Hemorrhoids during pregnancy are a disease that manifests itself as varicose hemorrhoidal veins located in the anus. This leads to the formation of hemorrhoids, which can become inflamed, bleed, thrombose, fall out of the anal canal and become strangulated. Hemorrhoids are the most common cause of rectal bleeding and are also one of the most common proctological diseases.

According to various sources, hemorrhoids occur in 25–50% of pregnant women

Hemorrhoidal plexuses are located in the submucosal layer of the wall of the anal canal; their structure is similar to the cavernous bodies of the penis. Due to their anatomical features, hemorrhoidal veins are susceptible to the development of blood stagnation in them, which, under certain conditions, contributes to the formation of hemorrhoids.

Both men and women are equally susceptible to hemorrhoids, and in women hemorrhoids often develop during pregnancy. According to various sources, hemorrhoids occur in 25–50% of pregnant women, and in 50–80% of women during childbirth. Sometimes pregnancy aggravates or reveals existing hemorrhoids, which were previously latent. In addition, hemorrhoids can complicate the postpartum period.

Causes and risk factors

Ultrasound examination makes it possible to diagnose or exclude concomitant diseases of the gastrointestinal tract. In order to determine the source of bleeding, in some cases a contrast X-ray examination of blood vessels (angiography) is performed.

Physical and instrumental examination is supplemented by laboratory diagnostics:

• general blood test - confirms the presence of signs of an inflammatory process (an increase in the level of leukocytes and erythrocyte sedimentation rate (ESR) is observed);
• coagulogram - performed if thrombosis of hemorrhoids is suspected.

According to various sources, hemorrhoids occur in 25–50% of pregnant women, and in 50–80% of women during childbirth.

Differential diagnosis is necessary with malignant neoplasms of the rectum, secondary syphilis, anal fibrous polyps, anal fissures, fistulas. It should be taken into account that anal itching can also be observed with diabetes mellitus, helminthiasis and fungal infections, however, with these pathologies there are no tumor-like formations in the anus.

Treatment of hemorrhoids during pregnancy

At the initial stages, as well as during the period of exacerbation of the chronic process, conservative treatment of hemorrhoids during pregnancy is used.

In some cases, there is a need for general therapy. Medicines are prescribed that help increase the tone of the veins (phlebotonics), drugs that improve blood microcirculation. If necessary, medications are prescribed to improve intestinal motility. In case of bacterial infection, antibiotics are used.

Hemorrhoids during pregnancy can be complicated by such serious conditions as thrombosis, strangulation and necrosis of hemorrhoids, as well as purulent inflammation of the tissues surrounding the anal canal. The addition of a bacterial infection is fraught with intrauterine infection of the fetus.

Constant bleeding from hemorrhoids causes anemia, which, in turn, negatively affects the condition of the pregnant woman and the fetus.

Forecast

The prognosis with timely diagnosis and properly selected treatment is favorable. Hemorrhoids are completely curable.

Prevention of hemorrhoids during pregnancy

In order to prevent hemorrhoids during pregnancy, as well as to avoid relapses and exacerbations, it is recommended:

• timely treatment of diarrhea and constipation, as well as other disorders of the digestive tract;
• a balanced balanced diet (including a sufficient amount of fiber-rich foods in the diet, plenty of drinking regime);
• correction of overweight and obesity;
• avoiding hypothermia;
• thoroughly toilet the anal area after defecation (if necessary, replace the use of toilet paper by washing the anal area with soap and water);
• avoiding excessive physical activity;
• daily exercises for pregnant women (after consultation with a doctor managing the pregnancy and under the supervision of a physical therapy specialist);
• daily walks;
• refusal to wear tight belts and bandages during pregnancy;
• wearing underwear made from natural materials.

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Every second woman who is carrying a child faces this delicate problem. Hemorrhoids during pregnancy can appear both at the beginning and at the end or after childbirth. The period of gestation is considered a provoking factor for this disease, due to changes in the body of the expectant mother.

Hemorrhoids are varicose veins in the rectal area. During pregnancy, it is the vascular system that undergoes the greatest stress, since the volume of circulating blood increases by 30%. As a result, venous problems often appear, such as varicose veins and hemorrhoids.

The mechanism for the formation of hemorrhoids during this period is as follows: the uterus, which grows throughout 9 months, begins to put pressure on the colon and rectum, which causes local stagnation of blood, and congested veins stretch, forming hemorrhoids. The latter protrude under the intestinal mucosa. This problem can greatly disturb a woman, and sometimes has a completely asymptomatic course.

note: The opinion that hemorrhoids first appear after childbirth is erroneous. If after the birth of the child it worsened, then this means that it was still present during pregnancy, but did not manifest itself in any way, because the hemorrhoids were internal.

Causes of hemorrhoids during pregnancy

There are a number of factors that provoke the appearance or exacerbation of this disease in expectant mothers:

• chronic constipation (the walls of the rectum stretch excessively during bowel movements);
• physical inactivity or life without a sufficient level of movement (if a woman moves little, lies or sits more, then eventually blood stagnation forms in the pelvis, which provokes hemorrhoids and thrombosis of the hemorrhoidal veins);
• regular intake of hormonal hormones before pregnancy (they negatively affect the condition of the venous wall);
• increased intra-abdominal pressure is formed due to insufficient blood circulation in the pelvis (due to the growing uterus);
• excess weight;
• changes in hormonal levels during pregnancy (an increase in progesterone causes relaxation of the smooth muscles in the body that line the walls of blood vessels and the intestines, and this in turn causes constipation).

Important: not everyone knows that hemorrhoids can worsen not only after natural childbirth, but also after cesarean section.

Stages and types of hemorrhoids in pregnant women

Most often, the disease is diagnosed in the third trimester of pregnancy, but this does not mean that hemorrhoids cannot appear during the first three months. It can be internal, that is, not noticeable during visual inspection, or external, the bumps of which are clearly visible.

There are several stages of development of hemorrhoids:

• Stage 1 – hemorrhoids in the lumen of the rectum, not extending beyond its limits;
• Stage 2 - the nodes sag from the anus, but when changing body position they are reduced;
• Stage 3 – hemorrhoids sag from the anus and are not reduced when changing position;
• Stage 4 – non-reducible nodes are accompanied by complications in the form of thrombosis and heavy bleeding.

In this case, pregnant women may experience two types of hemorrhoids:

• acute, in which the disease occurs suddenly. The woman complains of pain in the posterior passage, blood in the stool, foreign body sensation, and sometimes a burning sensation;
• chronic. It occurs much more often, its attacks are stopped by pharmaceutical means, but it is not completely cured, and after some time, due to provoking factors, it resumes.

Symptoms of hemorrhoids in pregnant women

The clinical picture depends on the stage at which hemorrhoids are located and may combine the following symptoms:

• sagging hemorrhoids from the rectum;
• pain during bowel movements;
• burning in the anus;
• defecation of feces with traces of fresh blood;
• itching and discomfort in the anus;
• nagging pain in the rectum, radiating to the lower back and sacrum.

note: the symptoms of hemorrhoids may worsen when pinchedhemorrhoidal node. This condition is manifested by severe pain in the rectal area and increased body temperature. If such symptoms appear, it is important for a pregnant woman to immediately seek medical help from a surgeon.

Signs of hemorrhoids after childbirth

If during pregnancy this disease did not manifest itself in any way, because the nodes were internal, then after childbirth the likelihood of its exacerbation is very high. A woman will be bothered by such symptoms in the anal area:

Diagnosis of hemorrhoids during pregnancy

Confirmation and diagnosis of hemorrhoids requires a visit to a proctologist. The doctor will prescribe an examination program that will help determine the stage of the disease and select the most appropriate treatment for hemorrhoids during pregnancy.

Diagnosis of hemorrhoids includes:

• Inspection. During an objective examination in the anal area, the doctor will visually notice hemorrhoids that sag outward. The anal mucosa with hemorrhoids is inflamed, has a red tint and a pronounced venous pattern of small dilated capillaries. The presence of nodes is a differentiating feature that allows you to distinguish hemorrhoids from rectal cancer or anal fissures. Digital examination helps clarify the diagnosis and determine the presence of internal nodes, their location, size and quantity, and also helps to exclude or confirm the presence of anal fissures.
• Instrumental studies. Sigmoidoscopy is an optical examination of the rectum using a special apparatus - a sigmoidoscope; during pregnancy it is performed in exceptional cases.
• Laboratory research.

For laboratory diagnosis of hemorrhoidsa pregnant woman is prescribed:

• coprogram (qualitative stool examination);
• blood test (will confirm anemia due to regular bleeding from hemorrhoids);
• stool test for the presence of occult blood.

How to treat hemorrhoids during pregnancy

The choice of treatment method depends on the stage of the disease.

Stage I hemorrhoids during pregnancy can be treated without the use of medications. Usually the doctor recommends that the expectant mother change her diet, include enough fiber and sour-milk products (to normalize stool), move more, do gymnastics for pregnant women, walk in the fresh air, and adhere to personal hygiene rules.

Stage II hemorrhoids require medication to eliminate unpleasant symptoms. The proctologist prescribes both tablet and ointment preparations, which have a vasoconstrictor, anti-inflammatory, and analgesic effect. Preference is given to local remedies (suppositories, ointments), since most of them do not have a systemic effect on the fetus.

Important: A pregnant woman should not independently use certain remedies for hemorrhoids, because many of them can have a negative effect on the fetus (for example, Bellatamine and Anuzol - suppositories with belladonna extract provoke miscarriage or premature birth).

Among the suppositories used are those that contain lanolin, cocoa butter, anesthetic substances (novocaine, benzocaine), heparin, oils of plant and animal origin (vitamin A, shark liver oils, sea buckthorn), anti-inflammatory and astringent substances.

The treatment regimen also includes:

• Duphalac;
• Ginkor-forte;
• Forlax;
• Chime;
• Prelax;
• Troxerutin;
• Pentoxifylline.

note: During pregnancy, it is prohibited to treat hemorrhoids with drugs that containbisacodyl, buckthorn, phenolphthalein, etc. as they cause an increase in uterine tone.

Stages III and IV of hemorrhoids are considered severe, and combination therapy is used in their treatment. In addition to changing the diet and daily routine, suppositories, ointments, and tablets are prescribed. Surgical methods are resorted to if prolapsed hemorrhoids cannot be reduced into the rectum, but surgery is performed after childbirth.

It is also possible to use such modern methods as injections with sclerosing drugs, infrared coagulation and ligation with latex rings, laser coagulation, which involve complete removal of nodes.

Indications for emergency hospitalization for hemorrhoids during pregnancy are heavy bleeding, strangulation and necrosis of hemorrhoids. In this case, bloodless technologies are used.

Suppositories for hemorrhoids during pregnancy

These drugs are always prescribed by a proctologist individually, taking into account the stage and form of the disease, the duration of pregnancy, and the characteristics of the course.

Most often, pregnant women with hemorrhoids are prescribed suppositories from the list below:

• Hepatrombin - has an analgesic, anti-inflammatory and hemostatic effect.
• Proctoglivenol - normalizes the tone of veins, reduces capillary permeability, has an anti-inflammatory effect, and eliminates pain.
• Natalsid is a plant-based suppository (brown algae) that fights inflammation, effectively heals, softens stool and thereby facilitates bowel movements.
• Relief - suppositories that contain shark liver oil, provide good pain relief, relieve inflammation, heal, and soften.
• Proctosan – suppositories with a combined composition in the form of bufexamac, lidocaine, bismuth subgallate, titanium dioxide, which perfectly disinfect, anesthetize, and dry.
• Suppositories with propolis have an excellent healing effect, eliminate pain and itching in the anus, and destroy pathogenic microorganisms.

In most cases, treatment of hemorrhoids during pregnancy gives the expected result and its exacerbation is eliminated before delivery. It is also important to exclude heavy physical labor.

Childbirth with hemorrhoids

Hemorrhoids are not a contraindication to natural childbirth. It can provoke some complications, but a planned caesarean section will not be performed because of it. The only exceptions can be severe grade 4 hemorrhoids, heavy bleeding from nodes, and vein thrombosis. The decision is always made exclusively by the attending physician individually in each specific case. It is important for a woman in labor to listen and follow what the doctor and midwife say during childbirth, since the correct tactics will allow the entire process to be carried out without unnecessary muscle tension, and therefore without rupture of nodes and complications. The prognosis of the disease depends on how the birth itself goes and what its duration will be.

During childbirth, when a woman experiences contractions and attempts, intra-abdominal pressure increases due to the fact that the fetal head presses the pelvic vessels directly to the rectum itself. Hemorrhoids become larger, their consistency thickens. When the contraction intensifies and the woman pushes, the veins protrude and turn blue; during the pause they become smaller.

Important: Regarding the possibility of the appearance or non-appearance of hemorrhoids, much depends on the speed of contraction of the anal sphincter after childbirth. If this process happens quickly, then there is a possibility of pinched nodes, but this rarely happens. When the reduction occurs gradually, the nodes usually return to their place on their own.

Treatment of hemorrhoids after childbirth

Therapy for hemorrhoids, both during pregnancy and after childbirth, includes the following general instructions:

• lifestyle correction;
• elimination of constipation;
• normalization of water balance;
• meals by the hour;
• gymnastics to strengthen the muscles in the anal area;
• daily walks;
• It is better to breastfeed your baby or watch TV while lying down to minimize pressure on the rectal veins;
• hygienic regime.

To activate intestinal function, it is important to consume more fiber, vegetables, bran bread, cereals, fruits, dried fruits, etc.

note: A woman after childbirth should not ignore this problem, thinking that everything will go away on its own. Contacting a proctologist will allow you to clarify the diagnosis and select a treatment that will not harm the baby if the woman is breastfeeding.

Drug therapy for hemorrhoids in a nursing mother after childbirth is the same as during pregnancy.

If the child is bottle-fed, then the drugs from the list below are allowed:

• Suppositories with methyluracil. They contain an antibiotic that has a regenerating effect, heals the mucous membrane, stops bleeding, activates the immune system, stops bleeding and relieves pain.
• Ginkor Procto. These are suppositories with Ginko Biloba extract - a venoprotector that normalizes the elasticity and tone of veins, local blood circulation, and relieves inflammation.
• Candles with belladonna. A medicine with active substances in the form of phenol and belladonna extract. It relieves pain, has an antimicrobial effect, removes spasms, and eliminates the infectious process in the anus.
• Anestezol. Suppositories with a combined composition (menthol, benzocaine, zinc oxide), which perfectly stop bleeding, eliminate pain in the rectum, dry out and have an antiseptic effect.

– the most common disease characterized by impaired blood supply to the hemorrhoidal veins, which leads to their expansion, blockage (thrombosis) and causes bleeding. According to statistics, of 80% of patients who complained of progressive hemorrhoids, 40% are pregnant women. At the same time, in women giving birth for the second time, the risk of developing pathology after childbirth increases by 2 times.

Causes of disease in pregnant women

The reasons for the development of hemorrhoids are due to global changes occurring in the body of the expectant mother. During pregnancy, the constantly increasing size of the uterus displaces the remaining organs of the abdominal cavity. In this case, their blood supply is disrupted and blood stagnation occurs in the veins.

Very often, hemorrhoids in pregnant women become a consequence of chronic constipation. They arise due to a decrease in the susceptibility of intestinal muscle tissue to nerve impulses, which stimulate its work. As a result, a pregnant woman experiences difficulties with bowel movements and suffers from difficult bowel movements that require strong straining, which can also cause hemorrhoids.

Predisposing factors to the occurrence of pathology during pregnancy are:

• genetic predisposition;
• the age of the pregnant woman is over 35 years old (especially if this is the first birth);
• second and subsequent births;
• sudden changes in hormonal levels;
• disorders of the thyroid gland;
• chronic constipation;
• physical inactivity (lack of physical activity);
• disordered eating, which is typical for pregnant women in the first trimester of pregnancy.

Symptoms of hemorrhoids during pregnancy

Hemorrhoids in pregnant women in the initial stages of their development may be asymptomatic. Its symptoms develop gradually in the following sequence:

• discomfort in the anus - there is often a feeling of a foreign body, itching, burning after defecation;
• Bleeding is the main symptom of hemorrhoids in pregnant women, occurring during bowel movements. The blood is scarlet in color. It does not mix with feces, but is located on top of them. The intensity of bleeding can vary: from a few drops to profuse hemorrhage, especially in the presence of rectal ulcers.
• pain - appears after inflammation or prolapse of hemorrhoids, as well as when they are pinched. Painful sensations occur during bowel movements, their intensity persists for some time after the act of defecation.
• itching - appears as a result of irritation of the skin around the anus. Prolonged irritation increases the risk of eczema, increases the risk of tissue injury and the development of purulent diseases.

All symptoms may appear in waves during the period of exacerbation of the disease. Hemorrhoids during pregnancy are complicated by the presence of many unfavorable factors: gestation in the last trimester, childbirth, during which intra-abdominal pressure increases several times. That is why you should consult a doctor when the first symptoms of the disease appear.

Stages and forms of manifestation

In modern medicine, there are two forms of hemorrhoids:

• primary, when problems arise due to hereditary predisposition, poor lifestyle, including nutrition, sudden changes in hormonal levels;
• secondary, when the pathology becomes a consequence of a disruption in the functioning of systems and organs: severe cardiovascular anomalies, diseases of the pelvic organs, tumor-like formations in the intestines that disrupt its normal blood supply.

According to the nature of localization, hemorrhoids are divided into:

• internal - the nodes are located under the mucous membrane inside the rectum, above the anal line;
• external (external) – the nodes are located under the layer of skin, below the anal line;
• combined (mixed) – a combination of internal and external types of hemorrhoids.

The development of hemorrhoids in pregnant women, as well as in other cases, occurs in accordance with four stages, which reflect the degree of its complication:

• Stage I - enlarged nodes protrude into the intestinal duct, but do not fall out. As feces pass through the intestines, the nodes are injured, causing blood to be released from the anus.
• Stage II - during bowel movement. After the act of defecation, they move back on their own.
• Stage III – the nodes fall out during defecation, with slight straining and physical exertion. They cannot be removed on their own; you need to push them into the anal canal with your hands.
• Stage IV - prolapsed hemorrhoids fall out constantly, even in the absence of physical activity. It is impossible to push them into the anal canal.

Diagnostics

The specific clinical picture, symptoms and complaints of a pregnant woman allow a specialist to quickly make the correct diagnosis. In some cases, to clarify it, the doctor may prescribe a number of additional procedures:

• – examination of the rectum using an anoscope, to a depth of 12 cm. The procedure is safe and painless, and is carried out to identify any pathologies in the mucous tissue;
• rectoscopy - examination of the entire rectum using a rectoscope, which is immersed inside to a depth of 20-30 cm from the anus. Most often, the method is used to study the condition of the mucous tissue of the intestinal walls and to identify pathological neoplasms;
• general blood test - prescribed for hemorrhoids complicated by heavy hemorrhoidal bleeding, to identify anemia.

Features of treatment of hemorrhoids during pregnancy

Hemorrhoids during pregnancy require mandatory treatment, as they can progress very quickly. Treatment tactics depend on the degree of its development. So, if in the first stages it is possible to use only conservative therapy (nutrition correction, exercise therapy), then in later stages an integrated approach is required, including minimally invasive procedures, drug treatment, and in advanced cases, microsurgical operations (only after childbirth).

Approximate tactics for treating hemorrhoids during pregnancy

Stage of development of hemorrhoids	Main clinical symptoms	Treatment tactics
Stage 1	Discomfort during bowel movements, small amounts of blood in the stool.	Conservative treatment.
Stage 2	Discomfort during bowel movements, blood in the stool, prolapse of nodes.	Conservative treatment. Minimally invasive methods: ligation; sclerotherapy; infrared coagulation.
Stage 3	The same as at stage 2 + manual adjustment of the fallen nodes is required.	Conservative treatment. ligation; sclerotherapy; infrared coagulation.
Stage 4	The same as at stage 3 + acute pain, with inflammation of the surrounding tissues.	Conservative treatment for inflammation: phlebotropic drugs; anesthesia; anti-inflammatory drugs. During pregnancy, stage 2 and 3 methods are used for further treatment after inflammation has been relieved.

During pregnancy, surgical treatment to remove external and internal hemorrhoids is not used, since it requires general anesthesia, which is an unjustified risk for the body of the developing fetus and the expectant mother.

Conservative therapy

Used to identify hemorrhoids in the initial stages of development. This includes dietary modification and moderate physical activity.

Nutrition

Considering that hemorrhoids during pregnancy most often develop against the background of occasional constipation, the menu should include products that improve intestinal motility. The diet should be enriched with fermented milk products, fresh fruits, and vegetables, which are best steamed. Meat and carbohydrates should be included in the menu in limited quantities, fatty pork, spicy and fatty foods should be completely excluded.

The diet should be consistent (fractional meals in small portions at the same time).

Physiotherapy

A set of physical exercises for hemorrhoids in pregnant women stimulates the intestines well, eliminates blood stagnation in the pelvic organs, normalizes blood circulation, strengthens the pelvic floor muscles and prevents the progression of the disease. Physiotherapy exercises are contraindicated if there is a threat of miscarriage or if there is a risk of premature birth. It is also not recommended to perform these exercises at the end of the third trimester of pregnancy.

1. Torso rotations. Starting position: feet shoulder-width apart, arms straight forward. As you inhale, turn your body to the side. As you exhale, return to the starting position. As you inhale, turn your torso again, but in the other direction and return to the starting position again. The recommended norm is 5 approaches in each direction (1 approach - 10 turns).
2. Squats. Starting position: feet shoulder-width apart, arms along the body. Squat down slowly, stretching your arms forward, and then return to the starting position. Watch your breathing. The recommended norm is 5 sets (1 set – 7 squats).
3. Sphincter muscle tension. This exercise helps to strengthen muscles well and prevent the formation of hemorrhoids. It can be done standing or sitting. It is necessary to periodically strain for 5 minutes (holding them in this position for 30 seconds) and relax the muscles of the anal area. It is advisable to perform the exercise 5 to 10 times a day.

Medications

Treatment of hemorrhoids during pregnancy allows the use of medications only after consultation with a specialist, since any use of such drugs should be justified as much as possible. All drugs must be absolutely safe for the health of the woman and the fetus.

Natalsid, candles

Rectal suppositories with an anti-inflammatory effect and hemostatic effect. An analogue of the drug is Alginatol suppositories.

Indications

Used to treat hemorrhoids and anal canal fissures during pregnancy.

Contraindications

• Allergy to the components of the drug.
• Children's age up to 14 years.

Dosage

The duration of use of the drug depends on the severity of hemorrhoids. Usually the course lasts 7 days, 1 suppository is inserted into the rectum in the morning and evening. The drug can be used at any stage of pregnancy.

Candles with sea buckthorn oil

They have a pronounced anti-inflammatory effect. Suppositories relieve itching, swelling, and skin irritation.

Indications

• Anal fissures.
• Ulcers of the sphincter and rectum.
• Hemorrhoids of any type.

Contraindications

Dosage

Use 2 suppositories 2 times a day for 7 days. If symptoms of hemorrhoids persist, treatment is extended for another 7 days. Suppositories can be used by women during pregnancy at any stage.

Suppositories with propolis, Prostopin and others

They have a local anti-inflammatory effect, relieve itching, dissolve small hemorrhoids, normalizing blood circulation.

Indications

• Severe inflammatory processes in internal hemorrhoids.
• Anal fissures.

Contraindications

Allergy to the components of the drug.

Dosage

Administer 1 suppository before bedtime.

Can be used throughout pregnancy.

Heparin ointment

Relieves pain, swelling, promotes the resorption of blood clots, restores blood circulation.

Indications

• External hemorrhoids, acute form.
• Prevention of thrombosis in the veins of the anus and rectum.

Contraindications

• Bleeding, bloody discharge from the rectum.
• Any damage to the mucous tissue and skin in the treatment area.
• Risk of miscarriage.
• Recent birth, last prenatal weeks.

Dosage

The amount of the drug and the mode of its use are prescribed by a specialist depending on the symptoms and clinical picture.

The drug should not be used in the last trimester of pregnancy. Heparin, which is included in the composition, thins the blood, which can contribute to severe uterine bleeding during childbirth. In all other cases, its use by a pregnant woman is possible only after approval by a doctor.

Ichthyol ointment

A product with a strong disinfectant and antibacterial effect. The ointment is advisable to use for the rapid healing of small wounds and sphincter cracks and to relieve inflammation in damaged tissues.

Indications

Inflammatory processes in external hemorrhoids.

Contraindications

Dosage

Ointment in an amount of 1 g is applied to the affected areas 2 times a day.

Considering that the components of the drug do not enter the general bloodstream of the body, it can be used at any stage of pregnancy.

Hepatrombin G, suppositories and ointment

A series of drugs with anti-inflammatory and tonic effects. The drugs relieve inflammation, normalize blood flow in damaged tissues, restore the elasticity of venous vessels and prevent the formation of blood clots in the veins and their blockage with blood clots.

Indications

• Hemorrhoids in acute or chronic stages.
• Ulcers, erosions in the anal area.
• Blood clots, inflammation caused by blood stagnation.

Contraindications

Ointment and suppositories should not be used if damaged areas of the skin or mucous membranes are infected with bacteria or fungi. The preparations contain substances that promote the growth of pathogenic microflora cells.

Dosage

Suppositories are inserted into the rectum, 1 piece at a time. morning and evening (before bed). For acute hemorrhoids, the ointment is applied in a thin layer 2 to 4 times a day; after the patient’s condition improves, the use of the ointment is reduced to 2 times a day.

During pregnancy, suppositories and ointment can be used only after 12-13 weeks of pregnancy.

Vishnevsky ointment

An anti-inflammatory drug that is advisable to use for swelling, inflammation, and the development of purulent processes in damaged tissues.

Indications

• Hemorrhoids in acute form.
• Sphincter fissures.
• Inflamed external nodes.

Contraindications

Dosage

Apply by applying a thin layer of ointment to damaged areas no more than 3 times a day.

During pregnancy, the drug can be used at any stage.

Fleming's ointment

A product made from medicinal herbs (St. John's wort, chamomile, sea buckthorn). Has a strong anti-inflammatory effect. Kills pathogenic microorganisms that can cause severe irritation and the development of purulent processes in damaged tissues.

Indications

Contraindications

Individual intolerance to the components in the drug.

Dosage

The ointment is applied to the inflamed external nodes 1 to 3 times a day. The total duration of treatment is usually 7 days. If the patient's condition does not improve, the specialist may recommend extending the course of treatment.

The ointment can be used by pregnant women at any stage of pregnancy.

Posterizan, suppositories and ointment

The drug has an anti-inflammatory effect, accelerates tissue regeneration, restores the permeability of damaged blood vessels and thereby normalizes blood circulation in inflamed hemorrhoids. Indications

• Discomfort in the anal area, expressed by itching, burning.
• Chronic form of hemorrhoids, prolapse of nodes.

Contraindications

• Infection of skin and mucous tissues by fungi or bacteria.
• Individual intolerance.

Dosage

1 suppository is inserted into the rectum. in the morning and in the evening.

During pregnancy, Posterizan can be used only after the approval of a specialist. The components included in its composition do not affect the intrauterine development of the fetus or the condition of the mother, but can provoke a severe allergic reaction.

Neo-Anuzol, suppositories

Rectal suppositories reduce pain from hemorrhoids and anal fissures, eliminate inflammation and itching, and have an antibacterial effect, preventing infection of damaged mucous tissues.

Indications

• Discomfort in the anal area.
• Hemorrhoids of any type.

Contraindications

• Hypersensitivity to the components included in the drug.

Dosage

1 candle 2 times a day.

The drug is approved for use for hemorrhoids during pregnancy, but strictly in recommended doses and under the supervision of a specialist.

Levomekol, ointment

An ointment with a strong antibacterial effect, a universal remedy for the treatment of damaged skin and mucous membranes. The ointment can also be used for hemorrhoids. It accelerates metabolic processes in cells, restores their functionality, and also kills pathogenic microflora that can cause the development of purulent processes in tissues.

Indications

• Anal fissures.
• Ulcers, erosions, non-healing wounds.
• Irritation of the anal canal.

Contraindications

Allergic reactions to the components of the drug are possible.

Dosage

The ointment is applied to damaged tissues once a day, before bedtime.

The ointment has no contraindications for use during pregnancy. Despite this, you should consult a specialist before using it, since the drug contains a strong antibiotic.

Relief, Relief Advance, suppositories and ointment

Rectal suppositories and ointment. Quickly relieve itching, irritation, pain during bowel movements due to vasoconstrictor and anti-inflammatory effects. The Relief Advance series of drugs has a greater anesthetic effect, so it is advisable to use them in acute hemorrhoids with severe pain.

Indications

• Hemorrhoids of any type.
• Cracks.
• Any manifestations of discomfort in the anal area (itching, burning).

Contraindications

• Tendency to form blood clots.
• High blood pressure.
• Allergic reactions to the components of the drug.

Dosage

For acute hemorrhoids, up to 4 suppositories are used per day; in other cases, the recommended dosage is 1 suppository in the morning and 1 suppository in the evening, respectively, the ointment is applied the same number of times.

Use during pregnancy is possible only on the recommendation of the attending physician, since there is information that the components included in the drug can increase the tone of the uterus, which can be dangerous if there is a threat of miscarriage, in the first and last trimester of pregnancy.

Troxevasin, ointment

Gel (an analogue of troxerutin) is used to relieve swelling and reduce hemorrhoids in external hemorrhoids. Normalizes blood circulation in damaged vessels and has an anti-inflammatory effect.

Indications

• Weeping type hemorrhoids.
• Inflammation of external hemorrhoids.

Contraindications

• Allergic reactions.
• Wounds or other damage to the skin in the treatment area.
• Fungal or bacterial infection of the skin.

Dosage

Apply a thin layer of ointment directly to the affected area.

During pregnancy, it can be used only as directed by a doctor and only after the first trimester of pregnancy.

Troxerutin, ointment

A medicine produced in the form of a gel for external use. The drug has a decongestant, partially analgesic and anti-inflammatory effect, well restores the elasticity of vascular walls, and normalizes blood circulation.

Indications

• Severe inflammation in external hemorrhoids.
• Discomfort in the sphincter area.
• Postoperative complications.

Contraindications

• Any damage to the skin (wounds, abrasions).
• Possible allergic reactions.

Dosage

Use no more than 4 g of ointment per day, applying 2 g in the morning and evening.

During pregnancy, it can be used only on the recommendation of a doctor, starting from the second trimester.

Procto-Glyvenol, ointment and suppositories

Drugs that have anti-inflammatory and anesthetic effects. Reduce blood stagnation in the veins, normalizing blood flow and restoring the elasticity of the vascular walls. In the acute form of hemorrhoids, they have an analgesic effect and relieve swelling of damaged tissues.

Indications

• Hemorrhoids of any type.

Contraindications

• Liver failure.

Dosage

For acute hemorrhoids, suppositories are inserted into the lower rectum in the morning and evening. When severe symptoms disappear and swelling decreases, use 1 suppository before bedtime.

The ointment is used to treat external hemorrhoids, applying a thin layer to the affected area 2 times a day. For the treatment of internal nodes, administered orally in an amount of 2 g, also twice a day. When acute symptoms disappear, reduce the use of the ointment to 1 time per day, applying it to the damaged areas immediately before bedtime.

Suppositories and ointment during pregnancy can be used only after the first trimester, after consultation with a specialist.

Brief overview of drugs by trimester of pregnancy

A drug	Indications for use during pregnancy
	1st trimester	2nd trimester	3rd trimester
	Yes	Yes		Yes
	Yes	Yes		Yes
	Yes	Yes		Yes
	Yes	Yes		Yes
	No	as prescribed by a doctor		No
Ichthyol ointment	Yes	Yes		Yes
	No	Yes		Yes
	Yes	Yes	Yes

According to medical statistics, hemorrhoids of varying severity occur in 80% of pregnant women. And if internal hemorrhoids cause relatively little discomfort, then external (or external) hemorrhoids threaten severe complications, including necrosis of adjacent tissues. At the same time, it is external hemorrhoids that prevail among pregnant women - 61.3% of patients suffer from it. Let's figure out why external hemorrhoids occur during pregnancy, as well as how to treat them: at home with the help of ointments and suppositories, surgical methods and folk recipes.

External hemorrhoids: what is it characterized by and why does it develop?

Hemorrhoids are divided into internal, located in the submucosal layer of the intestine, and external, located just under the skin of the anus. It is the inflammation of the external nodes that is characterized by external (or external) hemorrhoids, which should be distinguished from the prolapse of internal nodes.

The difference between these forms of hemorrhoids is clearly visible in the next photo.

The reasons for the development of hemorrhoids are:

• sedentary lifestyle;
• regular constipation;
• overweight;
• unusual physical activity;
• severe stress;
• smoking, spicy food, coffee, alcohol;
• tumors and inflammation in the intestines or liver;
• infections.

Although all groups of the population are susceptible to the disease, the huge percentage of pregnant women among them is explained simply: the first five of these causes of the disease almost always accompany women during pregnancy. So, according to statistics, 53% of pregnant women suffer from constipation, and of those suffering from hemorrhoids - as much as 86%. The trigger for the disease is pushing, during which the walls of the hemorrhoids often rupture, after which they begin to bleed.

Drug treatment of external hemorrhoids

Rectal suppositories, ointments, creams and sprays are the first remedy for treating any stage of hemorrhoids at home.

You can get rid of the disease with the following highly effective drugs:

Sold in the form of ointments and suppositories. The active ingredients are:

• polidocanol - provides sclerosing (“glues” damaged vessels) and analgesic (pain-relieving) effect;
• prednisolone - is responsible for anti-inflammatory and antiallergic effects, successfully relieves burning and itching;
• heparin - has an anti-edematous effect, treats damaged tissue and prevents thrombus formation (thrombosis is the main cause of complications such as acute hemorrhoids).

Most of the symptoms disappear by the 15th day of using the product.

Treatment of hemorrhoids with Hepatrombin G is allowed only after the first trimester of pregnancy. The drug should not be confused with regular Hepatrombin - this ointment is intended only for application to the skin, and on the mucous membrane it can cause a burn.

A completely naturopathic drug that includes only natural ingredients - mainly beekeeping products. Among them:

• extract from bee moth larvae - makes the walls of blood vessels more elastic, accelerates the healing of cracks;
• dead bee extract - helps get rid of inflammation, swelling and pain;
• beeswax - stops bleeding, regenerates tissue, relieves itching;
• propolis extract - stabilizes blood supply to affected vessels, promotes the resorption of blood clots;
• bee venom - eliminates muscle spasms, stimulates capillary blood circulation;
• olive oil - by accelerating blood flow, eliminates blood stagnation, relieves burning, heals damage;
• cedar resin - restores blood circulation, eliminates blood clots in prolapsed hemorrhoids, relieves swelling;
• a complex of vitamins C, B1 and B5 - strengthens the venous walls, accelerates the restoration of the mucous membrane.

The ointment successfully helps get rid of swelling, bleeding and anal fissures, but does not have an antiplatelet effect, so for thrombosis it should be used in conjunction with other medications.

One of the most popular antihemorrhoidal drugs. Available in the form of suppositories and ointments. The active ingredient in Relifa is the local anesthetic benzocaine.

The disadvantage of the drug is the presence of side effects and contraindications. Research into whether suppositories affect fetal development and whether benzocaine can pass into breast milk has not yet been conducted. Treatment with Relief during pregnancy and pregnancy can only be done with the permission of a doctor.

Another almost completely natural antihemorrhoidal drug, which can be treated at home. The main active ingredients of the spray are:

• Wormwood extract - has antiseptic properties, soothes inflamed skin, accelerates the elimination of toxins;
• extract from the leaves of Ginkgo biloba - helps get rid of swelling and inflammation, restores blood circulation, strengthens the walls of blood vessels;
• horse chestnut seed extract - softens burning and itching sensations, heals microcracks;
• extract from leaves of Stinging Nettle - stops bleeding, fights blood stagnation in the veins;
• troxerutin is a powerful venotonic, anti-inflammatory and decongestant agent;
• Disodium EDTA is an antioxidant.

When using Hemoderma, the pain goes away and the nodes stop bleeding within 2-3 days, but the full course of treatment usually takes about a month.

How to cure external hemorrhoids with folk remedies

You can also get rid of the initial stages of hemorrhoids using folk remedies prepared at home.

Among the most effective folk recipes:

1. Anti-hemorrhoids collection of nettle and buckthorn bark.
2. Treatment with yarrow decoction.
3. Treatment with juice of ripe rowan berries.
4. Treatment with alum.
5. Treatment with steam from milk with onions boiled in it.
6. Treatment with a decoction of aspen leaves.
7. Treatment with a decoction of Highlander.
8. Treatment with potato candles.
9. Treatment with ointment made from propolis, wax, honey and vegetable oil.
10. Treatment with smoke from chopped garlic.
11. Treatment with cold water compresses
12. Treatment with ice candles
13. Treatment with medicinal leeches.

If you couldn’t find the above ingredients or you don’t have time to prepare them at home, you can order ready-made antihemorrhoidal drugs made from natural ingredients on the Internet, such as Hemoderm spray and Zdorov cream.

Hemorrhoid removal

Proctologists usually do not prescribe surgical removal of hemorrhoids in pregnant women until after childbirth. However, in extreme cases (the onset of tissue necrosis or prolapse of nodes that cannot be reduced), it is permissible to treat hemorrhoids with minimally invasive procedures:

• sclerotherapy - injections of drugs that fuse blood vessels and promote spontaneous death of nodes;
• laser or infrared coagulation (cauterization);
• latex ligation - putting an elastic ring on the hemorrhoid;
• cryodestruction - removal of nodes with liquid nitrogen.

Prevention of hemorrhoids

Preventing hemorrhoids is much easier than treating it.
Preventive measures include:

1. Fight constipation. This is possible only by creating the right diet, which includes an abundance of plant fiber (cereals, dried fruits, vegetables, nuts) and fermented milk products, and limits the consumption of meat, flour products, hot spices and coffee.
2. Regular walks, if possible - special gymnastics (Kegel exercises, “Scissors”, “Bicycle”, “Birch”, etc.)
3. Hygiene. The anal area should be washed after each trip to the toilet.

Conclusion

External hemorrhoids during pregnancy are an extremely common phenomenon and can cause a lot of trouble for the expectant mother. This disease can be successfully treated at home using rectal suppositories, ointments, sprays (Gepatrombin, Zdorov, Posterizan, Hemoderm, etc.) and folk remedies (decoctions and suppositories from hemostatic and anti-inflammatory plants, ointments based on honey and propolis). In advanced cases, external hemorrhoids are treated with minimally invasive surgical methods, but, as a rule, after childbirth.

Hemorrhoids are dilation and inflammation of the veins of the final part of the rectum. For most women, external hemorrhoids appear for the first time during pregnancy or their chronic form worsens.

There are many reasons that provoke an exacerbation or initial appearance:

• the woman stops moving a lot;
• the enlarged uterus puts pressure on the blood vessels;
• the intestines are compressed, constipation appears;
• the pregnant period is characterized by an increase in the production of the hormone progesterone, which is necessary for normal gestation, but at the same time the intestinal walls become weak (intestinal motility decreases);
• improper, unbalanced diet;
• Heredity plays an important role.

The risk of developing nodes during pregnancy subsequently increases. What to do to reduce the likelihood of exacerbation? From the first days of conception, it is recommended to take medications that can improve blood flow and strengthen the walls of blood vessels.

Health hazard

The consequences of untreated hemorrhoids can be serious.

• If the hemorrhoid bleeds constantly, anemia may develop. A decrease in hemoglobin in the blood leads to oxygen starvation. All internal organs begin to receive less nutrients. The condition negatively affects the growth and development of the fetus.
• If hemorrhoids come out, an infection may develop. A purulent-inflammatory process is added. Toxins enter the bloodstream and enter the fetus through the placenta. Intrauterine infection occurs.
• Treatment should begin before labor. Hemorrhoidal lumps can cause even more pain and discomfort during pushing. If the nodes fall out, bleeding may occur during childbirth.

Once hemorrhoids appear, they are easier to treat at the initial stage. The disease is easier to treat in the first trimester. If you ignore the problem during the entire 9 months of pregnancy, then after childbirth the condition will only worsen.

Therapeutic measures

What to do if the disease appears during pregnancy? External hemorrhoids during pregnancy should be treated with extreme caution. Many components of medications cannot be used during this period. Some of them are prohibited in the first or second trimester. Preference is given to natural composition. In any case, the decision must be made by the doctor.

Medicines allowed during pregnancy:

• Candles or Gepatrombin G ointment. Narrows the area of ​​swelling and inflammation, reduces itching and burning. Relieves pain and strengthens the walls of blood vessels. Prevents the formation of blood clots. Treatment of hemorrhoids is allowed only from the second trimester.
• Relief. Ointment or suppositories promote rapid healing of wounds and cracks and resolve seals. The product quickly relieves pain.
• Natalsid. Damaged areas heal quickly, spasm and pain are reduced, and inflammation is eliminated. Increases local immunity of the rectal mucosa.
• Candles and ointment Posterisan approved for use not only during pregnancy, but also during breastfeeding. They contain E. coli cells and a hormonal component - hydrocortisone. The drug not only has an anti-inflammatory effect, but also increases the activity of the body's defense cells.
• Bezornil. The ointment has a natural base. Helps reduce the area of ​​swelling, inflammation, stops bleeding and heals anal fissures.
• Fleming. The ointment reduces inflammation, eliminates itching and burning. Relieves cracks in the anal area.
• Detralex, Venarus, Phlebodia. If the condition is accompanied by severe pain and bleeding, then a decision may be made to take venotonic tablets. They give strength and elasticity to the walls of blood vessels and improve blood flow. But they should be taken with caution, since the drugs make changes to the entire circulatory system.
• Heparin ointment. The product, penetrating into the inflamed area, relieves swelling and inflammation, resolves bumps, eliminates itching and prevents the formation of blood clots. The benzacoin contained in the composition copes well with pain.
• Vishnevsky ointment. Prevents the development of inflammation, improves local blood circulation. Relieves swelling and pain, disinfects the damaged surface.

How to treat hemorrhoids if suppositories, tablets and ointments do not help? There are cases when conservative methods do not help get rid of the disease or alleviate the condition only for a short period of time.

In this case, surgical intervention is indicated. The main indication is prolapse of nodes or their thrombosis. The condition is dangerous because during childbirth there may be a rupture of the rectum or other serious complications.

Minimally invasive (gentle) methods of getting rid of hemorrhoids, allowed during pregnancy:

• Cryotherapy. During the procedure, the node is frozen with liquid nitrogen.
• Ligation. The stem of the cone is tightened with a special thin latex ring. As a result, the power to the node stops and it disappears.
• Sclerotherapy. A special substance is injected into the cavity of the hemorrhoidal node, which glues the plexuses and nutrition is stopped.

Traditional medicine against hemorrhoids

What can you do at home? During pregnancy, medicinal herbs should be used with caution. Many of them can cause allergic diseases and complications during pregnancy.

• A decoction of yarrow will help when the first signs of the disease appear, stop bleeding and reduce pain.
• A decoction of buckthorn and nettle leaves will help relieve pain and stop the inflammatory process.
• A decoction of blueberries will help relieve bleeding and pain.
• Steam treatment with milk and onions helps relieve the unpleasant symptoms of the disease.
• A decoction of knotweed can eliminate pain and inflammation and stop bleeding. In addition, the decoction has a mild laxative effect.
• Potato candles. The starch contained in the vegetable envelops the walls of the rectum, creating a protective film. As a result, pain and inflammation reduce their intensity.
• An ointment made from propolis, honey and melted butter can relieve inflammation and pain, quickly heal cracks and abrasions.
• Ice chamomile candles are prepared from a decoction of medicinal flowers. It is poured into molds and placed in the freezer. After the liquid has hardened, it can be used for its intended purpose. Cold can constrict blood vessels. As a result, the pain goes away, the bleeding stops, the swelling subsides and relief comes.
• Candied honey candles have anti-inflammatory and bactericidal effects.
• If there is loss of nodes, a compress of grated carrots and beets will help. The procedure promotes natural resorption of nodes and relieves pain.

A pregnant woman is responsible not only for her own condition, but also for the health of her unborn child. Therefore, you should not self-medicate and select your own remedies. Only a gynecologist and proctologist can outline a treatment plan based on the characteristics of pregnancy and the severity of hemorrhoids.