HEMORRHOID DISEASE: DIAGNOSIS TREATMENT AND COMPLICATION MANAGEMENT

Hemorrhoidal_Disease_Bahadir_Egekapak

HEMORRHOIDAL DISEASE IN PREGNANCY

Mustafa Oruç

Ankara Bilkent City Hospital, Department of General Surgery, Ankara, Türkiye

Oruç M. Hemorrhoidal Disease in Pregnancy. In: Ege B, editor.Hemorrhoidal Disease: Diagnosis, Treatment and Complication Management. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.115-123.

ABSTRACT

Hemorrhoids are a common anorectal condition among pregnant and postpartum women, with an incidence ranging from 25% to 35%, reaching as high as 85% in some populations. Physiological changes during pregnancy significantly contribute to the development of hemorrhoids. These changes primarily include increased intra-abdominal pressure and the resultant venous dilation, hormonal changes leading to decreased gastrointestinal motility, and the frequent occurrence of constipation during pregnancy. Additionally, hemorrhoids often go unreported due to embarrassment and misconceptions, leading to delayed care and an increased frequency of complications such as thrombosis, fissures, and chronic bleeding.

Beyond physiological changes, constipation-exacerbated by low dietary fiber intake, iron supplementation, and reduced physical activity-plays a role in symptom severity. Clinically, internal hemorrhoids manifest as painless rectal bleeding, while external hemorrhoids are associated with severe pain and swelling. Thrombosis, a complication that can affect all types of hemorrhoids, significantly impacts quality of life.

Diagnosis primarily relies on a detailed clinical evaluation. Anoscopy and, less commonly, sigmoidoscopy can be used to exclude other anorectal conditions. Preventing hemorrhoids involves minimizing risk factors through a fiber-rich diet, hydration, physical activity, and proper toileting practices. Randomized studies emphasize that adhering to these recommendations can reduce the incidence of pregnancy-related hemorrhoids by nearly half.

Treatment methods vary based on symptom severity and pregnancy-related considerations. Conservative approaches, such as lifestyle changes, sitz baths, and topical therapies, form the foundation of management and are widely recommended as first-line treatments with proven success. Pharmacological interventions, including corticosteroid creams and flavonoids, provide symptomatic relief with minimal fetal risk when used appropriately. In severe cases, surgical options such as hemorrhoidectomy or thrombectomy may be required. Numerous studies, particularly regarding thrombosed cases, highlight the safety and efficacy of hemorrhoidectomy during pregnancy and postpartum. However, conducting strong evidence-based studies in pregnant individuals is challenging due to ethical concerns, and most available studies are retrospective. Consequently, a personalized approach is essential when determining the suitability of hemorrhoidectomy.

A multidisciplinary approach, integrating general surgery and obstetrics expertise, is crucial for optimal patient management. Conducting colorectal examinations alongside routine pregnancy check-ups in the second and third trimesters can aid in the diagnosis and management of the condition. Early diagnosis, patient education, and preventive measures play a vital role in reducing the disease burden and improving maternal health. This chapter aims to serve as a resource for healthcare providers by offering insights from the latest literature to enhance care standards for this common yet often overlooked condition.

Keywords: Hemorrhoids; Hemorrhoidectomy; Pregnancy; Pregnancy complications; Anorectal disorders

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