Belladonna extract suppositories during pregnancy: how to use and where to administer

Belladonna suppositories are rectal suppositories containing plant alkaloids such as atropine, hyoscyamine, and scopolamine. All of these are so-called anticholinergic agents: they block muscarinic transmission, thereby reducing smooth muscle spasms, decreasing secretions, and alleviating local pain associated with spasms. Historically, such suppositories were used to treat pain associated with hemorrhoids, anal fissures, and sphincter spasms. However, these are "old" approaches: today, we have safer and more predictable alternatives for pregnant women. [1]

Atropine-like substances can act not only locally. Even with rectal administration, some of the dose is absorbed, and systemic effects are typical: dry mouth, tachycardia, urinary retention, constipation, dilated pupils, and confusion in sensitive individuals. Therefore, contraindications for belladonna-containing products include angle-closure glaucoma, prostatic hypertrophy, intestinal atony, severe forms of ulcerative colitis, and toxic megacolon—this is important to know even if you are not pregnant. [2]

In some countries, the combination of belladonna and opioid is used rectally as a pain-relieving suppository for urological procedures. The instructions for these medications clearly state that use is not recommended during pregnancy, especially during labor, and during lactation, monitoring of the child is required due to the risk of sedation (this is due to the opioid, but the anticholinergics in the formulation do not alleviate this problem). This is important to us as a litmus test: even in a specially approved pharmaceutical form, an anticholinergic is not a first-line drug during pregnancy. [3]

The key: belladonna suppositories are a symptomatic treatment (to relieve spasms/pain), not a treatment for the underlying cause. During pregnancy, most anorectal complaints are caused by constipation and venous congestion (hemorrhoids). Problems should be addressed through bowel habits, lifestyle, and safe topical treatments, rather than anticholinergics "just in case." [4]

Table 1. Belladonna suppositories "on the fingers"

Parameter	What does it mean
Class	Anticholinergic alkaloids (atropine-like)
Effect	Relieves spasms and secretions, has a weak analgesic effect
Systemic risks	Tachycardia, urinary retention, dry mouth, constipation, blurred vision
Pregnancy status	Not the drug of choice; there are safer alternatives
The problem of approach	Does not treat the underlying cause (constipation/inflammation) and may worsen it.

What does current data say about safety during pregnancy?

Key fact: Atropine and related belladonna alkaloids readily cross the placenta. Observations in pregnant women and experiments have shown transient tachycardia and decreased heart rate variability in the fetus after exposure to atropine. These changes are usually transient and have not been associated with birth defects, but the mere fact of placental transfer is sufficient reason to avoid anticholinergics unless absolutely necessary. [5]

Clinical guidelines clearly state that belladonna-containing suppositories are not recommended for use in pregnant women, especially during labor, when proven methods of pain relief and uterine tone control are needed. When combined with opioids, the risks of respiratory depression in the newborn and withdrawal syndrome are added, making their use even less desirable. For our purposes (hemorrhoids, fissures, spasms), these are excessive risks without proven additional benefit. [6]

It's also important to note that anticholinergics can worsen constipation, which is a major trigger for hemorrhoid pain in pregnant women. This creates a vicious cycle: a belladonna suppository will briefly relieve the spasm, but due to constipation and decreased peristalsis, you risk aggravating the underlying problem. Therefore, international reviews and patient guidelines emphasize bowel movement modification and gentle topical treatments rather than anticholinergics. [7]

Finally, for localized treatment of hemorrhoidal pain during pregnancy, there are medications with a better profile: hydrocortisone + pramoxine, local anesthetics, sitz baths, cold, and, at the systemic level, paracetamol as the analgesic of choice. Individual studies have demonstrated the safety and clinical benefit of hydrocortisone-pramoxine in late pregnancy. This is a much more "smooth" approach than anticholinergics. [8]

Table 2. Anticholinergics and pregnancy - what is important to remember

Fact	Clinical meaning
Atropine crosses the placenta	Fetal tachycardia and decreased variability are transient but predictable. [9]
Belladonna suppositories are not recommended.	Especially near childbirth and without strict indications. [10]
Increases constipation	Worsen the underlying problem of hemorrhoids during pregnancy. [11]
There are safe alternatives	Hydrocortisone-pramoxine, sitz baths, paracetamol. [12]

How to effectively treat hemorrhoids and rectal pain in pregnant women

The starting line is bowel movement correction: adequate water intake (usually 8-12 glasses per day), a high-fiber diet, and physical activity as discussed with your obstetrician. If this isn't enough, laxatives are used first: psychillium (psyllium), methylcellulose, and polyethylene glycol. According to ACOG and gastroenterological societies, polyethylene glycol is the drug of choice for constipation during pregnancy; mild osmotic agents and Duphalac are also acceptable. Docusate can be used as a stool softener. [13]

Localized relief for hemorrhoids includes sitz baths with warm water (10-15 minutes several times a day), careful hygiene, short-term ice/cold applications, and soft toilet paper or wet wipes without alcohol or fragrances. This reduces swelling and spasms naturally and safely. Several studies have compared sitz baths with creams: warm baths have shown comparable or better symptom relief. [14]

Medications include local anesthetics (lidocaine) and short courses of hydrocortisone. Hydrocortisone-based creams with pramoxine have demonstrated satisfactory safety in late pregnancy. It is important to avoid prolonged courses of steroids to prevent thinning of the skin and mucous membranes. For systemic analgesia, use paracetamol as directed, rather than nonsteroidal anti-inflammatory drugs in late pregnancy. [15]

If there is an anal fissure with severe spasm, local vasodilators (for example, low-concentration nitroglycerin ointment) are considered, but this is decided on an individual basis with a proctologist and obstetrician. In the vast majority of cases, a properly planned "stool + baths + local anesthesia/short course of steroids" allows one to avoid the need for "harsh" medications. [16]

Table 3. What to do instead of belladonna suppositories

Target	First line	Comments/Notes
Normalize stool	Fiber, water, polyethyleneglycol, psyllium, docusate	ACOG/AGA Line #1. [17]
Relieve swelling/spasm locally	Sitz baths, cold briefly	Without medication, it can be done multiple times. [18]
Apply local anesthesia	Lidocaine, hydrocortisone ± pramoxine (short)	Demonstrated safety at a late stage. [19]
Relieve pain systemically	Paracetamol	Analgesic of choice during pregnancy.
Avoid relapses	Don't push, don't hold back the urge, put a footrest under your feet	Simple ergonomics of defecation.

But if we do consider belladonna: rare exceptions and technique

Sometimes a patient sees a doctor with outdated prescriptions or in a region where "old-school" combination suppositories are available. If the discussion turns to belladonna, it's important to understand: it's off-label in the context of pregnancy and doesn't meet modern obstetric safety priorities. A decision is only possible if there are no alternatives, at the minimum dose and for the shortest course, after an in-person risk assessment. [20]

Directions for use: rectally only (not vaginally). Insert the suppository after a natural bowel movement or micro enema, using clean hands, shallowly, preferably at night. Any signs of a systemic effect (severe dryness, increased heart rate, urinary retention, blurred vision), as well as worsening pain, should promptly discontinue use and contact a doctor. If you have a history of glaucoma, kidney stones, intestinal obstruction, or severe constipation, these suppositories are contraindicated. [21]

Anticholinergics are not used during the perinatal period (late third trimester, labor) due to their adverse effects on both mother and fetus. Please do not attempt to "relieve contractions" or "prepare the cervix" with belladonna-based remedies—these are myths unsupported by evidence. Any obstetrical treatment should be discussed only with your physician. [22]

Also, if you are breastfeeding, anticholinergics can potentially reduce lactation with prolonged use; atropine can pass into milk in small amounts. A single exposure, especially local, is unlikely to have an effect, but long-term use is undesirable. If any "non-standard" therapy is necessary, inform your pediatrician—this will help correctly interpret your child's behavior and weight gain. [23]

Table 4. When belladonna is definitely a no-no

Situation	Why
Late stages and period of labor	Risks to the fetus, no benefits. [24]
Severe/chronic constipation	Anticholinergic may worsen constipation.[25]
Glaucoma, urinary retention, intestinal atony, megacolon	Classic contraindications. [26]
Self-medication without diagnosis	It is possible to miss a crack, thrombosis of the node, or infection.

Constipation During Pregnancy: Why It's the Root of the Problem and How to Treat It Safely

Constipation is a common occurrence during pregnancy: hormones slow peristalsis, the growing uterus alters pelvic mechanics, and iron in vitamins increases stool stiffness in some women. The most common mistake is to procrastinate, then resort to "strong" topical remedies when pain begins. The correct approach is to prevent and gently treat constipation every day. [27]

Dietary fiber, water, and exercise are essential. If this doesn't help, the next pharmacological step is polyethylene glycol (an osmotic laxative) as the #1 option according to ACOG; psyllium and other bulk-forming laxatives are safe because they are not absorbed. Docusate softens stool; lactulose is suitable if polyethylene glycol is unavailable or intolerable. Stimulant laxatives (senna, bisacodyl) are acceptable briefly with prior consultation. [28]

What to avoid: castor oil, mineral oil, and phosphate enemas are not recommended for pregnant women. If, despite all measures, severe pain, blood in the stool, weight loss, or fever persist, this is not a sign of constipation, but rather a need for an in-person diagnosis by a doctor. [29]

A separate practical detail is toilet ergonomics: use a small stool under your feet, avoid sitting for long periods, and avoid straining. It sounds simple, but it reduces pressure on hemorrhoids and the risk of further ruptures. This often rivals any ointments or suppositories in effectiveness. [30]

Table 5. Constipation during pregnancy: what to do/what to avoid

Group of funds	Can	Not desirable
Bulk laxatives	Psyllium, methylcellulose	-
Osmotic	PEG (polyethylene glycol), lactulose	Phosphate enemas (as indicated, with caution)
Stool softeners	Dokuzat	Mineral oil (avoid)
Stimulants	Senna, bisacodyl - briefly	Castor oil (avoid)
Non-pharm.	Fiber, water, movement, "stool"	Long periods of sitting/straining
Summarized from ACOG/AGA and patient information leaflets. [31]

Lactation and belladonna: what a nursing mother should consider

For atropine itself, the LactMed database notes that single doses are unlikely to interfere with breastfeeding, but long-term use of anticholinergics may reduce milk production and secretion. This is logical: cholinergic transmission is involved in the milk-ejection reflex. Specific data on herbal preparations containing belladonna are scarce, but the precautionary principle remains the same. [32]

If you're breastfeeding and suffer from hemorrhoids, the protocol is essentially the same as during pregnancy: bowel movement, sitz baths, local anesthetics, and a short course of hydrocortisone as indicated. Any suppositories containing opiates or belladonna are undesirable: during lactation, the opioid component can cause drowsiness and respiratory depression in the baby, and anticholinergics can potentially reduce lactation. It's better to choose proven alternatives. [33]

If you do receive an anticholinergic for medical reasons, tell your pediatrician—then your child's symptoms (lethargy, poor sucking, infrequent urination) won't remain a mystery. At the slightest doubt, it's easier to return to basic, yet effective measures: soft stools and topical treatments with good evidence support. [34]

And remember: breastfeeding is compatible with most first-line laxatives—polyethylene glycol, psyllium, and lactulose. They are virtually not absorbed and do not enter milk in significant quantities. This makes "heavy" topical preparations almost always unnecessary. [35]

Table 6. Breastfeeding and hemorrhoids: a safe set

Target	Solution	Why is it safe?
Normalize stool	PEG, psyllium, lactulose	Minimal systemic absorption
Relieve local pain	Lidocaine, hydrocortisone in short	Locally, few systemic effects
Home support	Warm baths, cold, ergonomics	Without medication, works for most people
What to avoid	Belladonna suppositories ± opioid	Risks for lactation and the child. [36]

Myths and Questions: Short but Accurate Answers

"Bellium is a plant, meaning it's safe and 'natural.'" Naturalness doesn't equal safety. Belladonna alkaloids are pharmacologically active anticholinergics with systemic effects. They cross the placenta and can cause transient cardiac effects in the fetus; in the mother, they experience typical anticholinergic side effects. It is not a first-line drug during pregnancy. [37]

"Bellium suppositories are needed to relieve spasms associated with fissures." Spasms can be relieved both non-medicinally (warm baths) and with safer topical treatments. Furthermore, anticholinergics often worsen constipation, a major pain driver. Therefore, strategically, they work against you. [38]

"Can I use it once—will it do any harm?" A single dose likely won't cause any serious consequences, but that's not a reason to prescribe it. There are solutions with zero systemic "cost" and comparable (and often superior) effectiveness. It's better to adjust the bowel movements and add baths/local anesthetics. [39]

"For severe pain during pregnancy, something more powerful is better." "More powerful" doesn't necessarily mean "more dangerous." For systemic pain during pregnancy, the analgesic of choice is paracetamol; for topical pain, try proven medications and soaks. Nonsteroidal anti-inflammatory drugs are avoided after about 20 weeks. [40]

Table 7. At a glance: yes/no for a pregnant woman

Situation	Yes	No
Constipation/hemorrhoids without complications	Fiber, water, PEG, baths, lidocaine/hydrocortisone	Belladonna suppositories, self-medication "on the Internet"
Late term/preparation for childbirth	Obstetric protocols, pain relief according to standards	Anticholinergics "for the cervix"
Lactation	PEG/psyllium/lactulose topical agents	Belladonna + opioid combo
Red flags (severe pain, bleeding, fever)	See a doctor immediately	Pull and endure