What If I Need Hemorrhoid Surgery or Removal During Pregnancy?

Medically reviewed by: Gary H. Hoffman, MD

Hemorrhoid removal procedures, known as hemorrhoidectomies, are not the preferred option for taking care of hemorrhoids during pregnancy. However, this type of surgery is possible and not terribly uncommon during pregnancy or shortly after. Many women develop hemorrhoids during pregnancy or during childbirth, and some naturally require more intensive treatments than others because of the severity of their symptoms.

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If you are experiencing hemorrhoid symptoms, do not hesitate to discuss them with your obstetrician. If your symptoms are severe, they will likely refer you to a specialist. Alternatively, you can go ahead and make an appointment with us.

Attempt Noninvasive Treatments First

Most people, pregnant or not, do not require surgery for their hemorrhoids. We can prescribe stool softeners to prevent constipation and topical creams that help soothe symptoms, especially when used in conjunction with changes in diet and activity. We will also give you tips on how to lessen pain and swelling, including using sitz baths and ice packs.

If this is not effective, we also have other noninvasive and less-invasive treatments that we may be able to try, depending on your specific symptoms and situation.

When a pregnant woman comes to visit us for treatment or removal of hemorrhoids, we

try our best to avoid surgery. We try to shrink your inflamed tissue with noninvasive treatments or manage symptoms until you can deliver, but removal procedures are necessary in some cases.

Sometimes Hemorrhoid Removal During Pregnancy Is Necessary

While it is the last option we explore, some women will need hemorrhoid removal during pregnancy or shortly after delivery. Often, this stems from particularly painful hemorrhoids that do not respond to other, more conservative, treatments. Cases that present with uncontrolled bleeding may also require removal. Lastly, we recommend surgery when an internal hemorrhoid prolapses, or slips outside the anus, and cannot be manually replaced.  Some small hemorrhoidal surgical procedures may be done in the office but others may require to be performed in an operating room.

There Are Options for Removal

While hemorrhoids are often at their worst during the third trimester, we try to perform any necessary surgery during the second trimester. If the problem does not emerge until after week 27 or 28, we can determine if you require immediate surgery or if you can wait until after birth. This decision is dependent on the specific details of your case. If you need a removal procedure, we can use a spinal block or local anesthetic during removal, and avoid general anesthesia.

There are three general options for hemorrhoids that require treatment at this point:

Procedure for Prolapse and Hemorrhoids (PPH)

The procedure for prolapse and hemorrhoids, known as PPH, offers an effective alternative to a hemorrhoidectomy. This procedure works especially well to repair prolapsed internal hemorrhoids, and results in less postoperative pain than traditional surgery. Our surgeons are pioneers of this procedure and continue to research improved ways to perform the operation. If you qualify for a PPH, you may be able to return to your normal activities faster than with other types of removal surgeries.

Transanal Hemorrhoidal Dearterialization (THD)

This procedure involves the identification of hemorrhoidal feeding vessels using a Doppler system.  Once the feeding vessels are identified, they are ligated along with the hemorrhoid bundle to obliterate them.  No excision or removal of hemorrhoidal tissue is necessary.  As the procedure is done above the pain line and no tissue is surgically removed, recovery time can be shorter and quicker compared to traditional hemorrhoidectomy.

Traditional Hemorrhoidectomy

In some cases, a traditional hemorrhoidectomy is the best option to remove the offending tissue and stop your symptoms. This method requires stopping blood flow to the tissue, and then cutting it out with a scalpel. You will likely require stitches, and there may be some blood loss during this procedure. Depending on the circumstances, your surgeon may keep you in the hospital for a night or two. The most intense pain after hemorrhoid surgery can persist for a few weeks, and complete healing may require six weeks or more.

What to Expect After Hemorrhoid Removal During Pregnancy

What you can expect after a hemorrhoid removal depends heavily on the procedure you require, how quickly you heal, and whether you undergo the surgery during pregnancy or afterward. Even the least invasive method, PPH, requires several weeks of recovery. If you have surgery late in the third trimester, your obstetrician may recommend a c-section or other changes to your birth plan.

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