Piles are a common pregnancy symptom
Q: I am 31 weeks pregnant and have discovered varicose veins around my vagina. My midwife said they might rupture during delivery. Is this likely to happen? And will they go away after the pregnancy?
A: Varicose veins sometimes occur in the vulva (on the outside of the vagina), usually when the baby gets heavier. The baby’s head puts pressure on the veins in the pelvis, so that blood stagnates in the vulval area, causing discomfort. If you’ve been standing a lot during the day, symptoms are usually worse in the evening. You can ease the pain with an ice pack or cold pack, however. Sometimes, vulval varicose veins rupture during delivery, or if an episiotomy is done, but this is fairly unusual unless they are very extensive. Like varicose veins in the legs, the veins will shrink after you have your baby, because blood flow in the pelvis increases once the baby’s head is no longer causing an obstruction, and also because levels of the hormone progesterone drop, so the veins become less dilated.
Q: I’m worried that my yearly hay fever will be worse than usual this spring, as I’ve been reading that you can be more susceptible to allergies when pregnant. Will I be able to take antihistamines?
A: Variations in pollen levels make more of a difference to symptoms than whether you’re pregnant or not. Some antihistamines are best avoided when pregnant (like cetirizine and loratadine, for example). You would be safer taking an older type like chlorpheniramine (best known as Piriton), even though it may be more likely to make you drowsy. But, if you can, avoid taking any unnecessary medicines at all. Reducing your contact with pollen may reduce your symptoms dramatically. Try keeping windows shut when the count is very high, especially at night. Outside, wear big wrap-around sunglasses to keep pollen out of your eyes, and try a dab of Vaseline just inside your nostrils to trap pollen. Shower and change your clothes after coming in from a walk – and wash your hair as well, if possible.
Q: I’m trying for a baby, but I’m worried that I may get gestational diabetes. My parents had late onset diabetes, and my mum developed it while she was pregnant with me. Am I at risk?
A: You could be at risk, as diabetes can run in families. About one pregnancy in every 400 is complicated by diabetes, and it can persist after the baby is born. Since there’s no way to be sure anyone has it without doing tests, you may be offered a glucose tolerance test – a series of blood tests within hours of having a standard load of glucose to drink. If this is done, it’s usually offered at around 28 weeks. Excess weight increases the chances of diabetes, so keep your weight down. This makes good sense anyway if you’re trying for a baby, as overweight women can have trouble conceiving, and also run the risk of other problems during pregnancy, such as high blood pressure.
Q: Which cold remedies are safe to use during pregnancy? I usually take Echinacea, high-potency vitamin C and Lemsip or similar preparations, or paracetamol.
A: For many common remedies there’s no scientific evidence of risk. But that is not at all the same as ‘evidence of no risk’. There’s little research into Echinacea and pregnancy, so it may be best to avoid it. Some believe that high doses of vitamin C could endanger a pregnancy in it’s earliest stages. Lemsip contains phenylephrine, a decongestant, and it’s thought best to avoid it if you’re pregnant. Having said that, we’re talking about small doses of phenylephrine, so the likelihood is that it won’t do much harm. All the same, stick to paracetamol for fever and aches. If you have a sore throat or mild cough, make yourself honey and lemon drinks. To be on the safe side, avoid menthol and eucalyptus oil preparations, including Vicks.
Q: I know that piles can be a problem in pregnancy and I’m a little concerned because I already had them before I got pregnant. They weren’t a problem before (no pain, just a bit of blood occasionally), but will they get worse?
A: Piles (haemorrhoids) are very common in pregnancy, especially in the later stages. High levels of the hormone progesterone makes blood vessels dilate, while pressure from your bump prevents blood flow up from the rectal area. The pushing involved in labour in also a factor. And constipation is common in pregnancy – another result of raised progesterone levels.
If you’ve only got bleeding, rather than itching and / or a lump, check with your doctor to make sure it’s piles. Other possibilities include an anal fissure or crack or even something more serious.
If you do have piles, it may be worth suppositories – your GP can advise. One thing you should definitely do is eat plenty of fruit and veg to prevent constipation. Try to avoid straining when you use the loo, and always go when you get the urge. Finally, keep the area clean and dry to minimise itching and discomfort. Piles usually improves dramatically after the baby arrives.
Q: I am 35 weeks pregnant with my third baby in 3 years and have come across a strange problem. I have developed varicose veins around my vagina, which bleed regularly (sometimes quite heavily). Is this a normal part of pregnancy?
A: Although one usually thinks of varicose veins affecting the legs, they can affect the vulva, as in your case. This is because of the pressure on the pelvis from your growing baby, and that’s why they only come on, if at all, in the latter stages of pregnancy. They can be itchy or uncomfortable, but they’re not usually serious, and they rarely cause any trouble during labour.
Once your baby is born, these varicose veins shrink back to normal, though if you were to have a fourth baby you may well find they’d return. If they don’t go away after 3 months or so, it’s worth getting treatment, such as having them injected.
Meanwhile, you should take the opportunity to rest when you can. Lying down, with or without a cold compress or ice pack on the vulval area, can help a lot.
One more thing: you’ve described them as varicose veins, but I’d guess it’s hard for you to examine that area yourself. Your midwife or GP should really take a look at anything that bleeds in pregnancy, to make sure it’s only varicose veins.
Q: I’ve been suffering bad headaches, dizziness and feeling like I might be bleeding during my pregnancy, plus a purple rash on my face. I’ve gone into hospital each time but I am just offered tablets for sickness. Could it be something more serious?
A: You’re right in thinking that headaches, dizziness and a bleeding sensation can sometimes be serious. After 20 weeks of pregnancy, there’s a possibility of pre-eclampsia, a condition that’s linked with high blood pressure, protein in the urine and sometimes a variety of symptoms, which can include headache, upper abdominal pain and flashing lights. However, if you’ve been to hospital, then I’m sure you haven’t got pre-eclampsia because you’ll have been checked specifically for this.
Your symptoms are therefore probably nothing serious. While most women expect to have a glowing complexion during pregnancy, rashes and spots can often occur too. In fact, a whole range of minor complaints is very common in pregnancy. It’s said that the more troublesome the mums finds these, then the better the baby is doing. That’s because many of the symptoms, like headaches and morning sickness, are due to hormone changes in pregnancy. Babies that are growing particularly well cause the greatest impact on the mother’s hormone levels. However, if you develop new or puzzling symptoms, do go again to your doctor or midwife, who would no doubt check your blood pressure and urine again, as well as examine your tummy.
Q: I’ve heard of a condition involving too much fluid in the womb. What is this and how do you know if you have it?
A: This is called polyhydramnios (or simply hydramnios). There are a huge number of possible causes, including diabetes, expecting twins (or more), certain infections in the womb and abnormalities in the baby like a blocked gullet. Having said that, in most cases no cause is found. You might suspect hydramnios if your bump is bigger and more uncomfortable than it should be, or if your midwife finds it difficult to feel your baby when she examines your belly. However, only an ultrasound scan can confirm this.
It’s important to diagnose hydramnios to rule out diabetes or any problems that the baby might have that need treating. There’s also a risk of premature labour from the extra pressure, which is why your obstetrician might want to take off some fluid with a needle (like having an amniocentesis) or prescribe a drug, like indomethacin, that may help. But if hydramnios is only mild, it may need no action other than careful monitoring. During the birth there’s a hither chance of problems with the cord or placenta, so you would need close watching during labour too.
Q: I’ve developed bad haemorrhoids in my 34th week of pregnancy. It’s painful to sit or move around, so I’m worried about achieving the active labour I want. Can I get rid of them before the birth?
A: Haemorrhoids (often called piles) are dilated veins. They’re common during pregnancy because progesterone makes all the veins in the body dilate, and also because your bump puts pressure on the pelvis. Many mums-to-be just feel a lump or 2 at the back passage. But sometimes piles become painful, for instance, if a clot has formed in one of them (thrombosed piles) or there is an inflammation around the piles. Ask your GP what you can do, as she may be able to prescribe a cream that’s suitable for pregnancy.
If your piles are thrombosed, they may become less uncomfortable over the next few days or weeks but they won’t go away before your baby is born. If anything, they could become more prominent as your baby grows. However, piles are not usually much of a problem during labour, as you will have other things to concentrate on. After the birth, your piles will shrink. You will probably just be left with a few tiny skin tags, which should really be of no significance at all.