Managing Hemorrhoids During Pregnancy: Tips and Treatment Options

Q: Managing Hemorrhoids During Pregnancy: Tips and Treatment Options

1. <br>Internal Hemorrhoids： Internal hemorrhoids are commonly defined as hemorrhoids located inside the rectum. <br>They are classified into four stages, with symptoms as follows： Stage I： Symptoms include rectal bleeding, hard stools, difficulty in bowel movements, constipation

Hemorrhoids distress?

Hello, Doctor.
I am currently five weeks pregnant and have a problem with swollen external hemorrhoids.
Although it is not painful, I feel a foreign body sensation and swelling, and I am concerned it may worsen later on.
I would like to ask: 1.
Does warm water sitz bath have any effects? 2.
Is it safe to apply medication? I am currently using "New Hemorrhoid Pain Relief" and only applying a small amount.
3.
When can I undergo rubber band ligation for internal hemorrhoids? Thank you.

Grace, 30~39 year old female. Ask Date: 2017/08/01

Dr. Huang Jianzhong reply Obstetrics and Gynecology

1.
Internal Hemorrhoids: Internal hemorrhoids are commonly defined as hemorrhoids located inside the rectum.
They are classified into four stages, with symptoms as follows: Stage I: Symptoms include rectal bleeding, hard stools, difficulty in bowel movements, constipation, a feeling of fullness and pain in the anus, and post-defecation pain and swelling, with a persistent urge to defecate but unable to do so.
Stage II: After defecation, a protruding mass may appear, causing swelling and pain, along with a sensation of a foreign body in the anus; the mass can retract back into the anus on its own.
Stage III: After defecation, a protruding mass appears, causing swelling and pain, with the mass showing signs of bruising and a purplish color; the mass needs to be manually pushed back into the anus and is prone to slipping out.
Stage IV: The mass protrudes and cannot be pushed back into the anus, remaining outside for an extended period; sometimes only one hemorrhoid is protruding, while at other times, three or four may protrude simultaneously.
The mass may also protrude with rectal mucosa, leading to skin ulcers or itching.
The mass can become hard, extremely painful, and swell rapidly, with a dark purple appearance.
Symptomatic treatment methods include: (1) Applying a hemorrhoid cream specifically for pregnant women three times a day, after a warm water compress or sitz bath for 5-10 minutes.
(2) For pregnant women with severe rectal bleeding, it is recommended to switch from warm compresses to cool water compresses to help constrict blood vessels and reduce bleeding; once the bleeding improves after a few days of cool compresses, switch back to warm compresses.
(3) For pregnant women with protruding hemorrhoids, it is advised to apply the hemorrhoid cream, push the mass back into the anus, and use materials like cotton pads and medical tape to slightly secure it to prevent re-protrusion, allowing the mass to absorb the medication adequately and helping the muscles to adapt inside the anus.
It is recommended to rest in a side-lying position, avoiding prolonged sitting and lying flat.
(4) Engage in appropriate outdoor activities, performing Kegel exercises twice daily, with 30-40 repetitions each time.
Note: Kegel exercises involve rhythmically contracting and relaxing the anal sphincter.
2.
External Hemorrhoids: External hemorrhoids correspond to hemorrhoids located outside the anus.
They can be classified into inflammatory external hemorrhoids, connective tissue external hemorrhoids, varicose external hemorrhoids, and thrombosed external hemorrhoids.
Symptoms include: @Inflammatory external hemorrhoids: The perianal skin may be ulcerated or infected, with blisters at the anal margin, causing pain.
@Connective tissue external hemorrhoids: Due to chronic inflammation, there may be recurrent inflammation and swelling, leading to hyperplasia of the perianal skin or protruding areas, resulting in skin tags of varying sizes.
@Varicose external hemorrhoids: Increased abdominal pressure can lead to protruding masses or localized enlargement at the anal margin or surrounding area, with symptoms alleviating once the abdominal pressure subsides.
@Thrombosed external hemorrhoids: A sudden protrusion of a hard, purplish mass at the anal margin or perianal area, accompanied by severe pain.
Symptomatic treatment methods: For external hemorrhoids, regular application of hemorrhoid cream for pregnant women and gentle massage of the affected area with disposable gloves can generally alleviate symptoms.
However, special attention should be given to inflammatory and thrombosed external hemorrhoids.
Pregnant women with inflammatory external hemorrhoids must use a hemorrhoid cleansing solution to disinfect and clean the area before applying the hemorrhoid cream; otherwise, the inflammatory condition will not improve.
For pregnant women with thrombosed hemorrhoids experiencing severe pain, it is advisable to freeze a bottle of water and wrap it in a disinfected towel, applying it to the affected area for about 1-2 days to relieve pain.
Once the pain subsides, the hemorrhoid cream can be reapplied for treatment.
3.
Mixed Hemorrhoids: Mixed hemorrhoids refer to the presence of both internal and external hemorrhoids.
Most pregnant women with severe hemorrhoids have mixed hemorrhoids.
Treatment methods for mixed hemorrhoids can refer to those for both internal and external hemorrhoids.

Reply Date: 2017/08/01

More Info

Managing hemorrhoids during pregnancy can be a challenging experience, but with the right approach, you can alleviate discomfort and prevent further complications. Hemorrhoids, which are swollen veins in the lower rectum and anus, can occur due to increased pressure from the growing uterus, hormonal changes, and constipation, which is common during pregnancy. Here are some tips and treatment options for managing hemorrhoids during pregnancy:
1. Warm Water Sitz Baths: Taking warm water sitz baths can be very beneficial for hemorrhoid relief. This practice involves sitting in a few inches of warm water for about 15-20 minutes several times a day, especially after bowel movements. The warmth helps to soothe the area, reduce swelling, and promote blood circulation. It is safe to do during pregnancy and can provide significant relief from discomfort.

2. Topical Treatments: Using topical treatments like "新痔莫痛" (which is likely a topical hemorrhoid cream) can be helpful, but it’s essential to consult your healthcare provider before using any medication during pregnancy. While many topical treatments are considered safe, some may contain ingredients that are not recommended for pregnant women. Always apply such creams sparingly and follow the instructions provided by your healthcare provider.

3. Dietary Changes: A high-fiber diet can help prevent constipation, which is a significant contributor to hemorrhoids. Include plenty of fruits, vegetables, whole grains, and fluids in your diet. Staying hydrated is crucial, as it helps soften stool and makes bowel movements easier.

4. Exercise: Regular physical activity can help stimulate bowel function and reduce the risk of constipation. Simple activities like walking can be beneficial. However, avoid heavy lifting or straining, which can exacerbate hemorrhoids.

5. Avoid Straining: When using the bathroom, try not to strain or sit for prolonged periods. If you feel the urge to go, respond promptly to avoid constipation.

6. When to Consider Rubber Band Ligation: Rubber band ligation is a procedure typically used for treating internal hemorrhoids. However, it is generally not recommended during pregnancy due to the potential risks involved. Most healthcare providers will advise waiting until after delivery to consider this treatment. If your hemorrhoids become severe or cause significant discomfort, discuss alternative treatment options with your healthcare provider.

7. Consult Your Healthcare Provider: If your symptoms persist or worsen, it’s crucial to consult your healthcare provider. They can assess your condition and recommend appropriate treatments that are safe during pregnancy. They may also provide guidance on when to seek further intervention if necessary.

In summary, managing hemorrhoids during pregnancy involves a combination of lifestyle changes, safe topical treatments, and regular communication with your healthcare provider. By taking proactive steps, you can minimize discomfort and reduce the risk of complications as your pregnancy progresses. Always prioritize your health and well-being, and don’t hesitate to reach out for professional advice when needed.

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