Ewha Med J.  2022 Oct;45(4):e11. 10.12771/emj.2022.e11.

Treatment of Hemorrhoid in Unusual ConditionPregnancy

Affiliations
  • 1Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea

Abstract

Hemorrhoids are varicose veins of the rectum that are located in or near the anal canal and are covered by mucosa. They can occur at any age, are generally symptomless, and affect both sexes equally. Hemorrhoids are a common complaint among younger women and are more likely to occur during pregnancy and the menstrual cycle. In this article, we discuss the many approaches in the treatment of hemorrhoids. Laxatives, stool softeners, and fiber supplements are all considered safe for use by pregnant women. Moderate use of laxatives is also acceptable. Since there is a lack of sufficient evidence to support the safety and efficiency of topical medicines or oral phlebotomies during pregnancy, these treatments must to be utilized with an increased degree of extreme caution. In the case that considerable bleeding occurs, anal packing may be a straight forward and helpful operation to implement. A hemorhoidectomy is the treatment option for hemorrhoids that have become strangulated, badly thrombosed, or have bleeding that cannot be controlled.

Keyword

Hemorrhoids; Hemorrhoid therapy; Hemorrhoid in pregnancy; Hemorrhoid complication

Reference

References

1. Ng KS, Holzgang M, Young C. Still a case of “no pain, no gain”? An updated and critical review of the pathogenesis, diagnosis, and management options for hemorrhoids in 2020. Ann Coloproctol. 2020; 36(3):133–147. DOI: 10.3393/ac.2020.05.04. PMID: 32674545. PMCID: PMC7392573.
Article
2. Pham BV, Kang JH, Phan HH, Cho MS, Kim NK. Malignant melanoma of anorectum: two case reports. Ann Coloproctol. 2021; 37(1):65–70. DOI: 10.3393/ac.2020.01.07.1. PMID: 33730798. PMCID: PMC7989557.
Article
3. Goligher JC. Haemorrhoids or piles. In. Goligher JC, Duthie HL, Nixon HH, editors. editors. Surgery of the anus, rectum and colon. 4th ed. London: Baillière Tindall;1980. p. 96.
4. Sobrado Júnior CW, de Almeida Obregon C, da Silva e Sousa Júnior AH, Sobrado LF, Nahas SC, Cecconello I. A new classification for hemorrhoidal disease: the creation of the “BPRST” staging and its application in clinical practice. Ann Coloproctol. 2020; 36(4):249–255. DOI: 10.3393/ac.2020.02.06. PMID: 32674550. PMCID: PMC7508483.
Article
5. Fathallah N, Beaussier H, Chatellier G, Meyer J, Sapoval M, Moussa N, et al. Proposal for a new score: hemorrhoidal bleeding score. Ann Coloproctol. 2021; 37(5):311–317. DOI: 10.3393/ac.2020.08.19. PMID: 32972102. PMCID: PMC8566148.
Article
6. Jeong H. The effort to reduce vasovagal reaction and abdominal pain during stapled hemorrhoidopexy. Ann Coloproctol. 2020; 36(5):291–292. DOI: 10.3393/ac.2020.10.13. PMID: 33207111. PMCID: PMC7714375.
Article
7. Yano T. Is there a relationship between stool consistency and pain at first defecation after limited half hemorrhoidectomy? A pilot study. Ann Coloproctol. 2021; 37(5):306–310. DOI: 10.3393/ac.2020.08.10. PMID: 32972107. PMCID: PMC8566150.
Article
8. Bhatti MI, Sajid MS, Baig MK. Milligan–Morgan (open) versus Ferguson haemorrhoidectomy (closed): a systematic review and meta-analysis of published randomized, controlled trials. World J Surg. 2016; 40(6):1509–1519. DOI: 10.1007/s00268-016-3419-z. PMID: 26813541.
Article
9. Brown SR. Haemorrhoids: an update on management. Ther Adv Chronic Dis. 2017; 8(10):141–147. DOI: 10.1177/2040622317713957. PMID: 28989595. PMCID: PMC5624348.
Article
10. Altomare DF, Giannini I. Pharmacological treatment of hemorrhoids: a narrative review. Expert Opin Pharmacother. 2013; 14(17):2343–2349. DOI: 10.1517/14656566.2013.836181. PMID: 24024752.
11. Hills DL, Firth BG, Wi ni ford, Willer son IT. Pregnancy and cardiovascular abnormalities of clinical problems in cardiology. ABE;Milan: 1990. p. 917–927.
12. Struckmann JR, Meiland H, Bagi P, Juul-Jørgensen B. Venous muscle pump function during pregnancy. Assessment by ambulatory strain-gauge plethysmography. Acta Obstet Gynecol Scand. 1990; 69(3):209–215. DOI: 10.3109/00016349009028682. PMID: 2220341.
Article
13. Williams JW, Cunningham FG, Mc Donald PC, Gant NF. Williams obstetrics. 18th ed. Appleton & Lange;Nor walk: 1989. p. 129–168.
14. Cruikshank DP. Cardiovascular, pulmonary, renal and hematologic disease in pregnancy. In. Scott JR, Disain PJ, Hammond CB, Spellacy WN, editors. editors. Danforth’s obstetrics and gynecology. 6th ed. Philadelphia: Lippincott;1990. p. 433–459.
15. Loder PB, Kamm MA, Nicholls RJ, Phillips RKS. Haemorrhoids: pathology, pathophysiology and aetiology. Br J Surg. 1994; 81:946–954. DOI: 10.1002/bjs.1800810707. PMID: 7922085.
16. Pigot F, Siproudhis L, Allaert FA. Risk factors associated with hemorrhoidal symptoms in specialized consultation. Gastroentérol Clin Biol. 2005; 29(12):1270–1274. DOI: 10.1016/S0399-8320(05)82220-1.
Article
17. Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. 2012; 18(17):2009–2017. DOI: 10.3748/wjg.v18.i17.2009. PMID: 22563187. PMCID: PMC3342598.
18. Assaraf J, Lambrescak E, Lefèvre JH, de Parades V, Bourguignon J, Etienney I, et al. Increased long-term risk of anal fistula after proctologic surgery: a case-control study. Ann Coloproctol. 2021; 37(2):90–93. DOI: 10.3393/ac.2019.06.18. PMID: 32054251. PMCID: PMC8134930.
Article
19. Cho KJ, Hwang DY, Lee HJ, Hyun KH, Kim TJ, Park DH. Prospective comparative analysis of the incidence of vasovagal reaction and the effect of rectal submucosal lidocaine injection in stapled hemorrhoidopexy: a randomized controlled trial. Ann Coloproctol. 2020; 36(5):344–348. DOI: 10.3393/ac.2020.02.12. PMID: 32178498. PMCID: PMC7714374.
Article
20. Tsunoda A, Takahashi T, Sato K, Kusanagi H. Factors predicting the presence of concomitant enterocele and rectocele in female patients with external rectal prolapse. Ann Coloproctol. 2021; 37(4):218–224. DOI: 10.3393/ac.2020.07.16. PMID: 33445838. PMCID: PMC8391036.
Article
21. Büyükaşık S, Abdussamet Bozkurt M, Kapan S, Alis H. Analyzing the role of anal sphincter pressure in rectocele formation. Ann Coloproctol. 2020; 36(5):330–334. DOI: 10.3393/ac.2019.09.15. PMID: 32178503. PMCID: PMC7714383.
Article
22. Avsar AF, Keskin HL. Haemorrhoids during pregnancy. J Obstet Gynaecol. 2010; 30(3):231–237. DOI: 10.3109/01443610903439242. PMID: 20373920.
Article
23. Jewell DJ. Interventions for treating constipation in pregnancy. Cochrane Database Syst Rev. 2015; (9):CD011448. DOI: 10.1002/14651858.CD011448.pub2. PMID: 26342714. PMCID: PMC8958874.
24. Singh B. Psyllium as therapeutic and drug delivery agent. Int J Pharm. 2007; 334(1–2):1–14. DOI: 10.1016/j.ijpharm.2007.01.028. PMID: 17329047.
Article
25. Lee-Robichaud H, Thomas K, Morgan J, Nelson RL. Lactulose versus polyethylene glycol for chronic constipation. Cochrane Database Syst Rev. 2010; (7):CD007570. DOI: 10.1002/14651858.CD007570.pub2. PMID: 20614462.
26. Shafik A. Role of warm-water bath in anorectal conditions. J Clin Gastroenterol. 1993; 16(4):304–308. DOI: 10.1097/00004836-199306000-00007. PMID: 8331263.
Article
27. Maestre Y, Parés D, Salvans S, Ibáñez-Zafón I, Nve E, Pons MJ, et al. Cold or hot sitz baths in the emergency treatment of acute anal pain due to anorectal disease? Results of a randomised clinical trial. Cir Esp. 2010; 88(2):97–102. DOI: 10.1016/j.ciresp.2010.04.007. PMID: 20580349.
Article
28. Ashaal YE, Chandran VP, Siddiqui MN, Sim AJ. Local anal hypothermia with a frozen finger: a treatment for acute painful prolapsed piles. Br J Surg. 1998; 85(4):520. DOI: 10.1046/j.1365-2168.1998.00647.x. PMID: 9607538.
29. Lim SS, Yu CW, Aw LD. Comparing topical hydrocortisone cream with Hai's perianal support in managing symptomatic hemorrhoids in pregnancy: a preliminary trial. J Obstet Gynaecol Res. 2015; 41(2):238–247. DOI: 10.1111/jog.12523. PMID: 25256125.
Article
30. Bjørn AMB, Ehrenstein V, Nohr EA, Nørgaard M. Use of inhaled and oral corticosteroids in pregnancy and the risk of malformations or miscarriage. Basic Clin Pharmacol Toxicol. 2015; 116(4):308–314. DOI: 10.1111/bcpt.12367. PMID: 25515299.
Article
31. Elimian A, Garry D, Figueroa R, Spitzer A, Wiencek V, Quirk JG. Antenatal betamethasone compared with dexamethasone (betacode trial): a randomized controlled trial. Obstet Gynecol. 2007; 110(1):26–30. DOI: 10.1097/01.AOG.0000268281.36788.81. PMID: 17601892.
32. Lee BH, Stoll BJ, McDonald SA, Higgins RD. Neurodevelopmental outcomes of extremely low birth weight infants exposed prenatally to dexamethasone versus betamethasone. Pediatrics. 2008; 121(2):289–296. DOI: 10.1542/peds.2007-1103. PMID: 18245420.
Article
33. Bauer AZ, Swan SH, Kriebel D, Liew Z, Taylor HS, Bornehag CG, et al. Paracetamol use during pregnancy: a call for precautionary action. Nat Rev Endocrinol. 2021; 17(12):757–766. DOI: 10.1038/s41574-021-00553-7. PMID: 34556849. PMCID: PMC8580820.
Article
34. Abramowitz L, Benabderrhamane D, Philip J, Pospait D, Bonin N, Merrouche M. Pathologie hémorroïdaire de la parturiente. Presse Med. 2011; 40(10):955–959. DOI: 10.1016/j.lpm.2011.06.015. PMID: 21840677.
35. Alonso-Coello P, Zhou Q, Martinez-Zapata MJ, Mills E, Heels-Ansdell D, Johanson JF, et al. Meta-analysis of flavonoids for the treatment of haemorrhoids. Br J Surg. 2006; 93(8):909–920. DOI: 10.1002/bjs.5378. PMID: 16736537.
36. Jiang ZM, Cao JD. The impact of micronized purified flavonoid fraction on the treatment of acute haemorrhoidal episodes. Curr Med Res Opin. 2006; 22(6):1141–1147. DOI: 10.1185/030079906X104803. PMID: 16846547.
Article
37. Alonso P, Johanson J, Lopez-Yarto M, Martinez MJ. Phlebotonics for haemorrhoids. Cochrane Database Syst Rev. 2003; (1):004322. DOI: 10.1002/14651858.CD004322.
Article
38. Vazquez JC. Constipation, haemorrhoids, and heartburn in pregnancy. BMJ Clin Evid. 2010; 2010:1411.
39. Kubicsek T, Kazy Z, Czeizel AE. Teratogenic potential of tribenoside, a drug for the treatment of haemorrhoids and varicose veins: a population-based case–control study'. Reprod Toxicol. 2011; 31(4):464–469. DOI: 10.1016/j.reprotox.2010.12.001. PMID: 21182931.
Article
40. Lacroix I, Beau AB, Hurault-Delarue C, Bouilhac C, Petiot D, Vayssière C, et al. First epidemiological data for venotonics in pregnancy from the EFEMERIS database. Phlebology. 2016; 31(5):344–348. DOI: 10.1177/0268355515589679. PMID: 26060062.
Article
41. Menteş BB, Görgül A, Tatlicioğlu E, Ayoğlu F, Ünal S. Efficacy of calcium dobesilate in treating acute attacks of hemorrhoidal disease. Dis Colon Rectum. 2001; 44(10):1489–1495. DOI: 10.1007/BF02234604. PMID: 11598479.
Article
42. Falkay G, Kovács L. Calcium dobesilate (doxium) as a prostaglandin synthetase inhibitor in pregnant human myometrium in vitro. Experientia. 1984; 40(2):190–191. DOI: 10.1007/BF01963593. PMID: 6421615.
Article
43. Tamás P, Csermely T, Ertl T, Vizer M, Szabó I, Prievara FT. Calcium dobesilate lowers the blood pressure in mild to moderate midtrimester hypertension: a pilot study. Gynecol Obstet Invest. 1999; 47(3):210–213. DOI: 10.1159/000010080. PMID: 10087420.
Article
44. Kersting S, Loch H. Coloproctological problems in pregnancy and postpartum. Chir Mag. 2007; 29:22–25.
45. Brühl W, Wienert V, Herold A. Hämorrhoiden. Current proctology. Bremen: Uni-med Verlag;2005. p. 56–71.
46. Bussen S, Herold A, Schmittner M, Krammer H, Bussen D. Coloproctological diseases in pregnancy and the postpartum period. Geburtsh Frauenheilkd. 2008; (11):68:1–5. DOI: 10.1055/s-2008-1039050.
47. Di Re A, Toh JWT, Iredell J, Ctercteko G. Metronidazole in the management of post-open haemorrhoidectomy pain: systematic review. Ann Coloproctol. 2020; 36(1):5–11. DOI: 10.3393/ac.2020.01.08. PMID: 32146782. PMCID: PMC7069672.
Article
48. Herold A. Analvenenthrombose. In. Brühl W, Wienert V, Herold A. editors. Current proctology. Bremen: Uni-med Verlag;2005. p. 72–76.
49. Forner DM, Vestweber KH, Lampe B. Proctological diseases in gynecological practice. Frauenarzt. 2006; 47:102–106.
50. Gojnic M, Dugalic V, Papic M, Vidaković S, Milićević S, Pervulov M. The significance of detailed examination of hemorrhoids during pregnancy. Clin Exp Obstet Gynecol. 2005; 32(3):183–184.
Full Text Links
  • EMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr