Hemorrhoids with pregnancy
The hemorrhoidal disease affects 7.9 to 38% of pregnant women. After childbirth, 20% of women will suffer from hemorrhoidal disease. The interest that surrounds your baby and your gynecological follow-up, place this anal region in the third plane and yet it is sometimes a more painful memory than the delivery itself.
We call hemorrhoids the small vascular pads located in the anal canal. There are usually three hemorrhoidal arteries and therefore most often three hemorrhoidal bundles.
The origin of the hemorrhoidal disease is not formally known but several hypotheses are formulated.
When the internal hemorrhoids swell to the point of engaging in the anal canal where they are strangled by the anal sphincter, they become inflammatory, turgid and therefore likely to bleed and hurt. Since the blood circulation in this hemorrhoidal pad is hurting, a blood clot is sometimes called a hemorrhoidal thrombosis. This thrombosis is then either internal or external. It is most often external, at the level of external hemorrhoids.
Vascular overpressure during pregnancy, hormonal changes, and frequent constipation promote the formation of hemorrhoidal turgor. The major pushing efforts at the time of delivery favor the externalization of these hemorrhoids. When these hemorrhoidal pillows are strangled in the anal canal by the anal sphincter following their externalization, this promotes the occurrence of thromboses and inflammation.
If there are also repeated iterative pushes to the toilet due to untreated constipation, or frequent stools and acids in case of diarrhea then everything is together for the crisis to happen.
Hormonal impregnation during pregnancy certainly also plays a role, such as the hormonal changes that occur after delivery. The hemorrhoidal tissue is indeed rich in hormone receptors and there is a loosening of the supporting tissues under the effect of hormones.
Risk Factors for Hemorrhoidal Disease in Pregnancy
The proven risk factors for postpartum hemorrhoidal thrombosis are dyschesia (difficulty in evacuating stool, also known as terminal constipation) and late delivery, after 39.7 weeks of amenorrhea. A large baby and a first too long work phase are also risk factors for external hemorrhoidal thrombosis.
Thus, the cesarean section seems to protect thromboses: 4% external hemorrhoidal thromboses after cesarean section against 20% after a vaginal delivery. However, the existence of hemorrhoidal thrombosis is not an indication for cesarean section.
External hemorrhoidal thrombosis is the most common hemorrhoidal pathology after childbirth, but several types of hemorrhoidal disease can occur.
- External hemorrhoidal thrombosis (the most common): this is a blood clot that forms in the small hemorrhoidal pads located at the anal margin. It creates a very painful inflammatory reaction, and an anal swelling felt by the patient. This thrombosis is sometimes accompanied by edema. This small nodule resolves in several days, the pain disappearing in 2 to 4 days and the thrombosis may take several days or weeks to disappear. It sometimes leaves an ungainly but uncomfortable cutaneous outgrowth called a marisk.
- Internal hemorrhoidal thrombosis (much rarer): sometimes this clot affects entire hemorrhoid, its outer part as the inner part. The entire hemorrhoidal bundle is thrombosed and externalized. This type of thrombosis is particularly painful. Its evolution is identical to external thrombosis but its resorption is generally longer.
- Circumferential thrombosed prolapse: in rarer cases, the 3 packets are externalized, inflammatory and thrombosed. They constitute circular thrombosed hemorrhoidal prolapse. This disease requires heavier treatment and sometimes emergency surgery.
What to do in case of anal pain during pregnancy and after delivery?
In case of anal pain during pregnancy and after delivery, it is necessary to talk to a health professional (doctor, gynecologist, midwife or specialist).
The proctological examination will make the diagnosis. The examination of the anal margin allows to identify a possible external hemorrhoidal thrombosis in the form of bluish anal swelling with or without edema and to eliminate a cause other than hemorrhoids to these pains.
The anal fissure, a sore of the anal canal, is frequent after childbirth. It affects 15% to 30% of women after childbirth. It is a source of pain during and after the stool and can be surmounted by a marisk that can mimic external hemorrhoidal thrombosis. It sometimes causes bleeding.
We must also be wary of anal diseases that are not related to childbirth and may be revealed during this period. Like the abscess of the anal margin, painful swelling sometimes accompanied by purulent discharge. Do not hesitate to consult your doctor.
Treatment of transit disorders
It is essential, even if its effectiveness is proven only in case of diarrhea. Indeed, constipation remains poorly experienced in case of anal pain and its treatment also has an analgesic effect.
Dietary measures that consume fiber (fruits, vegetables, cereals) should be considered first. But if despite good food hygiene, constipation persists, a laxative treatment can help. In the same way, the colic dressings make it possible to have saddles more molded and less acid in case of diarrhea. This treatment is to be considered only after consultation with your doctor or gynecologist.
A wide range of suppositories and ointments is at our disposal. These topicals combine different molecules, often anti-inflammatories or even corticosteroids, local anesthetic, vitamin P and flavonoids.
Suppositories also have a role of lubricant of the anal canal, thus facilitating the evacuation of stool. While they are effective in relieving patients, they do not prevent seizures. Usually, suppositories are preferred for internal hemorrhoids and ointments for external hemorrhoids or internal prolapsed hemorrhoids, externalised. No study has compared these various treatments and self-medication in this area is important.
These local treatments can be used even when breastfeeding.
See more: How hemorrhoids are treated
One must know how to think of analgesics in general. They are used in many painful situations like headaches but very often forgotten in proctological pains.
Paracetamol should be used first during pregnancy and postpartum, but if it is not enough, medical advice is needed. Anti-inflammatory drugs are not recommended during pregnancy and prohibited after 24 weeks of amenorrhea and allowed with caution when breastfeeding. More potent analgesics containing morphine derivatives can also be used on medical advice.
Veinotonics would accelerate the resorption of thrombosis and can be used during pregnancy and breastfeeding.
Finally, in the case of thrombosed circular hemorrhoidal prolapse, local and oral treatments may not be sufficient. Corticosteroids and intravenous analgesics are then used.
They are unusually used during pregnancy. They treat internal hemorrhoids and are not suitable for the treatment of thrombosis attacks. These are the infrared, chemical sclerosis, the elastic ligatures. These treatments are performed by a proctologist.
It is to be avoided as much as possible. The evolution of the thromboses is most often favorable in the days which follow the delivery. Also, only one-third of patients still have hemorrhoids six months after delivery.
In case of purely external hemorrhoidal thrombosis, without edema, incision with thrombectomy (ie complete evacuation of thrombosis), under local anesthesia, is an effective treatment. But it is not a radical treatment and the appearance of other thromboses is possible. This treatment is ineffective if the thrombosis is accompanied by edema, which is often the case.
When it comes to a circular thrombosed hemorrhoidal prolapse, in case of failure of the medical treatment, a radical surgery taking away the three hemorrhoidal bundles may be proposed. This is the Milligan-Morgan intervention described in 1937. She leaves three open wounds that will take more than six weeks to heal. It is, therefore, necessary to try everything before considering such surgery.
While it is true that the disease evolves favorably after delivery, it sometimes happens that the hemorrhoidal disease persists and beyond six months, if the symptoms are sufficiently troublesome for the patient, more radical treatment is then desirable. At this time, surgery is most often proposed.
Doctors know the natural treatment
Between these two solutions ( chemical or surgical ), however, there is a treatment that has been proven.
heal hemorrhoids naturally better yet, this treatment uses natural foods ( the homeopathy applied to hemorrhoids should not please the doctors … ), is painless and can be offered at an extremely affordable price!
That’s why I’m angry at doctors. They know all that but continue to prescribe ointments or even consider surgical operations when this is not necessary.
So as not to make this mistake, I advise you to be interested in this type of treatment, like the one I recommend here. The success rates are extremely high.