Condition Management
Haemorrhoids (also known as piles) are abnormally swollen vascular mucosal cushions in the anal canal. It has been estimated that 25% to 35% of pregnant women will have haemorrhoids.
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.
Guidelines
NICE CKS Haemorrhoids provides advice on the management of haemorrhoids. Choice of treatment will largely be guided by recommendations for non-pregnant patients, but will need to take possible risks to the foetus into account.
You should check if there is local guidance for you to use in your area.
Stepwise recommendations
The guidelines recommend a stepwise approach starting with non-pharmacological measures if appropriate or possible, through the range of pharmacological options:
Non-pharmacological management
- Avoid constipation, adequate dietary fibre and increased fluid intake.
- Correct anal hygiene
- Avoid ‘stool withholding’ and undue straining during bowel movements,
Pharmacological management
If lifestyle measures are ineffective, or symptoms do not respond adequately, offer short-term simple analgesia (such as paracetamol) for pain relief.
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. OTC haemorrhoidal preparations should no longer be routinely prescribed
Refer to secondary care if unresponsive, or recurrent symptoms occur despite treatment.
Pregnancy outcome information
UKTIS has information on the treatment of haemorrhoids in pregnancy
Patient information
Each of the UKTIS summaries has corresponding BUMPS patient information.
NHS Medicines A-Z provides information on piles in pregnancy and summary statement on the use in pregnancy of specific medicines including lidocaine and hydrocortisone.