External hemorrhoids in pregnancy

The formation of hemorrhoidal nodes around the rectum is called hemorrhoids, and a distinction is made between internal and external hemorrhoids. The latter involves pathological changes in the form of vein dilation of the external rectus plexus located around the anus. Pregnancy contributes to the development of the disease. [1]

Epidemiology

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

Causes of the external hemorrhoids in pregnancy

Carrying a child is accompanied by a great load on the vascular system. During this period, the volume of circulating blood increases by one third. The causes of hemorrhoids are as follows:

• The growing uterus presses on the pelvic veins, impairing blood circulation and stretching the rectal veins;
  • Hormonal changes (increased progesterone relaxes the smooth muscles of the intestines and veins);
• Reduced movement and physical activity in the third trimester of pregnancy leads to venous stasis;
• Frequent constipation, characteristic of this period, reduces the tone of the walls of the end of the colon.

Risk factors

Risk factors for the development of hemorrhoids include long-term regular use of hormonal contraceptives before pregnancy, excessive weight, improperly organized diet. Spicy dishes with the use of abundant spices, alcohol, hypertension also contribute to pathology. [5]

Pathogenesis

The pathogenesis of hemorrhoidal nodes is associated with the overgrowth of cavernous vein tissue, 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 the internal form, the manifestations of which do not bother the patient much, to the external, very painful with dangerous consequences. [6]

Symptoms of the external hemorrhoids in pregnancy

At first, a woman may not even realize that there is trouble related to 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, refusal to visit a proctologist aggravates the symptoms. There is itching in the anus, mucous discharge appears, hemorrhoidal nodes prolapse.

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

This scenario is no less likely to develop after childbirth, which only confirms the fact of pathology during childbirth. The exertions only caused the nodes to fall outward. [7]

Complications and consequences

Hemorrhoids are a rapidly progressive disease. Lack of treatment can cause profuse bleeding, anemia with such a complication as thrombosis of hemorrhoidal nodes. Often the disease causes inflammation, dangerous development of acute purulent paraproctitis. The formation of fissures and swelling is possible. [8]

Diagnostics of the external hemorrhoids in pregnancy

Proctologic examination of pregnant women is performed by a proctologist, it involves external visual inspection, finger examination, conducted on a special proctologic chair.

In the diagnosis of the disease can not do without instrumental methods, since external hemorrhoids come from problems inside the anus. Anoscopy examines this area, rectoscopy - 20cm 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 until 24 weeks of pregnancy, after this period only anoscopy.

Hemorrhoidal nodes are differentiated with polyps, other neoplasms, rectal prolapse. [9]

Treatment of the external hemorrhoids in pregnancy

First of all, the doctor will advise the pregnant woman to pay attention to nutrition: increase the diet of raw vegetables and fruits, switch to a dietary method of cooking, bring the drinking regime to 2 liters per day. Effective and therapeutic enemas based on vegetable oils that soften the fecal lump.

A recent systematic review of both published and unpublished randomized controlled trials involving more than 350 patients showed that laxatives in the form of fiber have beneficial effects in the treatment of symptomatic hemorrhoids. [10] Reducing straining during defecation narrows the internal hemorrhoidal veins, resulting in symptom reduction. Bathing in warm water (40-50°C for 10 min) usually relieves anorectal pain. [11]

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

To remove the nodes, relieve inflammation and soreness, you can use ointments and suppositories that are safe for the fetus. [12]

Medications

The best way to treat external hemorrhoids during pregnancy is to use ointments. Before using them, you need to empty the bowels, wash and dry yourself. They are applied in a thin layer around the anus. [13] Among them are the following:

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

In combination with ointments are prescribed and rectal suppositories:

• Natalcid - suitable for the treatment of bleeding hemorrhoids. It is obtained from brown seaweed. It is inserted into the anus twice a day (if the doctor does not determine another scheme) after emptying the bowels. Contraindicated in case of individual intolerance to the components. Indispensable for long-term treatment;
• Sea buckthorn suppositories - well heal, reduce inflammation, soften. They are used from 1 to 3 times a day. The average course of treatment - 7-10 days. Allergic reaction to the plant is possible from side effects;
• Relief (suppositories and ointment) - anti-inflammatory, immunomodulating, healing agent. It is based on cocoa butter and shark liver oil. It is not prescribed for diabetes mellitus, diseases of the circulatory system, allergies to its components. It is applied to pregnant women only with the permission of a doctor. Candles, as well as 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, strengthen blood vessels (A, C, E, K, P, B group) should be present iron, 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).

Folk treatment

There are some folk wisdoms known to relieve soreness, relieve the condition of the patient. One of them is candles from raw potatoes. Their size should be within 3-4 cm in length and 1-1,5cm in diameter. Starch, vitamin C, which is part of its composition, promote healing, tonify blood vessels.

You can also prepare your own composition to lubricate the anus: finely chop garlic, combine with sea buckthorn oil, slightly frozen. For this purpose, honey, propolis, butter can be used.

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

Herbal treatment

Herbs for the treatment of hemorrhoids prepare decoctions and infusions for lotions, using such plants as blueberry leaves, strawberries, chamomile, calendula, aloe, oak bark. Bandage folded into several layers dipped in the liquid, slightly squeezed and applied for about 10 minutes to the anus.

Homeopathy

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

Fleming's ointment - has antiseptic, anti-inflammatory and drying effect. It is applied with a tampon three times a day for a week. The drug may cause allergies, other adverse reactions have not been identified;

• Esculus - ointment based on horse chestnut fruit. It relieves swelling, accelerates tissue regeneration. It is applied to a tampon, which is inserted inside 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, zhen-shen. It has anti-inflammatory and antimicrobial effect;
• Anti-K - suppositories with fir and tea tree oil, yarrow, wormwood, thuja. They relieve itching, dry ulcers, prevent purulent complications.

Surgical treatment

Surgical treatment of external hemorrhoids in pregnant women is resorted to only in case of acute need. There are several minimally invasive surgical procedures that are not dangerous for women: sclerotherapy and cauterization with laser or infrared rays. [14]

Prevention

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

Forecast

The success of treatment of external hemorrhoids depends on the timeliness of treatment, preventing them from progressing to the next more serious stage. [15] Under certain circumstances, exacerbations may recur.