Specific treatment of hemorrhoids should be tailored to the severity of the symptoms. In pregnancy special consideration should be made to the developing fetus. Drugs should therefore be used sparingly and surgery only done when absolutely necessary.
Hemorrhoids are rarely seen in countries where high fiber, unrefined diets are consumed. A low fiber diet, high in refined foods, contributes greatly to the development of hemorrhoids.
Individuals consuming a low fiber diet tend to strain more during bowel movements since their smaller and harder stools are difficult to pass. This straining increases the pressure in the abdomen, which obstructs venous return. The increased pressure will increase pelvic congestion and may significantly weaken the veins, causing hemorrhoids to form.
A high fiber diet is perhaps the most important component in the prevention of hemorrhoids. Diets rich in vegetables, fruits, and legumes help keep the feces soft and easy to pass. The net effect of a high fiber diet is significantly less straining during defecation.
Bulking agents: Natural bulking compounds can be used to reduce fecal straining. They are the first basic step in your preventative strategy. These fibrous substances, particularly Psyllium seed, possess mild laxative action due to their ability to attract water and form a gelatinous mass.
Hydrotherapy: The warm sitz bath is an effective non-invasive treatment for uncomplicated hemorrhoids. A sitz bath is a partial immersion bath of the pelvic region. The Temperature of the water in the warm sitz bath should be 100–104 °F.
Topical therapy: Topical therapy, in most circumstances, will only provide temporary relief. Topical treatment involves the use of suppositories, ointments and anorectal pads. Many over-the-counter products for hemorrhoids contain primarily natural ingredients, such as witch hazel, shark liver oil, cod oil, cocoa butter, Peruvian balsam, zinc oxide, live yeast cell derivative and allantoin.
Surgical Intervention: In severe cases where conservative therapy was unsuccessful, consideration should be given to surgical treatment. These patients should consult a colorectal surgeon to determine the procedure of choice. Procedures such as elastic band ligation, injection sclerotherapy, (5% phenol in almond oil) and infrared photocoagulation have been performed successfully in pregnancy. Infection and bleeding in the peri-anal area is the major risk factor. Surgical hemorrhoidectomy has been performed in pregnancy successfully in severe cases where office based procedures have failed. Some patients have required further therapy postpartum.
Hemorrhoids are a common problem during pregnancy. Treatment should focus on prevention and particularly high fiber diet and proper hydration.
When conservative measures fail, consulting a colorectal surgeon and discussing surgical options may be indicated.
Dr. Brown, founder of Beauté de Maman, is a board-certified member of the American College of Obstetrics and Gynecology, a member of the American Medical Association, the Fairfield County Medical Association, Yale Obstetrical and Gynecological Society and the Women's Medical Association of Fairfield County. She is a magna cum laude graduate of Tufts University, completed her medical training at George Washington University Medical Center and completed her internship and residency in obstetrics and gynecology at Yale-New Haven Hospital. Dr. Brown has a busy obstetrical practice in Stamford, Connecticut and, as a clinical attending, actively teaches residents from Stamford Hospital and medical students from Columbia Presbyterian Hospital in New York.
Copyright © Michele Brown. Permission to republish granted to Pregnancy.org, LLC.