Treatment of haemorrhoids (piles) in pregnancy
(Date of issue: April 2016. Version: 1)
This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by Public Health England on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.
What are they?
Haemorrhoids (piles) are areas of swollen tissue that protrude from the anus (back passage). They may not cause any other symptoms but if the veins within the tissue become enlarged and swollen, itching, burning, pain, painful bowel movements and/or bleeding may occur.
Haemorrhoids are common in pregnancy, especially in the second and third trimesters. This is thought to be partly due to the normal hormonal changes of pregnancy, some of which also increase the risk of constipation. Constipation can lead to haemorrhoids as straining during a bowel movement causes the tissue within the anus to bulge and protrude outside.
How are haemorrhoids treated in pregnancy?
Haemorrhoids in pregnancy are often treated using a step-by-step approach. Sometimes a combination of the measures described below will be required to fully relieve the symptoms.
(1) Lifestyle measures
Changes to lifestyle can help to reduce the risk of constipation and straining:
• Focus on not straining during a bowel movement
• Try to pass stools in the morning and/or after meals when the bowel is likely to be more active
• Eat plenty of fruit and vegetables, wholegrain bread, and wholegrain breakfast cereals to increase your fibre intake
• Maintain an adequate fluid intake (around 1.5 to 2 litres every day)
• Exercise regularly
Pregnant women with haemorrhoids who are taking an iron supplement might be switched to a slow-release form of the medicine to reduce the risk of it causing or aggravating constipation.
For more information on dietary advice to avoid constipation please see the bumps leaflet on treatment of constipation in pregnancy.
If lifestyle measures fail to relieve constipation, use of certain laxatives can be considered in pregnancy. However, laxatives should only be used under medical supervision and for short periods of time during pregnancy. Laxatives that are commonly used during pregnancy include:
• Bulk-forming laxatives (e.g. wheat bran, linseed, ispaghula [Fybogel,® Isogel,® Ispagel,® Regulan®], methylcellulose [Celevac®], and sterculia [Normacol®])
• Lactulose (Duphalac,® Lactugal,® Laevolac®)
• Glycerin suppositories
• Bisacodyl (Dulcolax®)
• Senna (Senokot®)
• Docusate sodium (Dioctyl,® Docusol®)
• Sodium picosulfate (Dulcolax Pico®)
• Macrogols (Laxido,® Molaxole,® Movicol®)
For more detailed information on use of laxatives in pregnancy please see the bumps leaflet on treating constipation in pregnancy.
(3) Haemorrhoid treatments
If lifestyle measures and laxatives do not provide relief of symptoms, topical haemorrhoid treatments (that are applied directly to the affected area) can be considered. Haemorrhoid treatments come in the form of creams, ointments, foams, sprays, and suppositories. They do not cure haemorrhoids but generally provide short-term relief from the symptoms.
There are numerous different types of haemorrhoid treatments. Some can be bought over the counter but others must be prescribed.
Brands available in the UK include Anugesic®, Anusol®, Anacal®, Germoloids®, Proctofoam®, Proctosedyl®, Scheriproct®, Ultraproct®, Uniroid,® and Xyloproct®.
Haemorrhoid treatments contain different combinations of active ingredients depending on the product. These include antiseptic agents (to prevent infection), lubricants (to ease discomfort), local anaesthetics (to numb pain), and corticosteroids (to reduce inflammation).
Are haemorrhoid creams safe to use during pregnancy?
None of the products listed above are licensed for use in pregnancy. However haemorrhoids are common in pregnancy and many of these products are used routinely on the basis that only small amounts of the active ingredients are likely to reach the baby in the womb. A baby’s body and most internal organs are formed during the first 12 weeks of pregnancy. It is mainly during this time that some medicines are known to cause birth defects. Haemorrhoids usually do not develop in pregnancy until after the first trimester and use after the first trimester would therefore not be expected to cause structural birth defects in the baby. In the UK the manufacturer of Anusol® cream, ointment and suppositories states that these products may be considered for use during pregnancy.
A study carried out in Canada found that women who used a haemorrhoid treatment containing a corticosteroid and a local anaesthetic in the third trimester were not at increased risk of premature delivery or of having a low birth weight baby compared to women not exposed to this product. Unfortunately, no other scientific studies have assessed haemorrhoid treatments in pregnancy.
Some pregnant women may experience severe pain from their haemorrhoids. Paracetamol is generally recommended for pain relief in pregnancy. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen should not be used as they can make haemorrhoids worse or increase the risk of bleeding. Use of NSAIDs during pregnancy is not advised unless prescribed by your doctor, especially if you are 30 or more weeks pregnant. For more information please see the bumps leaflets on use of paracetamol and ibuprofen in pregnancy.
Will my baby need extra monitoring during pregnancy or after delivery?
Most women will be offered a scan at around 20 weeks of pregnancy to look for birth defects as part of their routine antenatal care. Using haemorrhoid treatments in pregnancy is not expected to cause problems that would require extra monitoring of your baby.
Are there any risks to my baby if the father has used haemorrhoid treatments?
No studies have specifically investigated whether haemorrhoid treatments used by the father can harm the baby through effects on the sperm, however most experts agree that this is very unlikely. More research on the effects of medicine use in men around the time of conception is needed.
Who can I talk to if I have questions?
If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.
Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks. They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.
Medicines use in pregnancy
Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby. There are, however, some medicines that can harm a baby’s normal development. How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.
If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.
When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.
Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.