A review of Non-pharmacological and pharmacological treatments of Hemorrhoid in pregnancy

Document Type : Review Article

Authors

1 M.Sc. of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Ph.D. in Reproductive Health, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Assistant Professor, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

3 Assistant Professor, Department of Midwifery, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction: Hemorrhoid is one of the most common problems in pregnancy, especially in the second and third trimesters. In the absence of timely treatment and proper follow-up, the problem leads to a chronic disease that can impose harmful effects on the individual, the family and the society. Considering the high prevalence of this problem among pregnant women and failure to review the new advocacy, especially pharmacological and aggressive methods over the past 12 years, this study was performed with to review a variety of non-pharmacological and pharmacological treatments of hemorrhoids in pregnancy and their effectiveness.
Methods: To achieve the aim of the study, databases of PubMed, Scopus, ProQuest, Google Scholar, Science Direct, SID and Magiran were searched using English keywords of Hemorrhoid, Haemorrhoid, pregnancy, Pregnant, Medical Treatment, Conservative, Life style, Diet, Nutrition, Surgery, Hemorrhoidectomy and their Persian keywords were searched individually and in combination, from the timeframe covered until October 2019.
Results: There are several methods to treat hemorrhoids during pregnancy, but many of these methods are based on the results of clinical trials on the general population of patients with this condition, so, due to the lack of sufficient and powerful clinical studies on the application of some methods and the prohibition or caution of using some other methods during pregnancy, deciding about the choice of treatment depends on the condition of each patient and considering the criteria such as: gestational age, the severity and degree of sustainability of symptoms as well observing the hierarchy of treatment from conservative and non-invasive approach toward aggressive methods.
Conclusion: There are various methods for the treatment of hemorrhoids, but sufficient and robust studies to confirm the efficacy and safety of these methods to the specific population of pregnant women are limited.

Keywords


  1. American Society of Colon and Rectal Surgeons (ASCRS) [Internet]. 2007. Available at: https://www.fascrs.org/patients/disease-condition/hemorrhoids. Accessed February 21, 2018.
  2. Lohsiriwat V. Treatment of hemorrhoids: A coloproctologist's view. World J Gastroenterol 2015; 21(31):9245-52.
  3. Shirah BH, Shirah HA, Fallata AH, Alobidy SN, Hawsawi MMA. Hemorrhoids during pregnancy: Sitz bath vs. ano-rectal cream: A comparative prospective study of two conservative treatment protocols. Women Birth 2018; 31(4):e272-e277.
  4. Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. 19nd ed. New York: McGraw-Hill Education; 2015.
  5. Avsar AF, Keskin HL. Haemorrhoids during pregnancy. J Obstet Gynaecol 2010; 30(3):231-7.
  6. Beksac K, Aydin E, Uzelpasac E, Akbayrakc T, Ozyuncu O. Hemorrhoids and related complications in primigravid pregnancy. J Coloproctol 2018; 38(3):179-182.
  7. Vazquez JC. Constipation, haemorrhoids, and heartburn in pregnancy. BMJ Clin Evid 2008; 2008:1411.
  8. Gojnic M, Dugalic V, Papic M, Vidakovic S, Milicevic S, Pervulov M. The significance of detailed examination of hemorrhoids during pregnancy. Clin Exp Obstet Gynecol 2005; 32(3):183-4.
  9. Slauf P, Antos F, Marx J. [Complications of hemorrhoids]. Rozhl Chir 2014; 93(4):223-5.
  10. Quijano CE, Abalos E. Conservative management of symptomatic and/or complicated haemorrhoids in pregnancy and the puerperium. Cochrane Database Syst Rev 2005; (3):Cd004077.
  11. Brisinda G. How to treat haemorrhoids. Prevention is best; haemorrhoidectomy needs skilled operators. BMJ 2000; 321(7261):582-3.
  12. International Forum for Wellbeing in Pregnancy [Internet]. Available at: https://www.ifwip.org/reflexology-pregnancy/. Accessed January 18, 2018.
  13. Hejazi Sh, Alavi Majd H, Najafi Abedi Z. Study of association between lifestyle and hemorrhoids among patients referring to Tehran University of medical sciences hospitals in 2007. Medical Sciences Journal 2008; 18(2):127-131.
  14. Huang K, Tao F, Liu L, Wu X. Does delivery mode affect women's postpartum quality of life in rural China? J Clin Nurs 2012; 21(11-12):1534-43.
  15. Longo SA, Moore RC, Canzoneri BJ, Robichaux A. Gastrointestinal Conditions during Pregnancy. Clin Colon Rectal Surg 2010; 23(2):80-9.
  16. Staroselsky A, Nava-Ocampo A, Vohra-Miller S, Koren G. Hemorrhoids in pregnancy. Can Fam Physician 2008; 54(2):189-190.
  17. Zielinski R, Searing K, Deibel M. Gastrointestinal distress in pregnancy: prevalence, assessment, and treatment of 5 common minor discomforts. J Perinat Neonatal Nurs 2015; 29(1):23-31.
  18. Alonso-Coello P, Mills E, Heels-Ansdell D, Lopez-Yarto M, Zhou Q, Johanson JF, et al. Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis. Am J Gastroenterol 2006; 101(1):181-8.
  19. Shafik A. Role of warm-water bath in anorectal conditions. The "thermosphincteric reflex". J Clin Gastroenterol 1993; 16(4):304-8.
  20. Lim SS, Yu CW, Aw LD. Comparing topical hydrocortisone cream with Hai's Perianal Support in managing symptomatic hemorrhoids in pregnancy: a preliminary trial. J Obstet Gynaecol Res 2015;41(2):238-47.
  21. Vohra S, Akoury H, Bernstein P, Einarson TR, Pairaudeau N, Taddio A, et al. The effectiveness of Proctofoam-HC for treatment of hemorrhoids in late pregnancy. J Obstet Gynaecol Can 2009;31(7):654-9.
  22. Ebrahimi N, Vohra S, Gedeon C, Akoury H, Bernstein P, Pairaudeau N, et al. The fetal safety of hydrocortisone-pramoxine (Proctofoam-HC) for the treatment of hemorrhoids in late pregnancy. J Obstet Gynaecol Can 2011;33(2):153-158.
  23. Hylwa SA, Warshaw E. Contact allergy to pramoxine (pramocaine): the importance of testing to personal products. Dermatitis 2014; 25(3):147-8.
  24. Damianov L, Katsarova M. [Our experience in using the preparation Proctosedyl from the Roussel firm in pregnant women with hemorrhoids]. Akush Ginekol (Sofiia) 1993; 32(3):71.
  25. Lorenc Z, Gökçe Ö. Tribenoside and lidocaine in the local treatment of hemorrhoids: an overview of clinical evidence. Eur Rev Med Pharmacol Sci 2016; 20(12):2742-51.
  26. Jesmani E, Ebrahimzadeh Z, Kordi M, Rakhshandeh H, Mazloum S, Ghomian N. The effect of Coconut oil ointment on the symptom of Hemorrhoids in pregnant women: Randomized clinical trial. Iran J Obstet Gynecol Infertil 2019. [In press]
  27. Abramowitz L, Sobhani I, Benifla JL, Vuagnat A, Darai E, Mignon M, et al. Anal fissure and thrombosed external hemorrhoids before and after delivery. Dis Colon Rectum 2002; 45(5):650-5.
  28. Wijayanegara H, Mose JC, Achmad L, Sobarna R, Permadi W. A clinical trial of hydroxyethylrutosides in the treatment of haemorrhoids of pregnancy. J Int Med Res 1992; 20(1):54-60.
  29. Benzi G, Vanzulli A, Pozzi E, Acerboni S. [Clinical study for the evaluation of the tolerability of O-(beta-hydroxy-ethyl)-rutoside in the treatment of hemorrhoids during the 3d trimester of pregnancy and in the postpartum period]. Minerva Ginecol 1992; 44(11):591-7.
  30. Titapant V, Indrasukhsri B, Lekprasert V, Boonnuch W. Trihydroxyethylrutosides in the treatment of hemorrhoids of pregnancy: a double-blind placebo-controlled trial. J Med Assoc Thai 2001; 84(10):1395-400.
  31. Buckshee K, Takkar D, Aggarwal N. Micronized flavonoid therapy in internal hemorrhoids of pregnancy. Int J Gynaecol Obstet 1997; 57(2):145-51.
  32. Clinical Practice Committee, American Gastroenterological Association. American Gastroenterological Association medical position statement: Diagnosis and treatment of hemorrhoids. Gastroenterology 2004; 126(5):1461-2.
  33. Saleeby RG, Rosen L, Stasik JJ, Riether RD, Sheets J, Khubchandani IT. Hemorrhoidectomy during pregnancy: risk or reliefe?. Dis Colon Rectum 1991; 34(3):260-1.