Hemorrhoids in Second Trimester: Causes & Safe Relief

If you have new rectal itching, pain, or bright-red spotting on the toilet paper during the second trimester, you are far from alone. Pregnancy hemorrhoids are common and often surge between weeks 14 and 27 as your body adapts to growing a baby. The good news: with a few targeted changes and pregnancy-safe treatments, most people get meaningful relief.

Key takeaway: Hemorrhoids in the second trimester are common, treatable, and usually temporary. Early care helps prevent worsening and eases daily life.

1) Hemorrhoids 101: What they are and why they happen

Hemorrhoids are swollen veins in or around the anus and lower rectum. They can be:

Internal: inside the rectum; may bleed painlessly with bowel movements
External: under the skin around the anus; can itch, ache, or form a tender lump

Common symptoms include itching, burning, pain with sitting or bowel movements, swelling, mucus leakage, and bright-red bleeding on the stool or toilet paper. While anyone can develop hemorrhoids, pregnancy hemorrhoids are especially common due to hormonal and mechanical changes (Cleveland Clinic; Johns Hopkins Medicine).

Reassurance: In pregnancy, hemorrhoids are uncomfortable but typically not dangerous. Most improve with conservative care and after delivery (ACOG).

2) Why they rise in the second trimester

Many people notice hemorrhoids second trimester as the uterus grows quickly and blood volume rises. Weeks 14–27 bring big physiologic shifts that increase venous pressure in the pelvis and slow bowel motility, setting the stage for hemorrhoids.

What research shows:

25–35% of pregnant people develop hemorrhoids overall, with symptoms most common in the second and third trimesters (Staroselsky et al., 2008).
In a 2024 review, up to 85% reported symptoms of hemorrhoids and/or anal fissures during pregnancy, and about 45% developed some form of perianal disease in prospective data (Boughton et al., 2024).
A 2024 self-reported study found 51% had hemorrhoid symptoms in pregnancy, with the second and third trimesters the peak time for onset and flares (D’Alfonso et al., 2024).

Why the surge now:

The enlarging uterus increases pressure on pelvic veins, slowing blood return from the lower body.
Blood volume climbs 30–50%, putting extra strain on delicate rectal veins.
Progesterone rises, relaxing vessel walls and slowing the gut, which can lead to constipation during pregnancy (Cleveland Clinic; Johns Hopkins Medicine).

3) Spot the signs early

Typical, non-urgent symptoms:

Itching, burning, or irritation at the anus
Achy or throbbing discomfort when sitting
Bright-red streaks or drops of blood with wiping
A soft or firm lump at the anus (external hemorrhoid)

Concerning signs that warrant a call to your provider:

Heavy or persistent bleeding, passing clots, or dizziness/lightheadedness
Severe pain or a suddenly very tender, hard lump (possible thrombosed external hemorrhoid)
Fever, worsening redness, warmth, or drainage suggesting infection
Black or tarry stools, changes in bowel habits, or weight loss (these are not typical of hemorrhoids)

Early recognition matters. Treating symptoms promptly can prevent swelling from worsening and reduce the risk of thrombosis or prolapse.

4) Root causes in pregnancy

Several pregnancy-specific changes make hemorrhoids more likely, especially in the second trimester:

Pressure on pelvic veins: The growing uterus can compress the inferior vena cava and pelvic veins, slowing blood return and causing pooling in hemorrhoidal veins (Cleveland Clinic).
Higher blood volume: A 30–50% increase in circulating blood expands venous load and distends fragile rectal vessels (Cleveland Clinic; Johns Hopkins Medicine).
Progesterone effects: Relaxed vessel walls and slower gut motility increase the chance of venous dilation and constipation (Cleveland Clinic; Staroselsky et al., 2008).
Constipation and straining: Hard stools and pushing sharply raise pressure in the anal canal and can trigger or worsen hemorrhoids (Mayo Clinic; Boughton et al., 2024; D’Alfonso et al., 2024).
Increased intra-abdominal pressure: Everyday lifting, coughing, and later, the bearing down of labor, all add pressure to the perianal vasculature (Staroselsky et al., 2008; Boughton et al., 2024).

5) Prevention basics: Fiber-forward plate + hydration

Soft, regular stools are your best defense. Aim for:

25–35 grams of fiber daily
8–12 cups of fluids per day (about 2–3 liters), primarily water

Simple ways to get there:

Build every meal around plants: oatmeal with berries and nuts; big salads with beans; grain bowls with quinoa, lentils, roasted veggies; fruit with skins (pears, apples), leafy greens, carrots, sweet potatoes, peas.
Keep easy fiber snacks ready: hummus with whole-grain crackers, edamame, trail mix, chia pudding, fresh or dried fruit like prunes or figs.
Increase fiber gradually over 1–2 weeks to prevent gas and bloating.
Hydration cues: carry a water bottle, sip consistently, and aim for pale-yellow urine.

If food alone is not enough, ask your provider about fiber supplements like psyllium or methylcellulose and stool softeners when needed (Mayo Clinic). These can be helpful tools alongside diet and fluids.

6) Daily habits that help

Gentle, consistent habits reduce pressure on pelvic veins and protect healing tissue:

Move most days: brisk walking, swimming, or prenatal yoga boosts circulation and bowel regularity.
Avoid long stretches of sitting or standing: set a reminder to change position every 30–60 minutes.
Rest on your left side: this position eases pressure on the inferior vena cava and supports venous return.
Smart toilet posture: use a small footstool to raise your knees above your hips and lean forward slightly; this straightens the anorectal angle and helps you pass stool without straining.
Limit time on the toilet: aim for 5–10 minutes; if nothing happens, try again later.
Sit smart: choose cushioned seating. Some find a donut-style cushion helpful; if it increases pressure or discomfort, switch to a firm cushion with a center cut-out or use side-lying rest breaks.

7) Pregnancy-safe relief options

When symptoms flare, these strategies are safe and effective for most pregnant people:

Sitz bath during pregnancy

Soak your bottom in warm (not hot) water for 10–15 minutes, 2–3 times daily and after bowel movements.
Use a bathtub with a few inches of water or a sitz bath basin that fits over the toilet.
Pat dry gently after soaking. Avoid soaps, bubble bath, or fragrances that can irritate sensitive skin.

Evidence-informed relief: Warm water relaxes the anal sphincter, improves blood flow, and reduces pain and itching (Mayo Clinic; ACOG).

Cold and warm compresses

Apply wrapped ice packs for 10–15 minutes to ease swelling and numb pain.
Alternate with warm compresses if helpful.

Witch hazel pads

Witch hazel pregnancy safe when used topically as pads or compresses; it has natural astringent and soothing properties that can reduce itching and swelling (Mayo Clinic; ACOG). Apply after gentle cleansing.

Gentle hygiene

After bowel movements, rinse with warm water using a peri bottle or use unscented, alcohol-free wipes; pat, do not rub.
Keep the area dry; consider a thin layer of plain petrolatum to protect skin from moisture.
Wear breathable cotton underwear and change damp liners promptly.

OTC creams and suppositories

Some over-the-counter products can help, but always ask your prenatal provider before use in pregnancy. Short courses of low-potency topical steroids, local anesthetics, or protectants may be suggested if appropriate (Mayo Clinic). Avoid self-starting new meds without approval.

8) When to call your provider

Knowing when to see a doctor for hemorrhoids helps keep you safe and comfortable:

Call promptly if you have:

Heavy bleeding, repeated bleeding with clots, or dizziness
Severe pain or a hard, very tender lump (possible thrombosis)
Signs of infection: fever, increasing redness or warmth, foul drainage
Black or tarry stools or changes in bowel habits
No improvement after 7 days of consistent self-care

What your clinician may offer:

An exam to confirm the diagnosis and rule out other causes of bleeding
Guidance on safe stool softeners and fiber supplements (for example, psyllium, methylcellulose, docusate). Osmotic laxatives such as polyethylene glycol or lactulose may be used in pregnancy when needed; your clinician will individualize recommendations (Mayo Clinic)
Review of medications that can worsen constipation, like iron supplements, and strategies to balance iron needs with bowel comfort

9) How hemorrhoids affect pregnancy, birth, and postpartum

Quality of life: Pain, itching, and bleeding can disrupt sleep, exercise, and comfort with sitting; managing symptoms can markedly improve day-to-day wellbeing (Boughton et al., 2024).
Birth: Vaginal delivery can temporarily worsen hemorrhoids due to bearing down. This is common and usually improves with postpartum care (ACOG; Johns Hopkins Medicine).
Postpartum: Expect a short-term flare in the first days after birth, then gradual improvement. Some people continue to have symptoms for months; about 16% still report symptoms at 6 months postpartum in research, underscoring the value of ongoing care (Boughton et al., 2024).
Plan ahead: Stock sitz bath supplies, witch hazel pads, ice packs, peri bottles, high-fiber foods, and a water bottle for easy hydration. Discuss bowel regimens with your birth team before discharge.

10) If symptoms persist: medical treatments

During pregnancy, conservative care is the first-line approach. Procedures are typically deferred until after delivery unless urgently needed.

Urgent scenarios: A very painful thrombosed external hemorrhoid may be treated with local measures and, in select cases, office-based incision and clot removal within 72 hours of onset. Your obstetric and surgical teams will weigh benefits and risks (Staroselsky et al., 2008).
Postpartum options: If significant symptoms persist, office procedures such as rubber band ligation, sclerotherapy, or infrared coagulation may be considered after you have healed from birth. For advanced disease, surgical hemorrhoidectomy is rarely needed and reserved for severe cases. A referral to a colorectal specialist is appropriate when symptoms are refractory or diagnosis is uncertain.

11) Common mistakes and myths to avoid

Delaying care due to embarrassment: Hemorrhoids are common in pregnancy. Early help prevents worsening.
Overreliance on OTC meds: Creams can soothe, but without addressing constipation and straining, relief is often short-lived.
Skipping lifestyle changes: Fiber, fluids, movement, and toilet posture are the foundation of lasting relief.
Harsh wiping and scented products: These irritate delicate skin. Choose gentle cleansing and pat dry.
Straining and long toilet time: If it does not come easily in 5–10 minutes, get up and try later.
Myth: All rectal bleeding is hemorrhoids. Other conditions can cause bleeding; significant or persistent bleeding needs evaluation.

12) Support for partners and self-advocacy

Practical help from partners, family, or friends makes a real difference:

Prep fiber-forward meals and snacks; keep water bottles filled
Set up a sitz bath station and refresh witch hazel pads and ice packs
Encourage daily movement breaks and left-side rest
Run errands so the pregnant person can rest and soak as needed

Self-advocacy tips:

Track symptoms, bowel patterns, and what helps; bring notes to visits
Ask directly about safe stool softeners, fiber supplements, and topical options
Speak up if pain is severe or bleeding is frequent; you deserve relief and a clear plan

You are not alone, and you do not have to tough it out. With early prevention, pregnancy-safe relief, and a little support, most second-trimester hemorrhoids improve quickly.

References and trusted resources

Cleveland Clinic. Pregnancy Hemorrhoids. https://my.clevelandclinic.org/health/diseases/23498-pregnancy-hemorrhoids
Mayo Clinic. Hemorrhoids during pregnancy: What’s the best treatment? https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/hemorrhoids-during-pregnancy/faq-20058149
American College of Obstetricians and Gynecologists (ACOG). What can I do for hemorrhoids during pregnancy? https://www.acog.org/womens-health/experts-and-stories/ask-acog/what-can-i-do-for-hemorrhoids-during-pregnancy
Johns Hopkins Medicine. Hemorrhoids. https://www.hopkinsmedicine.org/health/conditions-and-diseases/hemorrhoids
Staroselsky A, et al. Hemorrhoids in pregnancy. Can Fam Physician. 2008. https://pmc.ncbi.nlm.nih.gov/articles/PMC2278306/
Boughton RS, et al. Haemorrhoids and Anal Fissures in Pregnancy. Cureus. 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC10849161/
D’Alfonso A, et al. Haemorrhoidal disease in pregnancy. Int J Colorectal Dis. 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11064321/

The bottom line

Hemorrhoids second trimester are common, but you do not have to suffer in silence. Focus on soft, regular stools; move gently each day; use sitz baths, cold/warm compresses, and witch hazel pads; and ask your provider about safe stool softeners or topical options. If bleeding is heavy, pain is severe, or symptoms are not improving, call your care team.

Ready for more tailored guidance? Bring this article to your next prenatal visit and make a simple, step-by-step plan with your provider so you can feel better fast.