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External hemorrhoids during pregnancy

 
, medical expert
Last reviewed: 15.09.2022
 
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The formation of hemorrhoids around the rectum is called hemorrhoids, while distinguishing between internal and external. The latter involves pathological changes in the form of vein expansion of the external rectal plexus, located around the anus. Pregnancy contributes to the development of the disease. [1]

Epidemiology

It has been estimated that between 25% and 35% of pregnant women suffer from this condition. [2],  [3]In some populations, up to 85% of pregnant women suffer from hemorrhoids in the third trimester.[4]

Causes of the external hemorrhoids during pregnancy

Bearing a child is accompanied by a large load on the vascular system. During this period, the volume of circulating blood increases by a third. The causes of hemorrhoids are as follows: [5]

  • the growing uterus puts pressure on the veins of the pelvis, while worsening blood circulation and contributing to the stretching of the veins of the rectum;
    • hormonal changes (an increase in progesterone relaxes the smooth muscles of the intestines and veins);
  • reduced motor and physical activity in the third trimester of pregnancy leads to venous congestion;
  • frequent constipation, characteristic of this period, reduces the tone of the walls of the terminal section of the colon.

Risk factors

Risk factors for developing hemorrhoids include long-term regular use of hormonal contraceptives before pregnancy, overweight, and improperly organized nutrition. Spicy dishes with abundant spices, alcohol, hypertension also contribute to pathology. [6]

Pathogenesis

The pathogenesis of the development of hemorrhoids is associated with the growth of the cavernous tissue of the veins, which occurs due to abundant blood flow through the arteries of the rectum or difficulty in outflow from its veins. It goes through several stages from an internal form, the manifestations of which do not disturb the patient much, to an external form, very painful with dangerous consequences. [7]

Symptoms of the external hemorrhoids during pregnancy

At first, a woman may not even understand that there are troubles associated with her health. The first signs are expressed in some discomfort in the anus, painful defecation appears, during which the feces contain fragments of scarlet blood.

Ignoring the problem, refusing to visit a proctologist aggravates the symptoms. There is itching in the anus, mucous discharge appears, prolapse of hemorrhoids occurs.

Further, pain increases during emptying, walking, external hemorrhoids begin to bleed.

No less likely is the development of the scenario after childbirth, which only confirms the presence of pathology during the bearing of the child. Attempts only caused the nodes to fall out. [8]

Complications and consequences

Hemorrhoids are a rapidly progressive disease. Lack of treatment can cause profuse bleeding, anemia with such complications as thrombosis of hemorrhoids. Often the disease causes inflammation, dangerous for the development of acute purulent paraproctitis. The formation of cracks and edema is possible. [9]

Diagnostics of the external hemorrhoids during pregnancy

Pregnant women undergo a proctological examination at the proctologist, it involves an external visual examination, a finger examination, carried out on a special proctological chair.

In the diagnosis of the disease, one cannot do without instrumental methods, since external hemorrhoids come from problems inside the anus. Anoscopy examines this area, rectoscopy - 20 cm of the rectum. With the help of a special sensor, the condition of the mucosa, the nodes themselves, is determined. Both procedures can be performed up to 24 weeks of pregnancy, after this period only anoscopy.

Hemorrhoids are differentiated with polyps, other neoplasms, prolapse of the rectum. [10]

Treatment of the external hemorrhoids during pregnancy

First of all, the doctor will advise the pregnant woman to pay attention to nutrition: increase raw vegetables and fruits in the diet, switch to a dietary way of cooking, bring the drinking regime to 2 liters per day. Medicinal enemas based on vegetable oils are also effective, softening the fecal lump. 

A recent systematic review of both published and unpublished randomized controlled trials involving more than 350 patients found that laxatives in the form of fiber have a beneficial effect in the treatment of symptomatic hemorrhoids. [11] Reducing strain during a bowel movement constricts the internal hemorrhoidal veins, leading to a reduction in symptoms. Bathing in warm water (40–50°C for 10 minutes) usually relieves anorectal pain. [12]

Topical preparations with analgesic and anti-inflammatory effects provide short-term local relief of discomfort, pain and bleeding. Due to low doses and limited systemic absorption, they can be used in pregnant women; however, the safety of any of these in pregnancy has not been adequately documented.

You can remove knots, relieve inflammation and soreness with the help of ointments and suppositories that are safe for the fetus. [13]

Medications

It is best to use ointments for external hemorrhoids during pregnancy. Before using them, you need to empty the intestines, wash and dry yourself. They are applied in a thin layer around the anus. [14]Among them are the following:

  • posterisan is the main active ingredient of the microbial cells of Escherichia coli killed by phenol. Using the applicator, it is applied to the surface twice a day and after defecation. Phenol in its composition can cause allergic manifestations, there are no other contraindications;
  • troxevasin ointment - has a good antioxidant effect, eliminates pain, swelling, venous insufficiency. Apply to the affected area in the morning and evening. Contraindicated in patients with severe renal impairment, very rarely causes skin reactions.

In combination with ointments, rectal suppositories are also prescribed:

  • natalside - suitable for the treatment of bleeding hemorrhoids. It is obtained from brown seaweed. It is introduced into the anus twice a day (unless a different scheme is determined by the doctor) after a bowel movement. Contraindicated in case of individual intolerance to the components. Indispensable for long-term treatment;
  • candles with sea buckthorn - heal well, relieve inflammation, soften. Apply 1 to 3 times a day. The average course of treatment is 7-10 days. Of the side effects, an allergic reaction to the plant is possible;
  • relief (suppositories and ointment) - anti-inflammatory, immunomodulatory, healing agent. It is based on cocoa butter and shark liver. It is not prescribed for diabetes mellitus, diseases of the circulatory system, allergies to its components. It is used for pregnant women only with the permission of a doctor. Candles, like ointment, should be used 4 times a day.

Vitamins

Chronic pathology can lead to iron deficiency anemia. Therefore, along with vitamins that increase the body's resistance, especially C, which strengthen blood vessels (A, C, E, K, P, group B), iron must be present, as well as copper and zinc necessary for its synthesis.

Food containing them may not be enough, so you need to take vitamin and mineral complexes (aevit, ascorutin).

Alternative Treatment

Some alternative wisdom is known to relieve pain, alleviate the patient's condition. One of them is raw potato suppositories. Their size should be within 3-4 cm in length and 1-1.5 cm in diameter. Starch, vitamin C, which is part of it, promote healing, tone blood vessels.

You can also prepare the composition for lubricating the anus yourself: finely chop the garlic, combine with sea buckthorn oil, and freeze slightly. For this purpose, honey, propolis, butter are used.

It is also useful to drink carrot-beetroot juice, taking equal proportions of the ingredients. It will prevent constipation.

Herbal treatment

From herbs for the treatment of hemorrhoids, decoctions and infusions for lotions are prepared using plants such as blueberry leaves, strawberries, chamomile, calendula, aloe, oak bark. A bandage folded in several layers is dipped into a liquid, slightly squeezed and applied for 10 minutes to the anus.

Homeopathy

In the list of homeopathic remedies for the treatment of external hemorrhoids:

Fleming's ointment - has an antiseptic, anti-inflammatory and drying effect. Apply with a swab three times a day for a week. The drug can cause allergies, other adverse reactions have not been identified;

  • esculus - an ointment based on horse chestnut fruits. Removes swelling, accelerates tissue regeneration. It is applied to a swab, which is inserted into the rectum 1-2 times a day. Contraindicated in case of individual sensitivity and may cause an allergic reaction;
  • nova vita - rectal suppositories, they contain sea buckthorn oil, propolis, ginseng. Has anti-inflammatory and antimicrobial action;
  • anti-K - candles, which involve fir and tea tree oil, yarrow, wormwood, thuja. Relieve itching, dry ulcers, prevent purulent complications.

Surgery

Surgical treatment of external hemorrhoids in pregnant women is resorted to only in case of urgent need. There are several minimally invasive surgical procedures that are not dangerous for a woman: sclerotherapy and cauterization with a laser or infrared rays. [15]

Prevention

Preventive measures include a mobile lifestyle, a balanced daily diet, frequent but fractional meals, and the prevention of constipation. It is also important to perform special exercises for pregnant women, which help increase blood circulation, increase muscle tone and reduce pressure on the pelvic organs.

Forecast

The success of the treatment of external hemorrhoids depends on the timeliness of the treatment, which does not allow the transition to the next more serious stage. [16]Under certain circumstances, exacerbations can be repeated.

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