From the Guidelines
To manage pregnancy hemorrhoids, start with conservative measures like dietary and lifestyle changes, including increased fiber and water intake, as recommended by the most recent guidelines 1. The goal is to prevent constipation, which is a major contributor to hemorrhoids during pregnancy, by consuming a high-fiber diet (approximately 30 g/d) and drinking plenty of water (8-10 glasses daily) 1.
- Prevent constipation by:
- Drinking plenty of water
- Consuming fiber-rich foods (fruits, vegetables, whole grains, and legumes)
- Taking a fiber supplement like psyllium husk or methylcellulose if needed
- Apply over-the-counter creams containing witch hazel or use witch hazel pads after bowel movements to soothe the area.
- Cold compresses can also help reduce swelling. For pain relief, acetaminophen (Tylenol) is safe during pregnancy at regular doses (up to 3000mg daily) 1. Avoid straining during bowel movements and don't sit for prolonged periods. If these measures don't provide relief, consult your healthcare provider, who might recommend prescription-strength hydrocortisone cream for inflammation or, in severe cases, refer you to a specialist, as suggested by recent guidelines 1. Hemorrhoids during pregnancy often result from increased blood volume and pressure from the growing uterus on rectal veins, combined with constipation, and most pregnancy hemorrhoids improve after delivery as these physiological changes resolve 1.
From the Research
Management of Pregnancy Haemorrhoids
There are no specific studies provided that directly address the management of pregnancy haemorrhoids. However, general information on hemorrhoid management can be applied, considering the unique needs and limitations of pregnant women.
General Management Principles
- Medical management, such as stool softeners and topical over-the-counter preparations, is often the first line of treatment 2.
- Dietary modifications, including increased fiber and water intake, can help alleviate symptoms 2.
- Behavioral therapies, such as sitz baths, may also be beneficial 2.
Treatment Options
- For internal hemorrhoids, rubber band ligation is a preferred office-based treatment due to its lower failure rate compared to infrared photocoagulation 2.
- Open or closed excisional hemorrhoidectomy may be considered for recurrent or higher-grade disease, but it is associated with more pain and a prolonged recovery 2.
- Other surgical treatments, such as stapled hemorrhoidopexy and hemorrhoidal artery ligation, may be useful for specific cases, but their effectiveness and potential complications should be carefully considered 3, 4.
Considerations for Pregnant Women
- Treatment options should be tailored to the individual, taking into account patient choice, convenience, and degree of hemorrhoids 4.
- The potential risks and benefits of each treatment option should be carefully weighed, considering the unique needs and limitations of pregnant women.