From the Guidelines
For hemorrhoids after pregnancy that are not controlled by oxycodone and a bowel regimen, I recommend non-operative management as first-line therapy, with dietary and lifestyle changes, and consider administering flavonoids to relieve symptoms. This approach is based on the most recent and highest quality study available, which provides a strong recommendation for non-operative management and a weak recommendation for flavonoids 1. The study suggests that dietary and lifestyle changes, such as increased fiber and water intake, along with adequate bathroom habits, can help alleviate symptoms. Additionally, flavonoids may be used to relieve symptoms, although the evidence is moderate quality.
Some key considerations for non-operative management include:
- Increasing dietary fiber to 25-30g daily
- Drinking at least 8 glasses of water daily
- Using stool softeners like docusate sodium (100mg twice daily)
- Applying topical treatments like over-the-counter hydrocortisone cream (1%) or prescription lidocaine ointment (2-5%) to the affected area
- Using witch hazel pads or medicated wipes containing witch hazel for additional relief
- Taking sitz baths for 15-20 minutes, 2-3 times daily using warm water
It's essential to note that if these measures fail after 1-2 weeks, or if there is severe pain, bleeding, or prolapse, consultation with a healthcare provider is necessary to consider procedural interventions like rubber band ligation or surgical removal 1. However, the decision to proceed with surgical treatment should be based on local expertise and patient preference, as the evidence for surgical treatment is low-quality 1.
From the Research
Treatment Options for Hemorrhoids After Pregnancy
- For hemorrhoids that are uncontrolled by oxy and bowel regimen after pregnancy, several treatment options are available, including:
- Medical management (e.g., stool softeners, topical over-the-counter preparations) 2
- Dietary modifications (e.g., increased fiber and water intake) 2
- Behavioral therapies (sitz baths) 2
- Office-based treatment of grades I to III internal hemorrhoids with rubber band ligation 2, 3
- Open or closed (conventional) excisional hemorrhoidectomy for recurrent or higher-grade disease 2, 3
- Minimally invasive procedures such as stapled hemorrhoidopexy and transanal hemorrhoidal dearterialization (THD) for advanced hemorrhoids 4
Considerations for Pregnant Women
- Fiber supplement, stool softener, and mild laxatives are generally safe for pregnant women 5
- Topical medication or oral phlebotonics may be used with special caution due to lack of strong evidence on their safety and efficacy in pregnancy 5
- Hemorrhoidectomy is reserved for strangulated or extensively thrombosed hemorrhoids, and hemorrhoids with intractable bleeding 5