Haemorrhoids in pregnancy

Haemorrhoids (also known as piles) are abnormally swollen vascular mucosal cushions in the anal canal

• women are predisposed to developing haemorrhoids during pregnancy particularly after the first trimester (1)
• pregnancy and vaginal delivery predisposes women to develop hemorrhoids because of hormonal changes and increased intra-abdominal pressure (2)
  • 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
• in many cases haemorrhoids do not cause major discomfort and can sometimes clear up by themselves
• haemorrhoids do not pose a significant health risk however they can be uncomfortable and painful
• treatments for haemorrhoids can help with the pain and discomfort but are not essential if haemorrhoids do not affect the quality of life

Management of haemorrhoids in pregnancy

• use a stepwise approach to treatment starting with non-pharmacological options if appropriate or possible (1)
  • choice of treatment will largely be guided by recommendations for non-pregnant patients taking into consideration the possible risks to the fetus into account
  • use local guidance if available
• non-pharmacological management
  • avoidance of constipation by eating a healthy balanced diet including adequate dietary fibre and drink plenty of water
  • avoid ‘stool withholding’ and undue straining during bowel movements
  • bathing with warm water (40°C to 50°C for 10 min) usually relieves anorectal pain (2)
  • exercise regularly
  • practise correct anal hygiene
• pharmacological management
  • if lifestyle measures are ineffective, or symptoms do not respond adequately, offer short-term simple analgesia (such as paracetamol) for pain relief
  • laxatives in the form of fibre had a beneficial effect in the treatment of symptomatic hemorrhoids (2)
    • decreased straining during bowel movements shrinks internal hemorrhoidal veins, resulting in a reduction of symptoms
  • topical over-the-counter (OTC) and prescription-only preparations for haemorrhoids
    • may contain antiseptic agents, astringents, lubricants, local anaesthetics, corticosteroids, and heparinoids in various combinations
    • are no preparations that are licensed for use in pregnancy (1)
      • however, the potential risk of harms to the pregnant woman and fetus is likely to be less with simple, soothing products than with those containing corticosteroid or local anaesthetic
  • refer to secondary care if unresponsive, or recurrent symptoms occur despite treatment

Reference:

1. NHS Specialist Pharmacy Service (March 2025). Haemorrhoids: treatment during pregnancy
2. Staroselsky A, Nava-Ocampo AA, Vohra S, Koren G. Hemorrhoids in pregnancy. Can Fam Physician. 2008 Feb;54(2):189-90.