Hemorrhoids and Other (Not Fun) Butt Stuff in Pregnancy
Written and reviewed by Anna McMaster, PT, DPT, PRPC
Nobody talks about this enough, so let's just say it: pregnancy can do a real number on your backside. Hemorrhoids and anal fissures are incredibly common during pregnancy, they're uncomfortable, and they're also almost never discussed at prenatal appointments. Consider this your honest guide to what's happening, why, and what you can actually do about it.
How Common Is This Really?
Very. Research suggests that up to 86% of pregnant women experience hemorrhoids at some point during pregnancy, with the third trimester being the most common time. Anal fissures are somewhat less common but still affect around 10% of pregnant women. If you're dealing with either of these, you are in very good company.
What Are Hemorrhoids?
Hemorrhoids are swollen veins in the lower rectum or around the anus. They can be internal (inside the rectum) or external (around the outside of the anus). During pregnancy, they happen most often in the third trimester because the growing weight of the baby increases pressure on the pelvis, decreases blood flow in the pelvic veins, and raises intra-abdominal pressure. Prolonged sitting and straining on the toilet can also cause or worsen hemorrhoids.
You may have hemorrhoids and not even know it — some women have no symptoms at all. If you do have symptoms, they may include itching around the anus, pain with sitting, pain with bowel movements, and bright red bleeding during bowel movements.
What Are Anal Fissures?
An anal fissure is a small tear in the lining of the anal canal. During pregnancy, fissures are most often caused by constipation and the passage of hard, bulky stool. The pain of a fissure is distinct from hemorrhoids: it typically starts during a bowel movement and can last anywhere from a few minutes to a few hours afterward due to muscle spasms in the anal sphincter. Some women also notice bright red blood on toilet paper. Unlike hemorrhoids, fissures don't usually cause itching.
One important thing to know: when a fissure causes pain, it can trigger a reflex where you avoid having bowel movements to avoid the discomfort. This leads to harder, drier stools, which then cause more tearing. Breaking that cycle early is really important.
Why Do These Happen During Pregnancy?
The common thread is constipation, which is extremely common during pregnancy due to hormonal changes, iron supplements, reduced physical activity, and the pressure of the growing uterus on the bowel. When stools are hard and difficult to pass, both hemorrhoids and fissures become much more likely. The added weight and pressure of pregnancy on the pelvic floor and surrounding vessels makes an already vulnerable area even more susceptible.
What You Can Do About It
The good news is that many of the same strategies help both hemorrhoids and fissures, and most of them are simple.
Improving your bowel mechanics is the single most important thing you can do. Use a squatty potty or a small stool under your feet when you use the toilet — this puts your hips into a more natural squatting position that makes bowel movements easier and reduces straining. Go when you feel the urge rather than waiting, and don't sit on the toilet for longer than necessary. Straining and prolonged sitting are two of the biggest contributors to both conditions.
Staying well hydrated and maintaining good fiber intake helps keep stools soft and easier to pass. Talk to your healthcare provider about whether a fiber supplement might be appropriate for you, especially if dietary changes alone aren't helping.
Ice to the area can provide meaningful relief for both hemorrhoids and fissures, particularly after a bowel movement when discomfort tends to peak. Wrap ice in a cloth rather than applying it directly to the skin.
Your healthcare provider can also recommend topical treatments such as hemorrhoid creams that are safe during pregnancy. Don't use any topical treatments without checking with your provider first, since not all over-the-counter options are appropriate in pregnancy.
What Happens After Baby?
This is where hemorrhoids and fissures part ways a little in terms of outlook.
Hemorrhoids often don't fully resolve on their own once you have them. Think of them a bit like skin tags — they can shrink and become asymptomatic, but they tend to come and go. If hemorrhoids are persistently bothering you after pregnancy, it's worth consulting a colorectal doctor. There are several effective in-office procedures that don't require surgery and can provide significant relief.
Anal fissures are a bit more complicated. Small acute fissures can resolve on their own, especially with good bowel habits and conservative care. However, fissures that persist beyond six weeks are considered chronic and typically require medical treatment. A colorectal doctor can prescribe medicated creams that help relax the anal sphincter and promote healing, and in some cases botox injections to the area are used to reduce muscle spasm and allow the fissure to heal. Don't try to wait out a fissure indefinitely — early treatment leads to much better outcomes.
When to Call Your Doctor
Contact your healthcare provider if you experience severe pain that is difficult to manage, significant bleeding with bowel movements, persistent constipation despite conservative measures, or any symptoms that are worsening rather than improving. Bleeding during pregnancy should always be reported to your provider so they can confirm the source.
The Role of a Pelvic Floor PT
While your OB or midwife and a colorectal doctor are your go-to for medical treatment, a pelvic floor PT can help address the underlying contributors — bowel mechanics, pelvic floor tension, breathing and bearing-down patterns — that can make both conditions worse. If you're dealing with either of these issues during pregnancy or postpartum, it's worth adding a pelvic floor PT to your care team.
For support with pelvic floor health throughout pregnancy and postpartum, Amie offers programs designed by pelvic floor PTs for every stage of your journey.
References:
Buzinskiene D., Sabonyte-Balsaitiene Z., Poskus T. (2022). Perianal diseases in pregnancy and after childbirth: frequency, risk factors, impact on women's quality of life and treatment methods. Frontiers in Surgery, 9, 788823.
Chen Y.Y., et al. (2023). Prevalence, characteristics, and treatment of hemorrhoids during pregnancy: a nationwide population-based cohort study in Taiwan. Journal of Women's Health, 32(12), 1394-1401.
Medich D.S., Fazio V.W. (1995). Hemorrhoids, anal fissure, and carcinoma of the colon, rectum, and anus during pregnancy. Surgical Clinics of North America, 75(1), 77-88.
Rishi M., Cornish J. (2025). Anal fissure. StatPearls. National Library of Medicine.