Condition Management

It is important to complete an individual risk assessment for your patient and to apply the principles of prescribing during pregnancy when looking at the available information and making treatment decisions. Check to see if a risk assessment has already been completed.

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.

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.

Guidelines

NICE CKS Haemorrhoids provides advice on the management of haemorrhoids, however it does not include specific information on treatment selection or use in pregnancy.

Treatment options

Treat haemorrhoids using a stepwise approach starting with non-pharmacological options if appropriate or possible. 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 options

Treatment options include lifestyle measures such as:

• 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
• exercise regularly
• practise correct anal hygiene

Pharmacological options

If lifestyle measures are ineffective, or symptoms do not respond adequately, offer short-term simple analgesia (such as paracetamol) for pain relief.

Topical treatments

Consider a topical haemorrhoidal preparation for symptomatic relief.

Over-the-counter (OTC) and prescription-only preparations may contain antiseptic agents, astringents, lubricants, local anaesthetics, corticosteroids, and heparinoids in various combinations. There are no preparations that are licensed for use in pregnancy. 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.

Monitoring in pregnancy

The use of topical haemorrhoid treatments at any stage in pregnancy is not regarded as grounds for additional fetal monitoring.

Pregnancy outcome information

UK Teratology Information Service (UKTIS) has safety and pregnancy outcome information on the treatment of haemorrhoids in pregnancy.

Patient information

UKTIS has corresponding BUMPS patient information on the treatment of haemorrhoids in pregnancy.

NHS Medicines A-Z provides summary statements on piles in pregnancy and for specific medicines in pregnancy including lidocaine and hydrocortisone.

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