Can Pregnant Women with External Hemorrhoids Consider Surgery?

Can pregnant women undergo surgery for external hemorrhoids?

Hello, Dr.
Ke...
I am currently pregnant with my second child, now over two months along.
During the later stages of my first pregnancy, I had external hemorrhoids, which improved somewhat after giving birth.
Although the external hemorrhoids are still present, I was able to push them back in after using the restroom, and they did not affect my daily life.
However, this time, the external hemorrhoids are much worse, with frequent bleeding and pain that is unbearable.
They have become so large that I can barely push them back in.
I have been soaking in warm water and applying ointment daily, but the recovery is very slow.
This situation has persisted for over a week.
What should I do now? Is surgery an option? Should I attempt to push the external hemorrhoids back in?

VIVIAN, 20~29 year old female. Ask Date: 2010/10/18

Dr. Ke Fangxu reply Surgery

In the early stages of pregnancy, surgical treatment for hemorrhoids is generally not recommended.
This is due to the potential pressure on the abdomen from the surgical position and the risk of transient bacteremia during the procedure, which cannot guarantee that the fetus will not be affected.
Therefore, conservative treatment is preferred.
However, if the hemorrhoids have become necrotic, early surgical intervention may be necessary.
If the condition is not severe, it is advisable to use oral medications along with topical ointments and sitz baths, while also avoiding constipation and spicy foods.
Regarding swollen external hemorrhoids, I do not recommend attempting to push them back in, as this process can be quite painful and there is no guarantee they won’t protrude again.
Instead, it is suggested to take warm sitz baths after using the restroom, which helps maintain cleanliness and alleviate pain.
Generally, with regular warm sitz baths, symptoms can significantly improve within two weeks.
Wishing you safety and well-being.
Dr.
Ke Fang-Hsu, Keelung Hospital, Department of Health.

Reply Date: 2010/10/18

More Info

When it comes to managing external hemorrhoids during pregnancy, especially in your case where the condition has worsened significantly, it’s essential to approach the situation with caution. First and foremost, it’s important to understand that while hemorrhoids are common during pregnancy due to increased pressure on the pelvic region and hormonal changes, severe cases can lead to discomfort and complications.

In your situation, where you are experiencing significant pain, bleeding, and difficulty managing the hemorrhoids, it’s crucial to consult with your healthcare provider. They can assess the severity of your condition and determine the best course of action. Here are some considerations regarding surgery and management of external hemorrhoids during pregnancy:
1. Surgical Considerations: Generally, surgery for hemorrhoids is not recommended during pregnancy unless absolutely necessary. The risks associated with surgery, including anesthesia and the potential for complications, can outweigh the benefits. Most healthcare providers prefer to manage hemorrhoids conservatively during pregnancy. However, if your condition is severely impacting your quality of life and conservative measures are ineffective, your doctor may consider surgical options, particularly if the hemorrhoids are thrombosed (clotted) or causing significant complications.

2. Conservative Management: Since you are currently experiencing severe symptoms, it’s important to continue with conservative management strategies. These may include:
- Warm Sitz Baths: Soaking in warm water several times a day can help relieve pain and reduce swelling.

- Topical Treatments: Over-the-counter creams or ointments specifically designed for hemorrhoids can provide relief. Always check with your healthcare provider before using any medication.

- Dietary Changes: Increasing fiber intake through fruits, vegetables, and whole grains can help prevent constipation, which can exacerbate hemorrhoids. Staying well-hydrated is also crucial.

- Avoid Straining: When using the bathroom, try to avoid straining, as this can worsen hemorrhoids. If necessary, consider using a stool softener after consulting your doctor.

3. When to Seek Immediate Care: If you experience severe pain, excessive bleeding, or if the hemorrhoid becomes very hard and painful, it’s important to seek medical attention promptly. These could be signs of a more serious condition that may require intervention.

4. Postpartum Considerations: After delivery, if your hemorrhoids do not improve or worsen, you may have more options for treatment, including surgical procedures that are typically safer to perform when not pregnant.

5. Avoiding Self-Reduction: It’s generally not advisable to attempt to push the hemorrhoid back in if it is too large or painful. This can lead to further irritation or complications. Instead, focus on managing the symptoms and consult your healthcare provider for guidance.

In summary, while surgery for external hemorrhoids during pregnancy is typically avoided, effective conservative management strategies can often provide relief. It’s essential to maintain open communication with your healthcare provider to monitor your condition and explore the best options for your specific situation. Your comfort and health, as well as that of your baby, should always be the priority.

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