Hemorrhoids Should Not Be Lanced During Pregnancy
Lancing (incision and drainage) of hemorrhoids is not recommended during pregnancy; instead, conservative management with dietary modifications, sitz baths, bulk-forming agents, and topical hydrocortisone should be used as first-line treatment. 1, 2
Why Lancing Is Not Appropriate
The evidence provided discusses management of hemorrhoids in pregnancy but does not support surgical lancing or incision procedures. The guidelines consistently emphasize conservative, non-invasive approaches:
- Hemorrhoids affect approximately 80% of pregnant women, most commonly during the third trimester, and the vast majority can be managed conservatively without surgical intervention 1
- Hemorrhoidectomy is reserved only for strangulated or extensively thrombosed hemorrhoids with intractable bleeding—not for routine hemorrhoid management 3
- Most hemorrhoid symptoms resolve spontaneously soon after birth, making aggressive interventions during pregnancy unnecessary 4
Recommended Conservative Management Algorithm
First-Line Treatment (Start Here)
- Increase dietary fiber to 30g/day through fruits, vegetables, whole grains, and legumes (aim for 3-4 servings of fruits and 3-4 servings of vegetables daily) 1, 2
- Ensure adequate fluid intake, particularly water, to soften stools 1, 2
- Sitz baths provide symptomatic relief and are safe during pregnancy 2, 5
- Avoid straining during bowel movements by providing ample time and using relaxation techniques 2
Second-Line Treatment (If No Improvement After 1 Week)
- Add psyllium husk (Metamucil) or methylcellulose as bulk-forming agents, which are safe during pregnancy due to minimal systemic absorption 1, 2
- Polyethylene glycol (PEG) 17g daily can be safely administered for persistent constipation 1, 2
- Magnesium hydroxide 400-500mg daily is also safe and effective if needed 2
Symptomatic Relief
- Topical hydrocortisone cream or foam for managing perianal irritation, itching, and inflammation 1, 2, 6
- Topical corticosteroids help reduce inflammation, though prolonged use of potent preparations should be avoided 2
When Surgical Intervention Might Be Considered
Surgery during pregnancy is extremely rare and only indicated for:
- Strangulated hemorrhoids 3
- Extensively thrombosed hemorrhoids 3
- Hemorrhoids with intractable bleeding despite conservative management 3
- In cases of massive bleeding, anal packing (not lancing) could be a simple and useful maneuver 3
Important Clinical Pearls
- Pain is generally not associated with uncomplicated hemorrhoids unless thrombosis has occurred—persistent pain suggests other pathology requiring evaluation 1, 2
- Perform careful anorectal evaluation to differentiate hemorrhoids from anal fissures, which may present with similar symptoms 1, 2
- Bright red rectal bleeding requires proper evaluation to rule out other causes beyond hemorrhoids 1, 2
- The mode of delivery should be guided by obstetric indications rather than the presence of hemorrhoids 1
Monitoring and Follow-Up
- Reassess bowel movement frequency and consistency after initiating treatment, with the goal of achieving soft, formed stools every 1-2 days 2
- Regular assessment of hemorrhoid symptoms throughout pregnancy is necessary 1, 2
- If bleeding persists despite treatment, further evaluation is needed to rule out other causes 1, 2