Managing Severe Hemorrhoids During Pregnancy: Tips and Insights

Pregnant at 28 weeks... experiencing severe hemorrhoids?

Hello, I am currently 28 weeks pregnant.
Last Friday night, I started experiencing severe swelling and pain from my hemorrhoids, and when I tried to push them back in, there was bleeding (but there is no bleeding during bowel movements or warm sitz baths).
By Saturday midnight, I couldn't bear it anymore and went to the emergency room, but the doctor only helped me push them back in.
The doctor was very skilled in doing this, and after pushing them back in, I felt no sensation, but I still felt pain.
The doctor mentioned that there were blood clots inside and that the hemorrhoids were quite large, making it difficult to push them back in.
So I would like to ask: 1.
Am I currently unsuitable for any surgical procedures? Should I just endure until delivery? 2.
Right now, I am only using topical medication and warm sitz baths.
Should I just wait for time to reduce the swelling, or are there other faster methods? 3.
Is it advisable to push the hemorrhoids back in again, or should I just leave them outside? Is there a technique for pushing them back in? I can only roughly push them in.
Thank you for your answers, doctor!

patty, 30~39 year old female. Ask Date: 2015/07/27

Dr. Ke Fangxu reply Surgery

1.
In the late stages of pregnancy, hemorrhoidectomy is generally not recommended to avoid potential risks to the fetus from anesthesia or postoperative infections.
2.
No.
3.
Whether or not to push it back in is a matter of personal judgment.
If it is not likely to fall out quickly, it is acceptable to push it back in.
However, if it is likely to fall out again soon, it is fine not to push it back in as long as there is no significant discomfort.
It is important to avoid constipation and prolonged sitting on the toilet; bowel movements should be quick to prevent excessive straining that could lead to hemorrhoidal prolapse.

Reply Date: 2015/07/27

More Info

Managing severe hemorrhoids during pregnancy can be quite challenging, especially as you are experiencing significant discomfort at 28 weeks. Hemorrhoids are a common issue during pregnancy due to increased pressure on the pelvic blood vessels, hormonal changes, and constipation. Here are some insights and tips to help you manage your condition effectively.

1. Surgical Options: Generally, surgery for hemorrhoids is not recommended during pregnancy unless absolutely necessary. The risks associated with surgery, including anesthesia and potential complications, can pose risks to both you and your baby. Therefore, it is advisable to manage your symptoms conservatively until after delivery.
2. Conservative Management: Since you are currently using topical medications and warm sitz baths, these are excellent first-line treatments. Warm sitz baths can help reduce swelling and relieve pain. You can do this several times a day, especially after bowel movements. Additionally, over-the-counter topical treatments containing hydrocortisone can help reduce inflammation and itching.
It is also crucial to maintain a high-fiber diet to prevent constipation, which can exacerbate hemorrhoids. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying hydrated by drinking plenty of water can also help soften your stool and make bowel movements easier.

3. Managing Pain and Discomfort: If you are experiencing significant pain, you might consider using ice packs on the affected area for short periods to reduce swelling and numb the pain. However, avoid applying ice directly to the skin; wrap it in a cloth or towel.

4. Positioning and Techniques: Regarding whether to push the hemorrhoids back in or leave them out, it is generally recommended to leave them alone if they are causing significant pain or discomfort. If you feel comfortable and the hemorrhoids are not too painful, you can gently push them back in after a warm sitz bath, which can help relax the area. Use a lubricating gel or ointment to make this process easier. However, if you find it painful or difficult, it may be best to leave them be until after delivery.

5. When to Seek Further Help: If your symptoms worsen, such as increased bleeding, severe pain, or if you notice any signs of infection (such as fever or pus), it is essential to seek medical attention. Your healthcare provider may have additional recommendations or treatments that can help alleviate your symptoms.

6. Postpartum Care: After delivery, hemorrhoids often improve significantly, but if they persist, you may want to discuss further treatment options with your healthcare provider. There are various procedures available that can be performed postpartum if necessary.

In summary, managing severe hemorrhoids during pregnancy involves conservative measures such as warm sitz baths, topical treatments, a high-fiber diet, and hydration. Surgery is typically avoided during pregnancy unless absolutely necessary. Always consult with your healthcare provider for personalized advice and to ensure the safety of both you and your baby. Remember, your comfort and health are paramount, and there are ways to manage your symptoms effectively until you can receive further treatment postpartum.

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