General considerations
It is important to complete an individual risk assessment for your patient and to apply the principles of prescribing in breastfeeding when looking at the available information and making treatment decisions.
This article includes the most commonly used medicines for treating rectal and anal disorders during breastfeeding. See also our advice on using rectal corticosteroid preparations. Contact our specialist service for further advice or if the medicine is not included here.
Recommendations
Topical rectal and anal preparations are compatible with breastfeeding, and the choice of product will depend on the indication.
For anal fissures
Glyceryl trinitrate rectal ointment and diltiazem cream or ointment (unlicensed) may be used during breastfeeding.
Haemorrhoids and related conditions
Local anaesthetics (such as cinchocaine or lidocaine), corticosteroids (such as hydrocortisone or prednisolone) and zinc oxide may be used topically and rectally to treat haemorrhoids and related conditions during breastfeeding, and they are often available as combination products.
Some of the commonly-used products (Anusol products, Germoloids, Proctosedyl, Scheriproct, Uniroid-HC, Xyloproct) contain additional ingredients such as bismuth compounds, peru balsam or benzyl benzoate. Due to the low dose of medication contained, small application area and minimal absorption, they are compatible with breastfeeding.
Further considerations
In general, try to minimise infant exposure by using the lowest effective dose for the shortest effective duration. If longer term treatment is required, additional infant monitoring may be necessary, particularly for corticosteroids.
Practical tips
Precautions should be taken to avoid direct contact of the breastfeeding infant with the medication, such as washing hands thoroughly after application and before touching the infant.
Specific recommendations
Patient Information
The NHS website provides advice for patients on the use of specific medicines in breastfeeding.
Contact us
Get in touch with the UK Drugs In Lactation Advisory Service (UKDILAS), our specialist breastfeeding medicines advice service if you need support in the following situations:
- you need further advice
- the medicine in question is not included here
- the infant is unwell or premature
- multiple medicines are being taken
About our recommendations
Recommendations are based on published evidence where available. However, evidence is generally very poor and limited, and can require professional interpretation. Assessments are often based on reviewing case reports which can be conflicting and lack detail.
If there is no published clinical evidence, assessments are based on: pharmacodynamic and pharmacokinetic principles, extrapolation from similar drugs, risk assessment of normal clinical use, expert advice, and unpublished data. Simulated data is now increasingly being used due to the ethical difficulties around gathering good quality evidence in this area.
Bibliography
Full referencing is available on request.