Hemorrhoids in pregnancy
The hemorrhoids refer to the tissue of the anal canal that has swollen. They are located on the lower part of the rectum or anus. They can be of many kinds. In pregnant women, hemorrhoids benefit because of pregnancy-related weight in the second or third trimester.
What are hemorrhoids in pregnancy?
Hemorrhoids are small vascular pads located in the submucosa of the anal canal (internal hemorrhoids) and directly under the skin, at the margin of the anus (external hemorrhoids). These are quite normal anatomical entities that play an important role in anal continence. But sometimes congestion, inflammation or thrombosis occurs in one or more of these hemorrhoids. We then distinguish different pathologies:
- the hemorrhoidal crisis: it results in a feeling of heat or perineal heaviness, accentuated with the saddle. It usually lasts 2 to 4 days.
- hemorrhoidal thrombosis: due to the formation of a small clot in an internal or external hemorrhoid, it results in severe pain and can lead to bleeding in the saddle.
- Hemorrhoidal prolapse: The internal hemorrhoid is defecated, even permanently, causing severe discomfort and pain.
Risk factors during pregnancy
During pregnancy, various factors will favor the occurrence of hemorrhoids, especially during the third trimester:
- the modification of the venous return, itself induced by the increase of the blood volume, the hormonal impregnation which causes a loosening of the tissues including venous, and the gravid uterus which compresses the pelvic region.
- constipation (through efforts to defecate) due to a decrease in intestinal motility, itself a consequence of hormonal changes and the weight of the uterus.
- a loosening of the tissues under the effect of the hormones, knowing that the hemorrhoidal tissue is very rich in estrogenic receptors and therefore very sensitive to hormonal variations.
The intense expulsion efforts during childbirth also favor the pairing of hemorrhoids in a series of diapers.
Multiple management of pregnancy hemorrhoids
During pregnancy, the management of hemorrhoids is based on dietary rules and medical treatments.
- it is advisable to carry out a local toilet after each saddle with a neutral soap, lotion or washing foam containing burdock. In case of associated pruritus, it is recommended to use instead of toilet paper hydrophilic cotton soaked in a mild almond oil-based toilet milk.
- it is essential to fight against constipation by starting with the usual lifestyle and dietary measures, namely good hydration and fiber intake (fruits and vegetables, whole grains) sufficient. If constipation persists, laxatives can be used knowing that during pregnancy, are privileged laxatives of ballasted mucilage (sterculia, ispaghul, psyllium, guar gum or bran), osmotic laxatives (macrogol, lactulose, lactitol, sorbitol ), and if necessary punctually, a lubricant laxative.
- local treatment: a cream containing a local anesthetic with or without corticosteroids may be prescribed during pregnancy.
- to relieve pain, it is possible to take an analgesic. Paracetamol is the reference analgesic throughout pregnancy, but in cases of severe haemorrhoidal pain, more powerful analgesics containing opioid derivatives may be prescribed during pregnancy.
- in case of associated venous insufficiency, oral venotonic treatment may be prescribed. Diosmin, hesperidin, troxerutin, and rutoside are the preferred molecules in pregnant women.
Instrumental treatments (sclerosing injections, infrared photocoagulation, elastic ligations, cryotherapy, mono, and bipolar coagulation) and surgery should be avoided during pregnancy.
Prevention of constipation
- Gradually increase daily fiber intake to 25 to 30 g / day
- Drink between 6 to 8 glasses of water a day (ie 1.5 to 2 liters) if no fluid restriction applies
- Exercise on a regular basis (walking, swimming, etc.)
- Do not delay the urge to go to the saddle
- Avoid forcing while going to the saddle
- Do not sit long (more than 5 minutes) on the toilet
- Thoroughly clean the anal area after each stool by gently blotting with a damp toilet paper or witch hazel compress (Tucks ® )
- Take sitz baths in warm water for 15 to 20 minutes, 3-4 times daily
Pharmacological measures :
Take 1 to 2 tablets every 4 to 6 hours as needed if pain (maximum 4000 mg per day)
- NB Do anti-inflammatories such as acetylsalicylic acid (Aspirin ® ) and ibuprofen (Advid MD, Motrin ® )
Relief of itching, irritation and burning sensation
Use instead of toilet paper to clean the anal area up to 6 times a day after each bowel movement.
To treat external hemorrhoids :
A local application on the affected external region.
To treat internal hemorrhoids :
- Remove the cap and lubricate the applicator first with a small amount of ointment.
- Then attach the applicator to the tube, insert it into the rectum and gently squeeze out the ointment.
- Wash the applicator with hot water and soap after each use.
- Repeat the application every 4 hours as needed and after each bowel movement (maximum 5 times a day) for 7 to 10 days.
Most hemorrhoids heal on their own in less than a week or two. They will tend to reappear if you do not do what it takes to prevent them.
PRODUCTS TO AVOID
- Shark liver oil (Preparation H MD )
When to consult?
- If symptoms persist for more than 7 to 10 days, despite the application of non-pharmacological measures and the use of Anusol MD ;
- If swelling persists after 2 to 4 weeks;
- If you have rectal bleeding
- At all times, do not hesitate to contact your pharmacist for more information!
We recommend reading the article: How to cure hemroids during pregnancy and after childbirth