Is rectal bleeding normal during pregnancy?

Rectal bleeding is common during pregnancy, most often caused by hemorrhoids or constipation-related fissures. While it is common, it should still be mentioned to your midwife or GP so they can confirm the source and ensure it is not something that needs further attention.

How can I tell the difference between rectal and vaginal bleeding?

Rectal bleeding comes from the anus and is usually associated with bowel movements. Vaginal bleeding comes from the vagina and is unrelated to bowel movements. If you are unsure of the source, or if you are experiencing vaginal bleeding, contact your midwife or GP promptly. Vaginal bleeding during pregnancy always needs assessment.

What causes hemorrhoids during pregnancy?

Several pregnancy-related factors contribute: increased blood volume causes veins to swell, the growing uterus puts pressure on pelvic veins, progesterone relaxes vein walls, constipation from hormonal changes and iron supplements leads to straining, and reduced physical activity in later pregnancy.

How is rectal bleeding treated during pregnancy?

Treatment focuses on safe measures: stool softening through fibre and hydration, pregnancy-safe stool softeners if needed, sitz baths for comfort, good toilet posture, and avoiding straining. Most prescription topical treatments for hemorrhoids and fissures are used with caution during pregnancy — discuss any treatments with your midwife or GP.

Will rectal bleeding get better after delivery?

For many people, pregnancy-related hemorrhoids and fissures improve after delivery as hormonal changes reverse and pelvic pressure reduces. However, delivery itself — particularly vaginal delivery — can temporarily worsen symptoms. Maintaining good stool management through the postpartum period supports recovery.

Rectal bleeding during pregnancy

At a glance

Rectal bleeding during pregnancy is common, usually caused by hemorrhoids or anal fissures that develop or worsen due to the physiological changes of pregnancy. While it is common, it should always be mentioned to your midwife or GP to confirm the source and rule out other causes.

This guide covers why rectal bleeding happens during pregnancy, the most common causes, safe management approaches, and when to seek urgent attention.

Why pregnancy causes rectal bleeding

Hemorrhoids

The most common cause. Pregnancy promotes hemorrhoid development through:

Increased blood volume — more blood flowing through the body, including the pelvic veins
Pelvic pressure — the growing uterus puts weight on the pelvic veins, impeding blood return and causing engorgement
Progesterone — this hormone relaxes smooth muscle in vein walls, making them more prone to swelling
Constipation — hormonal changes slow bowel motility; iron supplements compound this
Straining — from constipation, leading to increased pressure on hemorrhoidal veins

Hemorrhoid bleeding in pregnancy is typically bright red, associated with bowel movements, and often painless (from internal hemorrhoids) or accompanied by a painful lump (thrombosed external hemorrhoids).

Anal fissure

The second most common cause:

Hard stools from pregnancy-related constipation cause tears in the anal lining
The characteristic pattern: sharp pain during bowel movements with bright red blood
Tends to respond to stool management, though many fissure treatments are restricted in pregnancy

Constipation

Hard, dry stools can cause minor bleeding from abrasion of the rectal lining, even without a defined fissure or hemorrhoid.

Safe management during pregnancy

Stool management (the foundation)

Fibre: increase gradually to 25 to 30 grams daily from fruits, vegetables, whole grains, and safe supplements
Water: at least two to three litres per day — increased demand during pregnancy
Pregnancy-safe stool softeners: osmotic laxatives are generally considered safe; discuss specific products with your midwife or GP
Iron supplements: if causing constipation, discuss alternative formulations with your midwife

Sitz baths

Warm water for 10 to 15 minutes, particularly after bowel movements
Completely safe during pregnancy
Provides comfort and reduces swelling

Toilet habits

A footstool to raise the knees
Never straining — if the bowel movement does not come easily, try again later
Responding to the urge promptly
Limiting toilet time

Topical care

Plain barrier creams (zinc-based) for protection
Discuss any medicated creams with your midwife or GP before use
Many over-the-counter hemorrhoid products have not been studied in pregnancy

When to seek attention

Routine mention at next appointment

Small amounts of bright red blood associated with bowel movements
Hemorrhoid or fissure symptoms that are manageable

Prompt assessment

Rectal bleeding that is heavy or increasing
Dark red or black blood
Blood mixed through the stool
Bleeding with abdominal pain or cramping
Bleeding with dizziness or faintness
Any vaginal bleeding — this is distinct from rectal bleeding and always needs urgent assessment in pregnancy
Any bleeding that concerns you

Important distinction

During pregnancy, distinguishing between rectal and vaginal bleeding is important. If you are unsure of the source, contact your midwife or GP promptly. Vaginal bleeding during pregnancy can indicate conditions that need immediate assessment, and it should never be assumed to be rectal without confirmation.

After delivery

Rectal bleeding patterns typically change after delivery:

Pregnancy-related hemorrhoids often improve as pelvic pressure reduces and hormone levels normalise
Delivery itself — particularly vaginal delivery, especially with forceps or prolonged pushing — can worsen hemorrhoids or cause new fissures
The postpartum period is a time to continue stool management
Breastfeeding increases hydration needs — maintain water intake
If symptoms persist or worsen after delivery, treatments that were restricted during pregnancy may become available — discuss timing with your GP