Talking about your tush, particularly what’s coming out of it and how you feel when these things come out, is no one’s idea of a good dinner conversation. Even during a ladies’ lunch, it’s rare to hear someone say, “So, do you have pain with defecation?” And no matter what you like to call it (defecation is the medical way to say bowel movement), most of us don’t like to call attention to our bowel habits. However, after pregnancy and delivery, pooping can become a pretty big problem. Here’s why…

Pregnancy is a pressure-filled time (and we are not referring to the pressure of knowing that a baby is about to come and change your whole life). During pregnancy, your blood volume increases, you hold on to more fluid, and you usually gain a fair amount of weight. All of these pluses lead to an increase in the pressure bearing down on things like your ankles, your joints, your pelvis, and even your rectum. The local pressure on the anus can lead to varicosities (dilated/swollen blood vessels) in the anal canal (a.k.a. hemorrhoids). Additionally, constipation, a common complaint of pregnant and postpartum women, will make matters worse and will increase the pressure on an already pressured system.

Although hemorrhoids come in two “varieties” (internal and external), most of us are only aware of the external ones. The reason is that the internal ones are sort of invisible. They rarely cause pain or discomfort and only present themselves with rectal bleeding. Therefore, unless you go looking for a cause for the bleeding, you probably won’t find them.

External hemorrhoids, however, are much “flashier.” They cause a pretty good amount of pain with defecation and often move, or prolapse, to the outside of the anus after a bowel movement. On occasion, blood clots form within these prolapsed external hemorrhoids, making them doubly painful. The extra blood will not only cause extra pain but it can also turn the hemorrhoid a bluish purple color, which can cause a good amount of fear. However, the reality is that even though they look and feel bad, they are not dangerous or serious. No matter how little we may talk about hemorrhoids, they are super common, particularly in the last trimester of pregnancy (when pressure is at its peak) as well as during the post-partum period. As you can imagine, labor and all that pushing will not help the hemorrhoid situation, and most women report even more hemorrhodial discomfort (pain, bleeding, rectal itching) in the postpartum period. Not fun.

And while hemorrhoids can be a major pain in the butt, there are many treatment options available, even for pregnant women. From the most basic (anti-inflammatory, anti-itching, and pain relief creams) to the most aggressive (surgery), we have ways to take care of those hemorrhoids and those nagging symptoms. Additionally, changing your diet and increasing fluid and fiber intake can decrease constipation. Decreased constipation = less pushing = less pressure on the rectum = less hemorrhoids.

How your bottom feels can be the basis of how bad (or good) your day is. Let’s face it, we all need to sit, and we all need to have bowel movements—without pain. If you dread defecating, you need to dial up your OB/GYN. Although talking to anyone about your tush seems totally off limits, it’s a pretty standard part of an OB/GYN’s day. We hear this stuff all the time. And if we can’t help you return to the toilet without terror, we have many GI (gastroenterology) friends who can. We promise your hemorrhoids are not here to stay.