Treatment of hemorrhoids during pregnancy and after childbirth
With this delicate problem, every second woman who has a baby is confronted.Hemorrhoids during pregnancy can manifest itself both in its beginning, and at the end or after the birth.The period of bearing of the child is considered a provoking factor of this disease, due to changes in the body of the future mother.
Hemorrhoids are varicose dilated veins in the rectal area.In pregnancy, it is the vascular system that undergoes the greatest burden, as the volume of circulating blood increases by 30%.In the end, often there are problems of venous nature, such as leg varicose and hemorrhoids.
The mechanism of hemorrhoids formation during this period is the following: the uterus, which grows all 9 months, begins to press on the thick and rectum, which causes local stagnation of blood, and the crowded veins stretch to form hemorrhoids.The latter protrude under the mucous membrane of the intestine.This problem can greatly disturb a woman, and sometimes has an absolutely asymptomatic course.
Note: view that hemorrhoids appear for the first time after birth, erroneous.If after the birth of a child it worsened, it means that he was still during pregnancy, but did not show himself, because the hemorrhoidal nodes were internal.Table of contents: Causes of hemorrhoids during pregnancy Stages and types of hemorrhoids in pregnant women Symptoms of hemorrhoids in pregnant women
Causes of hemorrhoids during pregnancy
There are a number of factors that trigger the appearance or exacerbation of this disease in future mothers :
- Constipation that is chronic( the walls of the rectum stretch excessively during bowel emptying);
- physical inactivity or a life without sufficient level of movement( if a woman moves little, lies or sits more, then blood stasis forms in the pelvis, which provokes hemorrhoids and thrombosis of hemorrhoids);
- regular reception of contraceptives of hormonal origin before pregnancy( they negatively affect the condition of the venous wall);
- increased intra-abdominal pressure is formed due to insufficient circulation of blood in the small pelvis( due to the growing uterus);
- excess weight;
- a change in the hormonal background during pregnancy( an increase in progesterone causes a relaxation of smooth muscles in the body that lines the walls of the vessels and the intestines, which in turn causes constipation).
Important : not everyone knows that hemorrhoids can become worse not only after natural birth, but also after cesarean section of .
Stages and types of hemorrhoids in pregnant women
The most common disease is diagnosed in the third trimester of pregnancy, but this does not mean that hemorrhoids can not appear during the first three months.It can be internal, that is, not noticeable by visual inspection, and an external one, which can be clearly seen.
There are several stages of the development of hemorrhoids :
- Stage 1 - hemorrhoidal nodes in the lumen of the rectum, not extending beyond it;
- 2nd stage - the nodes sag from the anus, but when the position of the body changes, they are corrected;
- Stage 3 - hemorrhoids sag from the anus and is not adjusted when changing positions;
- Stage 4 - non-guided nodes are accompanied by complications in the form of thromboses, heavy bleeding.In this case two types of hemorrhoids may appear in pregnancy:
- acute, in which the disease occurs suddenly.
- A woman complains of pain in the back hike, blood in the stool, foreign body sensation, sometimes burning sensation;
- chronic.He meets much more often, his attacks are stopped by drugs, but he does not heal completely, and after a while because of provoking factors he resumes.
Symptoms of hemorrhoids in pregnant women
The clinical picture depends on the stage at which hemorrhoids are located and can combine such symptoms :
- sagging hemorrhoids from the rectum;
- pain during defecation;
- burning in the anus;
- feces by stools with traces of fresh blood;
- itching and discomfort in the anus;
- pains of a pulling character in the rectum, irradiating the lower back and the sacrum.
Note: symptoms of hemorrhoids may worsen when the is infringed by the hemorrhoids.This condition is manifested by a strong pain syndrome in the rectum and an increase in body temperature.A pregnant woman with the appearance of such symptoms is important to immediately seek medical help from a surgeon.
Signs of hemorrhoids after childbirth
If during pregnancy this illness did not manifest itself, because the nodes were internal, then after birth the probability of its aggravation is very high. A woman will be disturbed by such symptoms in the anal area of :
- acute pain;
- mucosal discharge;
- burning sensation;
- sense of foreign body in the anus;
- feces with blood veins.
Diagnosis of hemorrhoids during pregnancy
Confirmation and diagnosis of hemorrhoids requires a visit to the proctologist.The doctor will prescribe a screening program that will help determine the stage of the disease and choose the most appropriate treatment for hemorrhoids during pregnancy.
Diagnosis of hemorrhoids includes :
- Inspection.During an objective examination in the anal area, the doctor will visually notice hemorrhoids that are sagging outward.Mucous anus with hemorrhoids inflamed, has a red tint and pronounced venous pattern of small dilated capillaries.The presence of nodes is a differentiating feature that distinguishes hemorrhoids from colon cancer or anal fissures.Finger research helps to clarify the diagnosis and determine the presence of internal nodes, their location, size and quantity, and also helps to exclude or confirm the presence of anal fissures.
- Instrumental research.Recto-manoscopy - an optical examination of the rectum by means of a special device - a sigmoidoscope, during pregnancy is carried out in exceptional cases.
- Laboratory research.
In the laboratory diagnosis of hemorrhoids , a pregnant woman is prescribed:
- coprogram( qualitative study of feces);
- blood test( confirm anemia due to regular bleeding from hemorrhoids);
- analysis of feces for the presence of hidden blood.
How to treat hemorrhoids during pregnancy
The choice of method of therapy depends on the stage of the disease.
Hemorrhoids of the 1st stage during pregnancy are treated without the use of medication.Usually, the doctor recommends a future mother to change the diet, include enough fiber and sour-milk products( to normalize the chair), move more, perform gymnastics for pregnant women, walk in the fresh air, adhere to the rules of personal hygiene.
II stage of hemorrhoids requires the administration of drugs to eliminate unpleasant symptoms.The proctologist prescribes both tableted and ointment preparations that have a vasoconstrictive, anti-inflammatory, analgesic effect.Preference is given to local remedies( candles, ointments), so most of them do not have a systemic effect on the fetus.
Important to the : , a pregnant woman should not use any particular remedy for hemorrhoids, because many of them can have a negative effect on the fetus( for example, Bellatamine and Anuzol - candles with belladonna extract provoke miscarriage or premature birth).
Among the candles used are those that contain lanolin, cocoa butter, anesthetics,( novocaine, benzocaine), heparin, vegetable and animal oils( vitamin A, shark liver oil, sea buckthorn), anti-inflammatory and astringents.
The treatment regimen also includes:
- Ginkor forte;
Note: during pregnancy is forbidden to treat hemorrhoids with such preparations that contain bisacodyl, buckthorn, phenolphthalein, etc. since they cause an increase in uterine tone.
III and IV stages of hemorrhoids are considered severe, and combined therapy is used in their treatment.In addition to changing the diet and daily regimen prescribe candles, ointments, tablets.The surgical methods are resorted to if the dropping hemorrhoidal nodes do not fit into the rectum, but perform the operation after the birth.
It is also possible to use modern methods such as sclerosing injections, infrared coagulation and latex ligation, laser coagulation, which involve the complete removal of nodes.
Indication for emergency hospitalization during hemorrhoids during pregnancy is a heavy bleeding, infringement and necrosis of hemorrhoids.In this case, bloodless technologies are used.
Candles from hemorrhoids during pregnancy
These remedies are always prescribed by the proctologist individually, taking into account the stage and form of the disease, the duration of pregnancy, the characteristics of the course.
Most often pregnant women with hemorrhoids are prescribed suppositories from the list below:
- Hepatrombin - has analgesic, anti-inflammatory and blood-restoring effect.
- Proctoglivenol - normalizes vein tone, reduces permeability of capillaries, has anti-inflammatory effect, eliminates pain syndrome.
- Natalsid - plant-based candles( brown algae) that fight inflammation, effectively heal, soften the stool and thereby facilitate the emptying of the intestine.
- Relief suppositories that contain shark liver oil, well anesthetize, relieve inflammation, heal, soften.
- Proctosan - candles with a combined composition in the form of bufexamak, lidocaine, bismuth subgallate, titanium dioxide, which are perfectly disinfected, anesthetized, dried.
- Candles with propolis - have a wonderful healing effect, eliminate pain and itching in the anus, destroy pathogenic microorganisms.
In most cases, the treatment of hemorrhoids during pregnancy gives the expected result and until its delivery, its aggravation is eliminated.It is also important to exclude heavy physical labor.
Births with hemorrhoids
Hemorrhoids are not a contraindication to natural delivery.It can provoke some complications, but planned cesarean section because of it will not conduct.An exception can be only hemorrhoids severe 4 degrees, heavy bleeding from the nodes, thrombosis of the veins.The decision is always made exclusively by the attending physician individually in each specific case.For a woman in labor it is important to listen and do what the doctor and midwife say during labor, since the correct tactics will allow the entire process to be carried out without unnecessary muscle strain, and thus without rupture of knots and complications.The prognosis of the disease depends on how the delivery itself passes, what will be their duration.
In childbirth, when a woman has contractions and attempts, intra-abdominal pressure rises, due to the fact that the fetal head presses the pelvic vessels directly to the rectum.Hemorrhoidal nodes become larger, their consistency thickens.When the struggle is growing and the woman is pushing, the veins bulge, they become blue, during the pause they decrease.
Important : on the possibility of the appearance or non-appearance of hemorrhoids depends a lot on the rate of reduction of the anus sphincter after delivery.If this process occurs quickly, then there is a possibility of jamming the nodes, but this happens rarely.When the reduction occurs gradually, then the nodes usually return to their own place.
Treatment of hemorrhoids after delivery
Hemorrhoid therapy, as during pregnancy and after childbirth, includes such general requirements:
- lifestyle correction;
- eradication of constipation;
- normalization of water balance;
- power supply by hours;
- gymnastics for strengthening muscles in the anus zone;
- daily walks;
- breastfeed or watch TV better lying down to minimize pressure on the rectal veins;
- hygienic treatment.
To activate the intestinal robots, it is important to consume more fiber, vegetables, bread with bran, cereal, fruit, dried fruits, etc.
Note: ignore this problem to a woman after childbirth is not worth it, thinking that everything will pass by itself.An appeal to the proctologist will help clarify the diagnosis and choose a treatment that will not harm the baby if the woman is breastfeeding the baby.
Medical treatment of hemorrhoids of a nursing mother after delivery is the same as during pregnancy.
If the infant is on formula feeding, then the drugs listed below are allowed:
- Candles with methyluracil . They include an antibiotic that has a regenerating effect, heals the mucous membrane, stops bleeding, activates the immune system, stops bleeding and relieves pain.
- Ginkor Procto. This suppository with extract of Ginko Biloba is a venoprotectant that normalizes the elasticity and tone of the veins, local blood circulation, relieves inflammation.
- Candles with belladonna.Drug with active substances in the form of phenol and extract of belladonna.It removes the pain syndrome, has an antimicrobial effect, removes spasm, eliminates the infectious process in the anus.
- Anestesol.Candles with a combined composition( menthol, benzocaine, zinc oxide), which perfectly stop bleeding, eliminate pain in the rectum, dry and have an antiseptic effect.
- Nigepan. These candles contain benzocaine and heparin, which determine its anelgizing and antimicrobial effect, and also prevent the formation of thrombi.
This video review is devoted to the problems of diagnosis, prevention and treatment of hemorrhoids during pregnancy and after childbirth:
Viktorova Julia, obstetrician-gynecologist