Pain while passing stool after delivery is usually either piles (haemorrhoids) or an anal fissure — both common after childbirth, and both very treatable. The pushing of labour, pregnancy-related constipation, and the first bowel movements after delivery all put pressure on the same area. A stool softener helps many women, but if pain and bleeding keep coming back after you stop it, that's a sign the underlying tear or swelling hasn't actually healed yet.
Why this happens after delivery
- Pushing during labour puts sustained pressure on the pelvic floor and anal area, which can cause or worsen piles and small tears
- Constipation in late pregnancy and after delivery — slower bowel movement from progesterone, less mobility, and iron supplements — means harder stool that strains the area more
- A first bowel movement that's delayed or forced after delivery often causes the initial tear or flare, especially if there's also perineal stitching to be careful of
- Piles and fissures can occur together, and the pain from one makes people avoid passing stool, which only makes the next one harder
Piles vs a fissure — how to tell them apart
| Piles (haemorrhoids) | Anal fissure | |
|---|---|---|
| What it is | Swollen veins around the anus or just inside it | A small tear in the skin lining the anal canal |
| Pain pattern | Discomfort, itching, a feeling of fullness; may be painless | Sharp, cutting pain during and for a while after passing stool |
| Bleeding | Bright red blood, often coating the stool | Bright red blood, often a streak on the stool or tissue |
| What makes it worse | Straining, prolonged sitting, standing | Hard stool stretching the tear open again each time |
You can have both at once, which is why pain that doesn't fit cleanly into one pattern is still worth having a doctor actually look at rather than guessing.
What actually helps
- A stool softener or mild laxative (such as lactulose) is the first step for almost everyone — softer stool means less re-injury with each bowel movement, which lets things heal
- Fibre and water — enough of both to keep stool soft without needing medication long-term
- A topical soothing cream or sitz bath (sitting in warm water for a few minutes after a bowel movement) can ease pain from both piles and a fissure
- Not straining, and not delaying the urge — both make the underlying tear or swelling worse
- These measures are compatible with breastfeeding; ask your doctor to confirm any specific product you're using
When a laxative alone isn't enough
Using a stool softener like lactulose for a few weeks and feeling better is normal. What's worth flagging to your doctor is when the same pain and bleeding come back once you stop it, or when symptoms haven't meaningfully improved after a few weeks of consistent use. That pattern usually means the fissure hasn't fully healed, or the piles need something beyond softer stool alone — a topical prescription cream, or occasionally a minor procedure. Going back to your obstetrician or a colorectal specialist at that point, rather than restarting the same laxative indefinitely, is the right next step.
A stool softener treats the trigger, not necessarily the tear itself. If pain and bleeding keep recurring every time you stop it, the fissure needs its own treatment, not just softer stool.
Frequently asked
How long do piles or a fissure from delivery normally take to heal?
Most resolve within a few weeks with softer stool and basic care. A fissure that keeps reopening because stool keeps being too hard, or because of continued straining, can drag on much longer — which is usually a sign to get it looked at rather than a reason to wait longer.
Can I keep using lactulose indefinitely if it's the only thing that helps?
A short stool softener course to get through the healing window is reasonable and breastfeeding-compatible, but it's meant to be temporary. If you find you can't come off it without pain and bleeding returning, that's the cue to see your doctor for the fissure itself, not a reason to keep extending the laxative.
Is it normal to see blood every time I pass stool, weeks after delivery?
Occasional bright red blood from a fissure or piles is common in the early weeks, but blood that continues weeks later, especially with ongoing pain, needs an in-person look to confirm there isn't something else going on and to get appropriate treatment.
Can piles or a fissure affect future deliveries?
Having had piles or a fissure after one delivery doesn't mean it will definitely happen again, but the same risk factors — pushing, constipation — apply each time. Keeping stool soft in the last weeks of a future pregnancy and right after delivery is a reasonable preventive step.