely to worsen during a second pregnancy. So, you may want to consider treatment before you get pregnant again. Keep in mind that if hemorrhoid-related complications occur late in your pregnancy, they may have an effect on delivery. It may not be possible to have a normal vaginal delivery if you have severe prolapsing or thrombosed hemorrhoids. Also, if you require surgery for a hemorrhoidal complication late in your pregnancy, then you will likely need to deliver the baby by C-section to avoid placing undue pressure on the surgical site. You should get a referral to a colorectal surgeon experienced in the care of hemorrhoids for a full evaluation and recommendations regarding therapy for your hemorrhoids.