Hemorrhoids are swollen veins in the anal canal. Veins can swell inside the anal canal (internal hemorrhoids) or they can swell near the opening of the anus (external hemorrhoids).
Overall, hemorrhoids happens when too much pressure on the veins in the pelvic and rectal area.
Normally, tissue inside the anus fills with blood to help control bowel movements. If you strain or sit on the toilet a long time to move stool, the increased pressure causes the veins in this tissue to swell and stretch. This can cause hemorrhoids. Diarrhea or constipation also may lead to straining and can increase pressure on veins in the anal
canal. Being overweight can also lead to hemorrhoids.
Your growing baby also puts pressure on the large veins behind your uterus. Hemorrhoids usually go away soon after your baby is born.
- https://www.nhs.uk/conditions/pregnancy-and-baby/piles-haemorrhoids-pregnant/
Anyone can get piles – they don’t just happen in pregnancy. When you’re pregnant, piles can occur because hormones make your veins relax.
Symptoms of piles can include:
- itching, aching, soreness or swelling around your anus
- pain when passing a stool (faeces, poo) and a mucus discharge afterwards
- a lump hanging outside the anus, which may need to be pushed back in after passing a stool
- bleeding after passing a stool – the blood is usually bright red
The most common symptoms of both internal and external hemorrhoids include:
- Bleeding during bowel movements. You might see streaks of bright red blood on toilet paper after you strain to have a bowel movement.
- Itching.
- Rectal pain. It may be painful to clean the anal area.
If hemorrhoids bulge out, you also may see mucus on the toilet paper or stool.
(3)Try to keep your stools soft and regular by eating plenty of food that’s high in fibre.This includes: wholemeal bread, fruit, vegetables. Drinking plenty of water can help, too.
Other things you can try include:
- avoid standing/sitting for long periods
- take regular exercise to improve your circulation
- use a cloth wrung out in iced water to ease the pain – hold it gently against the piles
- if the piles stick out, push them gently back inside using a lubricating jelly
- avoid straining to pass a stool, as this may make your piles worse
- after passing a stool, clean your anus with moist toilet paper instead of dry toilet paper
- pat, rather than rub, the area
Medicines can help soothe the inflammation around your anus. These treat the symptoms, but not the cause, of piles.
(1)How are hemorrhoids diagnosed?
Your doctor can tell if you have hemorrhoids by asking about your past health and doing a physical examination. Rectal bleeding can be a sign of a more serious problem, such as colon, rectal, or anal cancer. So if the first examination does not show a clear cause of your problems, your doctor may use a lighted scope (sigmoidoscope) to
look at the lower third of your colon. Or your doctor may use another kind of scope (colonoscope) to look at the
entire colon to check for other causes of bleeding.
If your hemorrhoids are severe, you may need other treatment.
Surgery to remove hemorrhoids may be done if other treatments don’t work.
https://www.webmd.com/baby/hemorrhoids-during-pregnancy
Your growing baby also puts pressure on the large veins behind your uterus. Hemorrhoids usually go away soon after your baby is born.
https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/hemorrhoids-during- pregnancy/faq-20058149
To ease the discomfort of hemorrhoids during pregnancy:
- Soak in warm water. Fill the tub with warm water and soak the affected area. Don’t put soap or bubble bath in the water.
- Avoid sitting for long periods of time. Sitting puts pressure on the veins in your anus and rectum. When
you can, lie on your side or stand up. If you must sit, take frequent breaks or sit on a hemorrhoid pillow, also known as a ring cushion or doughnut.
- Use an over-the-counter remedy. Apply witch hazel medicated pads to your anal area. Or ask your health care provider to recommend a hemorrhoid cream or rectal suppository that’s safe to use during pregnancy.
Keep in mind that constipation contributes to hemorrhoids during pregnancy. To relieve or prevent constipation:
- Ask your health care provider to recommend a safe fiber supplement to take during pregnancy
- Ask your health care provider to recommend a safe stool softener to take during pregnancy
If your hemorrhoids get worse, talk to your health care provider. Surgical treatment might be recommended after your pregnancy.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2278306/
training in toilet habits.
Although none of the topical antihemorrhoidal agents commonly used have been assessed for safety in pregnancy, it is unlikely that the constituent parts (anesthetic, corticosteroids, and anti-inflammatory agents) will harm the third- trimester infant.
Pregnancy and vaginal delivery predisposes women to develop hemorrhoids because of hormonal changes and
increased intra-abdominal pressure. It has been estimated that 25% to 35% of pregnant women are affected by this condition. In certain populations, up to 85% of pregnancies are affected by hemorrhoids in the third trimester. burning, painful swellings at the anus, dyschezia (painful bowel movements),
A recent systematic review of both published and unpublished randomized controlled trials, which included the
enrolment of more than 350 patients, showed that laxatives in the form of fibre had a beneficial effect in the treatment of symptomatic hemorrhoids.Decreased straining during bowel movements shrinks internal hemorrhoidal veins, resulting in a reduction of symptoms. Bathing with warm water (40°C to 50°C for 10 min) usually relieves
anorectal pain. Suppositories and ointments that contain local anesthetics, mild astringents, or steroids are available.
More aggressive therapies, such as sclerotherapy, cryotherapy, or surgery, are reserved for patients who have persistent symptoms after 1 month of conservative therapy. Some recent studies have shown the effectiveness of
botulinum toxin injections as a treatment for chronic anal fissure and hemorrhoids. Because of its mechanism of action, however, botulinum toxin is contraindicated during pregnancy and lactation.
Although most pregnant women experience improvement or complete resolution of their symptoms with the
conservative measures mentioned above, some women will need medications. Oral treatment with ruto-sides, hidrosmine, Centella asiatica, disodium flavodate, French maritime pine bark extract, or grape seed extract can decrease capillary fragility and reduce symptoms improving the microcirculation in venous insufficiency.
However, evidence of their safety in pregnancy is not yet conclusive.
Topical medications with analgesics and anti-inflammatory effects provide short-term local relief from discomfort, pain, and bleeding. Because of the small doses and limited systemic absorption, they can be used by pregnant women; however, the safety of any of them in pregnancy has not been properly documented.
Most topical preparations for hemorrhoids have been used in Canada for more than 25 years. They often contain
anesthetics, corticosteroids, and anti-inflammatory agents in varying proportions. Most of these products help to maintain personal hygiene and alleviate symptoms. However, there are no prospective randomized trials that suggest topical preparations reduce bleeding or prolapse in nonpregnant patients.
http://www.cfp.ca/content/54/2/189.full
https://www.seslhd.health.nsw.gov.au/sites/default/files/migration/Mothersafe/
documents/Haemorrhoids2017.pdf
Medical treatments
Laxatives are considered safe in pregnancy and can be taken to reduce straining during bowel movements.
Painkillers may be necessary if the pain is significant, and paracetamol is safe at any stage of pregnancy.
Codeine containing products are best avoided as codeine can cause constipation.
Suppositories and ointments
Many products which help relieve the symptoms of haemorrhoids are available over the counter (without prescription) from a pharmacy. There have been no studies confirming the effectiveness of topical haemorrhoid preparations, though they are widely used and not considered to increase risks to the baby at any stage of pregnancy.4 Medicines in these products help relieve the itch or discomfort of haemorrhoids, but do not treat the underlying varicose veins. A haemorrhoid preparation will contain some of the following medications.3
Hydrocortisone and prednisolone (corticosteroids) – reduce inflammation and itching. Lignocaine and cinchocaine (local anaesthetics) – reduce pain and irritation.
Witch hazel (hamamelis), aluminium acetate and allantoin – reduce inflammation.
Zinc oxide – protective.
Peru balsam and benzyl benzoate – mild antiseptic and anti-itching action. Suppository and ointment formulations are both safe to use in pregnancy. Follow the manufacturer’s directions for dosage and administration. Some products carry warnings
about a maximum period of use, as corticosteroid and local anaesthetic medications may cause changes to the skin or increase the risk of infection with prolonged exposure. It may be preferable to switch from one preparation to another over time to minimise side effects for the pregnant woman herself.
https://www.cfpc.ca/ProjectAssets/Templates/Resource.aspx?id=4218
https://www.rxlist.com/hemorrhoids_piles/article.htm
OTC MEDICATIONS AND HOME REMEDIES FOR HEMORRHOIDS
- Stool softeners work by increasing the water and fat content within the stool allowing it to be passed more easily. Docusate sodium is most often recommended drug in this class (Colace, Surfak, Correctal).
- Inflammation can be controlled with over-the-counter creams or suppositories.
Some brand ingredients (Preparation H) include low dose topical anesthetics to
help with symptoms. Others (Anusol, witch hazel) contain astringents that help shrink the swollen tissues. Both may contain low dose steroids (hydrocortisone) to decrease inflammation.
- If the medication contains a vasoconstrictor (for example, phenylephrine HCI, ephedrine, or epinephrine) it may elevate blood sugar levels if absorbed in large amounts.
- Prescription strength lidocaine or hydrocortisone may be offered by the health care professional.
Management of Haemorrhoids
In majority of the cases, haemorrhoids resolve on their own by simple life style modifications. Treatments help to reduce the discomfort such as burning, itching, constipation, bleeding and so on.
Too much straining when doing bowel movements, due to constipation is one of the common causes of heamorrhoids. A change in diet can help keep the stools regular and soft. This involves eating more fiber, such as fruit and vegetables, or switching your cereal breakfast to bran.
Patient may be advised to increase his/her water consumption. Avoid too much caffeine , processed food and aerated drinks.
If the patient is obese, losing weight may help reduce the incidence and severity of haemorrhoids.
Sedentary life style is found to be one of the common causes for venous stasis. Regular exercise, preferably long walk shall help the chances of haemorrhoids.
There are some over-the-counter (OTC) medications which help soothe the redness and swelling around the anus area. They do not cure piles, they only treat the
symptoms. Do not use them for more than seven consecutive days – longer periods may
irritate the anus area and cause skin thinning.
Homoeopathic remedies
Hamamelis virginica: Bleeding haemorrhoids. Any form of venous congestion and venous bleeding comes under the purview of this medicine and the rectal region is the most prominent. There is a feeling of soreness and bruised sort of sensation.
Ratanhia: Painful haemorrhoids. There is pain while passing stool and the pain persists for hours afterwards. The pain is as if there is broken glass inside the rectum. Sometimes there is pain as if a knife is thrust inside. Dry heat or burning may also be felt. This burning may be relieved by cold water.
Graphities: Haemorrhoids with constipation with hard, knotty stools and united by mucous threads. The patient may be obese, constipated with history of skin eruptions this remedy is mostly indicated.
Nux vomica: Patients with haemorrhoids and having a sedentary life style. People with more mental work with little physical activity and tends to take lot of rich food. Use of stimulants like liquor or cigarettes is also quite high. It not only cures the piles but also sets the gastrointestinal system in order again.
Aesculus Hippocastanum: There is pain in the back along with the piles. There may be pain in the rectum as if it is full of small sticks. More often, the piles is blind in character, which means that there is no bleeding.
Other medicines commonly used in homeopathy for haemorrhoids are Aloe socotrina, Nitricum acidum, Sulphur and Collinsonia canadensis
Reference http://www.medicalnewstoday.com http://www.homeopathicdoctor.co.in/
- PUBLISHED DATE : May 11, 2016
- PUBLISHED BY : Zahid
- CREATED / VALIDATED BY : Dr. Eswara Das
- LAST UPDATED ON : May 11, 2016