From the Guidelines
For hemorrhoids during pregnancy, the most effective treatment approach is to start with conservative measures, including increasing fiber intake to 30 grams daily, as recommended by the latest guidelines 1. This approach is based on the latest evidence from a 2024 study published in Gastroenterology, which emphasizes the importance of dietary fiber in preventing constipation and alleviating hemorrhoid symptoms during pregnancy 1.
Key Recommendations
- Increase dietary fiber intake to 30 grams daily, focusing on fruits, vegetables, whole grains, and legumes to promote regular bowel movements and prevent constipation 1.
- Encourage adequate fluid consumption, particularly water, to soften stools and ease bowel movements.
- Consider using bulk-forming agents like psyllium husk or methylcellulose, which are safe for use during pregnancy due to their lack of systemic absorption 1.
- Avoid straining during bowel movements by providing ample time, using relaxation techniques, and adjusting diet and hydration.
Additional Considerations
- Topical treatments, such as hydrocortisone foam, have been shown to be safe and effective in reducing inflammation and symptoms associated with hemorrhoids during pregnancy 1.
- Osmotic laxatives like polyethylene glycol or lactulose can be used safely during pregnancy, but excessive use may cause maternal bloating 1.
- Stimulant laxatives should be avoided due to conflicting safety data 1.
From the Research
Treatment Options for Haemorrhoids in Pregnancy
- Fiber supplement, stool softener, and mild laxatives are generally safe for pregnant women 2
- Topical medication or oral phlebotonics may be used with special caution due to lack of strong evidence on their safety and efficacy in pregnancy 2
- Increasing fibre content in the diet, administering stool softeners, increasing liquid intake, and training in toilet habits can help treat most forms of haemorrhoids 3
- Anal packing could be a simple and useful maneuver in case of massive bleeding 2
- Hemorrhoidectomy is reserved for strangulated or extensively thrombosed hemorrhoids, and hemorrhoids with intractable bleeding 2
Non-Operative Measures
- Rubber band ligation and injection sclerotherapy can be effective for low-graded internal hemorrhoids 4
- Medical management, such as stool softeners and topical over-the-counter preparations, can be used as initial therapy 5
- Dietary modifications, such as increased fiber and water intake, and behavioral therapies, such as sitz baths, can also be used 5
Surgical Options
- Excisional hemorrhoidectomy remains the mainstay operation for advanced hemorrhoids and complicated hemorrhoids 4
- Minimally invasive operations, such as Ligasure hemorrhoidectomy, doppler-guided hemorrhoidal artery ligation, and stapled hemorrhoidopexy, have been introduced to avoid post-hemorrhoidectomy pain 4
- Closed hemorrhoidectomy with diathermic or ultrasonic cutting devices may decrease bleeding and pain 5
- Stapled hemorrhoidopexy can elevate grade III or IV hemorrhoids to their normal anatomic position, but has potential postoperative complications 5