Causes of Third Trimester Hemorrhoids: Why They Happen

Feeling soreness, itching, or spotting bright red blood after a bowel movement late in pregnancy can be alarming. You’re not alone—and you haven’t done anything wrong. Hemorrhoids are a common, treatable part of pregnancy for many people, especially in the final stretch. In this guide, we explain the causes of third trimester hemorrhoids, who’s at higher risk, what symptoms to watch for, and how to prevent and soothe them safely.

Key takeaway: Third trimester hemorrhoids are usually temporary. With smart prevention and gentle care, symptoms often improve after birth (and sometimes even before).

What are hemorrhoids in pregnancy?

Hemorrhoids are swollen, enlarged veins in and around the anus and lower rectum. In pregnancy, they may appear for the first time or flare if you’ve had them before.

External hemorrhoids: Form under the skin around the anus. They can feel like tender lumps and often itch or hurt, especially if a clot forms (thrombosis).
Internal hemorrhoids: Develop inside the rectum. They may bleed painlessly or prolapse (bulge) through the anus during a bowel movement.

Clinicians grade internal hemorrhoids by prolapse:

Grade I: Bleed but don’t prolapse
Grade II: Prolapse with straining but reduce on their own
Grade III: Prolapse and need manual reduction
Grade IV: Prolapsed and cannot be reduced; may thrombose and be quite painful

Hemorrhoids are common in pregnancy and tend to peak in late pregnancy and shortly after birth. Estimates vary, but many sources suggest a substantial portion of pregnant people experience them, particularly in the third trimester (Cleveland Clinic; BMC Pregnancy and Childbirth review) (https://my.clevelandclinic.org/health/diseases/23498-pregnancy-hemorrhoids) (https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04503-6).

Why the third trimester raises your risk

The final trimester brings rapid fetal growth, a heavier uterus, and shifting body mechanics. Together these drive:

Higher intra‑abdominal pressure, which compresses pelvic veins
Venous congestion in the pelvis and rectum
Slower gut motility and more constipation

This mix makes hemorrhoids in late pregnancy more likely and can worsen existing ones.

Cause 1: Uterine pressure and impaired venous return

As the uterus grows, it presses on pelvic veins and sometimes the inferior vena cava, especially when lying flat on your back. That pressure can slow blood return from the legs and pelvis, leading to pooling in the hemorrhoidal veins and swelling. This venous congestion is a leading driver of third trimester hemorrhoids (Stanford Medicine Children’s Health) (https://www.stanfordchildrens.org/en/topic/default?id=hemorrhoids-and-varicose-veins-in-pregnancy-134-9).

Helpful tip: Resting on your left side can relieve some pressure on the vena cava and improve venous return.

Cause 2: Hormonal shifts (progesterone)

Progesterone rises in pregnancy and relaxes smooth muscle. Two downstream effects matter here:

Blood vessels relax, reducing venous tone and making veins more likely to distend and engorge.
Gut motility slows, which can lead to harder stools and constipation—major contributors to hemorrhoids.

These hormonal shifts set the stage; straining and pressure do the rest.

Cause 3: Increased blood volume and vascular changes

By the third trimester, circulating blood volume increases by roughly 30–50%, which helps support the placenta and growing baby. The trade‑off is greater venous distension throughout the body—including in the hemorrhoidal plexus—so those veins are more prone to engorgement when other stressors (constipation, straining, prolonged sitting) are present (Cleveland Clinic) (https://my.clevelandclinic.org/health/diseases/23498-pregnancy-hemorrhoids).

Cause 4: Constipation and straining mechanics

Constipation during pregnancy is common, and it’s one of the most important pregnancy hemorrhoids causes. When stool sits longer in the colon, more water is absorbed, making it hard and dry. Passing hard stool and straining spikes pressure in the anal canal, aggravating hemorrhoidal veins and triggering bleeding or prolapse. A few everyday habits can compound the issue:

Delaying the urge to go
Sitting on the toilet for long stretches (especially while scrolling or reading)
Poor positioning (hips tucked, feet flat) that kinks the anorectal angle

A small footstool to elevate your feet, leaning forward with a straight back, and relaxing your belly can reduce strain (NHS; Mayo Clinic) (https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/piles/) (https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/hemorrhoids-during-pregnancy/faq-20058149).

Who is at higher risk?

You may be more likely to experience third trimester hemorrhoids if you have:

Prior hemorrhoids (before or in a previous pregnancy)
Multiparity (more than one pregnancy)
Higher BMI or rapid weight gain
Chronic constipation or low‑fiber intake
Prolonged sitting or standing at work
Heavy lifting or straining
Family history of varicose veins or hemorrhoids

Some risks are not modifiable (e.g., genetics, prior history), but many are. Small changes—fiber, fluids, movement, and toileting posture—can make a big difference.

Symptoms to watch for and when to call your provider

Common symptoms include:

Pain, tenderness, or swelling around the anus
Itching or irritation
Bright red bleeding on toilet paper or in the bowl after a bowel movement
A soft bulge that prolapses during or after a bowel movement
A firm, exquisitely painful lump (possible thrombosed external hemorrhoid)

Red flags: Seek prompt care if you have any of the following:

Heavy bleeding, clots, or dizziness/lightheadedness
Severe, sudden pain or a purple‑blue, very tender lump
Fever, chills, pus, or spreading redness (possible infection/abscess)
Persistent bleeding that doesn’t improve

Not all rectal bleeding is from hemorrhoids. Anal fissures, abscesses, inflammatory bowel disease, and (rarely) colorectal polyps or cancer can also cause bleeding or pain—another reason to loop in your clinician for a proper diagnosis (BMC review) (https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04503-6).

Evidence‑based prevention and relief

When it comes to how to prevent hemorrhoids in pregnancy—and how to feel better if you already have them—professional groups emphasize conservative, safe strategies.

Nutrition and hydration (ACOG, Mayo, NHS)

Fiber: 25–30 grams/day. Focus on fruits, vegetables, whole grains, legumes, nuts, and seeds.
Fluids: 8–12 cups/day. Water is best; consider warm liquids in the morning and small amounts of prune or pear juice if constipated.
Supplements and stool softeners: If diet alone isn’t enough, ask your clinician about fiber supplements (psyllium/ispaghula) and pregnancy‑safe stool softeners or osmotic agents such as docusate, polyethylene glycol, or lactulose (NHS; Mayo Clinic) (https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/piles/) (https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/hemorrhoids-during-pregnancy/faq-20058149).

Bowel habits and posture

Go when you feel the urge. Delaying makes stool drier and harder.
Don’t strain or hold your breath. Exhale gently; think “relax and release,” not “push.”
Use a footstool. Elevate feet 6–8 inches to optimize the anorectal angle.
Limit toilet time. Aim for 5 minutes or less; save scrolling for the couch.

Movement and pressure management

Stay active daily (e.g., walking, swimming, prenatal yoga) as approved by your provider; movement supports regularity and venous return.
Change positions often. Avoid long periods of sitting or standing; take brief movement breaks each hour.
Sit smart. Use a donut or wedge cushion; avoid hard chairs. Rest on your left side when possible to reduce pelvic venous pressure (Stanford Medicine Children’s Health) (https://www.stanfordchildrens.org/en/topic/default?id=hemorrhoids-and-varicose-veins-in-pregnancy-134-9).

Soothing care (ACOG & Mayo Clinic)

Warm sitz baths for 10–15 minutes, 2–3 times daily and after bowel movements—no soaps or bubble bath.
Witch hazel pads for cooling relief and gentle cleansing.
Cold compresses wrapped in a cloth for 10–20 minutes to reduce swelling.
Topicals: Ask your clinician before using over‑the‑counter creams or suppositories. Some contain mild anesthetics or low‑dose steroids; your provider can help you choose what’s safe and effective for pregnancy (ACOG; Mayo Clinic) (https://www.acog.org/womens-health/experts-and-stories/ask-acog/what-can-i-do-for-hemorrhoids-during-pregnancy) (https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/hemorrhoids-during-pregnancy/faq-20058149).

Key takeaway: Fiber + fluids + movement + gentle toilet habits are the foundation. Add sitz baths, witch hazel, and cushions for comfort.

Labor, birth, and the postpartum window

Pushing during a vaginal birth can temporarily worsen hemorrhoids or bring on new ones due to intense pressure. The good news: most pregnancy‑related hemorrhoids improve within weeks postpartum as hormones shift, blood volume normalizes, and abdominal pressure falls (ACOG; NHS) (https://www.acog.org/womens-health/experts-and-stories/ask-acog/what-can-i-do-for-hemorrhoids-during-pregnancy) (https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/piles/).

Postpartum care is similar: fiber, hydration, stool softeners as advised, sitz baths, witch hazel pads, and cushions.
Procedures (like rubber band ligation or surgery) are usually deferred until after pregnancy and breastfeeding when symptoms persist or are severe. Rarely, a very painful thrombosed external hemorrhoid may be treated sooner; your clinician will guide you (EMJ review) (https://e-emj.org/journal/view.php?number=120).

Emotional impact and partner support

Hemorrhoids can affect sleep, movement, and mood—on top of all the changes late in pregnancy. It’s okay to feel frustrated or embarrassed.

Self‑compassion: This is common and not your fault.
Comfort menu: Keep witch hazel pads, a sitz bath basin, a cushion, and a water bottle within reach.
Partner helps: Prep fiber‑rich snacks, remind about hydration, set up the bathroom footstool, draw a warm sitz bath, and handle chores that require standing or lifting.
Mental health: If symptoms are disrupting sleep or daily life, or if you feel persistently down or anxious, reach out to your maternity care team for added support and resources.

Myths and quick FAQs

Myth‑busting

Myth: “Hemorrhoids always need surgery.”

- Fact: Most pregnancy hemorrhoids improve with conservative care and after birth. Surgery is rarely needed during pregnancy (ACOG; EMJ review) (https://www.acog.org/womens-health/experts-and-stories/ask-acog/what-can-i-do-for-hemorrhoids-during-pregnancy) (https://e-emj.org/journal/view.php?number=120).

Myth: “Any rectal bleeding is just hemorrhoids.”

- Fact: Hemorrhoids are common, but bleeding warrants a check to rule out fissures, infection, or other conditions (Cleveland Clinic) (https://my.clevelandclinic.org/health/diseases/23498-pregnancy-hemorrhoids).

Myth: “Hemorrhoids mean I can’t have a vaginal birth.”

- Fact: Most people with hemorrhoids can birth vaginally. Your care team will help manage comfort and postpartum recovery (NHS) (https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/piles/).

Quick FAQs (for you and your support person)

What do third trimester hemorrhoids feel like?

- Itching, tenderness, bleeding with wiping, and sometimes a painful lump. Internal hemorrhoids may bleed without much pain; external ones can be sore.

Can I use OTC creams or wipes?

- Many are safe, but check with your clinician first to ensure ingredients are appropriate for pregnancy (ACOG; Mayo Clinic).

What helps fastest today?

- Warm sitz bath, witch hazel pads, and a cold compress. Avoid straining; use a footstool on the toilet.

What’s the best prevention plan?

- Daily fiber (25–30g), 8–12 cups of fluids, gentle activity, prompt bathroom trips, and minimal straining.

Will this affect my baby?

- Hemorrhoids are uncomfortable for you but generally don’t impact the baby’s health (Pregnancy, Birth and Baby) (https://www.pregnancybirthbaby.org.au/haemorrhoids-during-pregnancy).

Putting it all together: A simple plan

1. Eat for ease: Add produce, whole grains, legumes, nuts/seeds; consider a psyllium supplement if needed. 2. Hydrate: Keep water handy; aim for pale‑yellow urine. 3. Move: Short, regular walks and position changes every hour. 4. Bathroom basics: Answer urges promptly, use a footstool, and keep toilet time brief. 5. Soothe: Sitz baths, witch hazel pads, soft wipes, and cold compresses. 6. Ask early: If pain or bleeding persists, contact your clinician to tailor treatment and rule out other causes.

If you’re worried about bleeding, severe pain, or a painful new lump, call your provider. Quick evaluation brings peace of mind and targeted relief.

References and further reading

American College of Obstetricians and Gynecologists (ACOG): Hemorrhoids in pregnancy—prevention and relief (https://www.acog.org/womens-health/experts-and-stories/ask-acog/what-can-i-do-for-hemorrhoids-during-pregnancy)
Mayo Clinic: Hemorrhoids during pregnancy—relief tips (https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/hemorrhoids-during-pregnancy/faq-20058149)
NHS: Piles in pregnancy—self‑care and when to seek help (https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/piles/)
Cleveland Clinic: Hemorrhoids in pregnancy—overview and FAQs (https://my.clevelandclinic.org/health/diseases/23498-pregnancy-hemorrhoids)
BMC Pregnancy and Childbirth: Hemorrhoids in pregnancy—literature review (https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04503-6)
EMJ Review: Hemorrhoids in pregnancy—treatment considerations (https://e-emj.org/journal/view.php?number=120)
Stanford Medicine Children’s Health: Hemorrhoids and varicose veins in pregnancy (https://www.stanfordchildrens.org/en/topic/default?id=hemorrhoids-and-varicose-veins-in-pregnancy-134-9)

Conclusion

Third trimester hemorrhoids happen because pregnancy changes—uterine pressure, hormonal shifts, increased blood volume, and constipation—stack up to stress the hemorrhoidal veins. The silver lining: most cases respond well to simple, consistent steps and often settle after birth. If symptoms are new, severe, or worrisome, connect with your care team for tailored advice.

Ready to feel better now? Start with a warm sitz bath, a glass of water, and a plan to add fiber to your next meal—and message your clinician if bleeding or pain persists.