### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
hi this is a embarrising question about rectal bleeding. I am 21 weeks pregnant and have been bleeding from my anus most times i go to the toilet for a poo. the poos are hard and hurts abit (stings) today i noticed i had a clot in the blood. it only happenes sometimes when i go to the loo not always.

### output:

Hallow Dear, During pregnancy, due to the effect of raised progesterone hormone, the blood vessels along with other involuntary muscles get relaxed. The same changes take place in the rectal blood vessels also resulting into hemorrhoids (piles). Whenever these hemorrhoids are disturbed, some vessels break resulting in rectal bleeding through anus. It seems from your history that you have engorged inflamed hemorrhoids in the rectum. Moreover, you have hard stools. The stools could be hard because of slow movement off the residual food in the intestines due to relaxing effect of the progesterone on the intestinal muscles or could be due to amoebic infection. To overcome the problem of bleeding through anus, you have to take care of:1. Hard stools: Initially have some osmotic purge to soften the stools. Though liquid paraffin is a good stools softener, particularly in such condition, I would not advise that as a medicine of choice as it dissolves the fat soluble vitamins like It. A, D, E causing their deficiency. Sub GUL, saline purge, Dulcolax would be better to start with. Also include in your diet good amount of fresh fruits, particularly orange, banana, Figs, etc. Green leafy vegetables always help to soften the stools. 2. If the hard stools are due to amoebas, you may have to take anti-amoebic treatment with the help of your Obstetrician. Some anti-amoebic medicines are harmful to the growing bay in the uterus. 3. To handle the inflammation of hemorrhoids, you may apply local ointment like Practosedyl. Even though it comes with an applicator, I would not advise you to use the applicator as it may hurt the hemorrhoids causing bleeding. Finger application is preferred as in addition it facilitates the thorough application of the ointment to the piles. Before application, please clip your nails short and flush. 4. Usually, pregnancy piles can be managed with such treatment; however in occasional cases, if they start bleeding too much rendering the mother anemic, and cannot be controlled, surgery may be required to ligate the bleeding hemorrhoids, particularly if they are prolapsed outside the anus. Please report to your Obstetrician for timely appropriate treatment. I hope this serves your purpose.