Hemorrhoids appeared during pregnancy. The reasons for the appearance of hemorrhoids during pregnancy and how to treat it. Removal of hemorrhoids during pregnancy

Why hemorrhoids often occur during pregnancy, how to cope with this problem for the expectant mother?

It is one of the most common diseases of the rectum and is expressed by an increase in venous nodes located under the mucous membrane of the rectum. Translated from Latin, the word "hemorrhoids" means "bleeding", it is this symptom that is considered one of the typical clinical signs of the disease.

The development of this pathology is due to the peculiarities of the anatomical structure of the rectum - under its mucous membrane there is a branched network of venous vessels, which forms special cavernous bodies that create connections between veins and arteries (called by specialists the hemorrhoidal vascular plexus), which have a very thin vascular wall. With development hemorrhoids during pregnancy under the influence of predisposing factors, which we will discuss below, the walls of the rectum, together with the vascular plexuses in the thickness, are significantly stretched, expanded and form hemorrhoids, bringing significant discomfort to the pregnant woman.

Hemorrhoid symptoms

By the location of hemorrhoids haemorrhoids subdivided into indoor and outdoor.
With internal hemorrhoids, the nodes are located in the rectal cavity and are not detected by palpation, the main symptom with such localization of the nodes is bleeding during bowel movements. It can have a different intensity - from smearing bleeding, which a pregnant woman will notice on toilet paper, to profuse bleeding, leading to the development of anemia (a decrease in the level of hemoglobin in the blood).

With external localization of the nodes, they are located in the region of the anus, when palpated, they are determined in the form of a single or multiple rounded formations, painful when touched. The main clinical sign of external hemorrhoids is pinching of the nodes, which is accompanied by pain.

According to the type of disease, hemorrhoids are of two types: chronic and acute, which, in fact, are stages of the same process.

Chronic hemorrhoids

Chronic hemorrhoids in the initial stages, it is often asymptomatic or with a minimal number of complaints, but gradually the manifestations of the disease become more and more noticeable.

There are 4 stages during the course of the disease:

Stage I- internal hemorrhoids increase, which do not fall out of the rectum during bowel movements. Patients periodically complain of a feeling of incomplete emptying of the rectum, discomfort in the anus, the release of a small amount of scarlet blood at the end of the act of defecation.

Stage II- Hemorrhoids fall out after bowel emptying, but they adjust themselves into the rectum. Unpleasant sensations at this stage are already more pronounced, patients complain of itching and burning in the anus after each bowel movement, spotting may be more abundant, there is a feeling that there is a foreign body in the rectum.

Stage III- hemorrhoids, falling out of the rectum after defecation, do not adjust on their own (it is possible to adjust them manually), pain syndrome joins the above complaints.

Stage IV- hemorrhoids cannot be put into the rectum, incontinence of gases and feces, abundant mucous and bloody discharge from the rectum can join a rather pronounced pain syndrome.

Acute hemorrhoids

Acute hemorrhoids(or, as specialists call it, thrombosis of hemorrhoids) has an even more vivid clinical picture and brings the patient significant discomfort due to the formation of blood clots (thrombi) in the venous plexus, which is accompanied by an inflammatory process in the perianal region (i.e. around the anus ). With an advanced inflammatory process, the body temperature rises.

The characteristic clinical manifestations of acute hemorrhoids are pronounced bursting pains, aggravated after defecation, enlargement and swelling of inflamed painful hemorrhoids from the anus, redness in the perianal region, and blood flow from the rectum.

According to the degree of pronounced inflammatory process, acute hemorrhoids are divided into 3 degrees of severity:

I degree- thrombosis of hemorrhoids without signs of an inflammatory process. The patient's condition is satisfactory (body temperature is normal), pain in the anus is moderate, occurs after defecation, persisting for some time after it.

II degree- a pronounced pain syndrome joins due to the development of an inflammatory process in the area of sharply enlarged hemorrhoids, the body temperature rises to 38 ° C. Inflamed hemorrhoids fall out and deform the anus, leading to difficulty in defecating. Mucus is secreted from the anus, which, irritating the perianal region, provokes itching and burning, which further increases the discomfort.

III degree- the inflammatory process spreads deep into the tissues (due to which the area of the anus, buttocks and perineum turns red), this increases the pain - in the area of the anus they become permanent, spreading to the buttocks and perineum. The body temperature rises to 39 ° C and above, in the rectal area there is a constant sensation of a foreign body, distention and pressure. The pains reach such intensity that walking, and even more so sitting, becomes almost impossible, the most comfortable position for the patient is lying on his stomach.

Complications of hemorrhoids during pregnancy

In addition to the fact that acute hemorrhoids in itself is a rather severe pathology that requires immediate medical attention, its danger lies in the fact that it can lead to the development of the following complications:

Necrosis(necrosis) of the hemorrhoid, which is possible when it is infringed, is expressed by the blackening of the enlarged node and the appearance of an unpleasant odor.

The development of profuse bleeding from the hemorrhoid, which in some cases, due to a very rich blood supply, can pose a real threat to the patient's life. In order to prevent the development of profuse (i.e. massive, life-threatening) bleeding, in no case should you try to correct the hemorrhoids that have fallen out on your own, you should consult a specialist.

Formation paraproctitis- purulent inflammation of the fatty tissue surrounding the rectal area - due to the spread of the inflammatory process deep into the pelvis.

Paraproctitis manifested by sharp throbbing pains, which intensify with movement and radiate (give) to the anus, accompanied by severe fever, intoxication (weakness, apathy, etc.). With the development of paraproctitis, immediate surgical care is required, since the abscess must be opened so that the pus comes out, then treatment continues in a surgical hospital, since careful wound care and antibiotic therapy are required.

Hemorrhoids during pregnancy: causes

Pregnancy refers to the factors provoking an exacerbation (if a woman has encountered this problem before) or development of hemorrhoids... It has been established that in women who have given birth, the disease occurs several times more often than in those without children, and during gestation, almost half (up to 40%) of expectant mothers suffer from hemorrhoids!

The predisposing factors leading to such a frequent development of this disease in pregnant women are:

A significant increase in intra-abdominal pressure as pregnancy progresses due to compression by the growing uterus of large vessels (for example, the inferior vena cava) that carry out venous outflow from the lower extremities and pelvic organs (including the rectum), which leads to impaired blood circulation below the level of compression, the consequence of which is stagnation of blood in the veins of the lower extremities and rectum.

Chronic constipation during pregnancy... The predisposition to constipation is due, firstly, to the influence of the main pregnancy hormone progesterone, which is responsible for relaxing the muscles of the uterus, which ensures successful gestation. But, in addition to the uterus, under the progesterone influence, relaxation of the hollow organs with smooth muscles, including the intestines, occurs, and this leads to a decrease in the activity of peristalsis (contractions of the intestines that contribute to the advancement of the food bolus). Secondly, the growing uterus puts pressure on neighboring organs, which include the rectum, which makes it difficult to empty it. Increased straining accompanying constipation provokes an increase in hemorrhoids.

Physical inactivity, or a sedentary lifestyle, also contributes to a decrease in intestinal contractile activity. As you increase gestational age even in the case of its normal course, it is more and more difficult for the expectant mother to behave as actively as before, she is lying or sitting more and more. In some cases, purely medical restrictions are also added, when physical activity for a woman is contraindicated in the interests of maintaining pregnancy, for example, with the threat of termination of pregnancy, placenta previa (abnormal location of the placenta, in which it attaches to the lower part of the uterus, which is dangerous due to the likelihood of development profuse bleeding).

A large number of births in the anamnesis (3 or more), since repeated sudden changes in intra-abdominal pressure during previous pregnancies and childbirth with each subsequent pregnancy increase the risk of developing either exacerbation of hemorrhoids.

Hereditary predisposition, since the structural features of the connective tissue, and therefore the vascular wall, are inherited.

So, the longer the gestation period, the higher the likelihood of developing hemorrhoids due to the growing load on the body of the expectant mother and an increasingly significant increase in intra-abdominal pressure, therefore, most often this disease develops in the third trimester, although a woman may face it in the first or second trimesters ...

Hemorrhoid treatment during pregnancy

Considering the serious consequences that running hemorrhoids during pregnancy, it becomes obvious the need for a timely visit to a doctor at the first sign of a problem. This is especially true for those expectant mothers who had hemorrhoids even before pregnancy, since the likelihood of an exacerbation of this disease while waiting for the baby is very high.

Treatment hemorrhoids during pregnancy carried out only under the guidance of a doctor!

When planning the amount of treatment depending on the severity of the disease, patients suffering from hemorrhoids can be divided into 3 groups:

The first group includes pregnant women with asymptomatic hemorrhoids (which can be detected only with a specialized medical examination), as well as those with a history of episodes exacerbations of hemorrhoids... Of primary importance for such expectant mothers is careful adherence to preventive measures, which we will talk about below, in order to minimize the deterioration of the course of the disease as the pregnancy progresses.

The second group includes patients with fairly obvious manifestations of hemorrhoids(1–2 stages of chronic hemorrhoids), and in this case, in addition to the conservative methods used to treat patients of the first group, there is a need for drug therapy. Do not forget that not all medicines can be used during pregnancy, which once again emphasizes the importance of consulting a specialist.

One of the important points of treatment hemorrhoids during pregnancy is the normalization of the stool, since not only constipation, but also diarrhea have an adverse effect on the course of the disease. It is necessary to adjust the stool so that it has a soft consistency, avoiding straining when emptying the intestines. To normalize the stool, it is extremely undesirable to abuse cleansing enemas, since the intestines quickly get used to them, after which they simply "refuse" to work on their own, which leads to the formation of a vicious circle when it becomes extremely problematic to go to the toilet without an enema.

To regulate stool during pregnancy, it is possible to use flaxseed, bran, methylcellulose and kelp preparations, which cause swelling and softening of feces in the intestine, facilitating its emptying.

Also, for the treatment hemorrhoids during pregnancy preference is given to topical preparations (in the form of suppositories, ointments or gels), since they have an effect directly at the site of application, not being absorbed into the mother's bloodstream and not entering the fetal bloodstream. The convenience of such dosage forms also lies in the fact that one tool combines components that have several effects at once (for example, anesthetic, anti-inflammatory and venotonic), which eliminates the need for massive drug therapy.

For anesthesia, suppositories with NOVOCAINE, LIDOCAINE, VENITAN gel (has an analgesic and antipruritic effect) are used.

In order to relieve inflammation, GEPATROMBIN G (in the form of suppositories or ointment), PROCTOSEDIL, NATALSID (which, in addition to anti-inflammatory, has a hemostatic and wound healing effect, and also facilitates the act of defecation), candles with sea buckthorn oil, can be prescribed.

To relieve spasm of the anal sphincter, suppositories with DIMEDROL are used, with local anesthetics (for example, with NOVOCAINE, ANESTHESIN, etc.), warm water also helps to relieve spasm gently, therefore, sedentary warm baths with a pale pink solution of MANGANESE or herbs with antiseptic properties (chamomile). To increase the tone of the venous wall, relieve inflammation, TROXEVASIN, VENORUTON, PROCTOGLIVENOL, GINKOR-FORTE, DETRALEX are used.

The third group includes patients with advanced forms hemorrhoids during pregnancy(III-IV stages), when it is not possible to correct the fallen out hemorrhoids on your own, as well as if there are complications of this disease. In such cases, there is a need for surgical treatment.

Surgical correction methods hemorrhoids can be divided into radical ones, when hemorrhoids are removed under general anesthesia (most often this is necessary in severe, complicated cases) and non-radical ones, which are less traumatic and contribute to a decrease in the size of hemorrhoids.

Non-radical methods:

sclerotherapy, which consists in introducing a special substance into the thickness of the node, causing the walls of the vessel to stick together, and replacing the affected area with connective tissue;
compression methods based on the imposition of special rings on the base of the node, which leads to compression of the vessels feeding it and necrosis (necrosis);
coagulation with infrared radiation causes cauterization of the vessels of the hemorrhoid, leading to a decrease in its size.

Fortunately, such severe cases, when during pregnancy there is a need for surgery, are extremely rare. As a rule, the situation can be kept under control with the help of drug therapy, and if the operation still cannot be avoided, it can be postponed until the postpartum period.

Prevention of hemorrhoids during pregnancy

Given how serious this disease can be, the importance of preventive measures can hardly be overestimated. Despite being simple enough, these measures are highly effective:

It is necessary to exclude the use of hard toilet paper, which leads to the appearance of microcracks in the anus. It is advisable to wash off after each trip to the toilet with cool water, since, in addition to the hygienic effect, this helps to increase the tone of the veins. If you cannot use a shower or bidet, you should use special wet wipes that do not contain alcohol.

It is necessary to wear only cotton underwear, do not use thongs, underwear with hard lace, traumatizing the delicate skin of the intimate area.

Physical activity is an important measure to promote regular bowel movements. Expectant mothers benefit from regular outdoor walks for 30–
40 min, morning exercises. Do not sit for too long or, conversely, lift weights (since a sharp drop in intra-abdominal pressure can provoke an increase and? /? Or prolapse of hemorrhoids), engage in heavy physical labor, which can include hand washing, washing floors.

Properly organized nutrition during pregnancy, as well as a drinking regimen are the most important measure for the prevention of hemorrhoids. The daily diet should include foods containing fiber that stimulate intestinal motility - black and bran bread, fruits and vegetables, cereals, especially oatmeal and buckwheat. Fermented milk products with bifidobacteria are also useful for expectant mothers. Prunes and dried apricots have a mild laxative effect. It is undesirable to use spicy, fatty, pickled foods, smoked meats, white flour products (buns, muffins, white bread). The diet should have enough liquid - from 1200 to 1500 ml, preference should be given to still water, fruit drinks, unsweetened natural juices, excluding strong tea and coffee, carbonated drinks with artificial colors.

Thus, with a focus on prevention hemorrhoids during pregnancy, and if its signs appear, by contacting a doctor in a timely manner, it is quite possible to avoid serious adverse consequences for the health of the expectant mother.

Many diseases and pathologies lie in wait for expectant mothers during pregnancy. Some are easy to heal, such as dental problems, swelling, and more. Others, such as hemorrhoids, cause a lot of inconvenience, physical and psychological discomfort. Hemorrhoids in expectant mothers happen quite often (20% of patients under 30 years old, and 50% from 30 and older). Modern medicine allows you to treat an ailment at different stages, to select an individual therapy that takes into account both the duration of pregnancy and its features.

Causes of hemorrhoids during pregnancy

Unfortunately, there are many causes of the disease. In the early stages (1st trimester and the beginning of the 2nd), the risk of ailment increases due to the hormone progesterone. Its production is enhanced after conception and affects the structure and tone of muscle cells, contributing to their relaxation. In nature, this function of progesterone allows the fetus to be carried out without the risk of unexpected uterine contractions. But at the same time as the uterus, the smooth muscle walls of the intestine relax, as a result of which the woman suffers from regular constipation.

Starting from the second trimester, a woman's mobility is limited (for medical reasons or for health reasons). Headaches, muscle weakness, increased swelling, dyspepsia and high blood pressure - all this forces expectant mothers to rest more often while lying and sitting. Lack of activity causes stagnation of blood in the vena cava and its branches in the pelvic region. The accumulation of blood leads to swelling of the natural vascular nodes that every person has.

In the 3rd trimester, the enlarged uterus compresses the inferior vein, preventing normal blood flow to the pelvic and rectal areas. At all stages of pregnancy, hemorrhoids may be favored by congenital pathology of the walls of blood vessels (in particular, the vena cava). Their natural weakness, combined with minimal mobility, increases the risk of ailment by 2-3 times.

Symptoms of hemorrhoids in pregnant women

Symptoms begin in the second and third trimester. Blood often stagnates in the intestinal area, the hemorrhoids of the rectum begin to expand and fill with fluid. The longer the gestation period, the greater the stretching of the blood vessels. They also lose their tone, which is fraught with protrusion of the plexuses under the mucous membrane.

important The early stage of the disease is characterized by protrusion of nodes into the lumen of the rectum. In this case, there is a burning sensation or itching around the anus, pain and discomfort during bowel movements, there is a sensation of a foreign object in the intestine. Often there are minor bleeding after bowel movement, blood impurities in the feces. As a rule, the first stage is characteristic of the 1st and 2nd trimester.

The peculiarities of the second stage are the prolapse of the nodes from the anus, and their automatic reduction back into the intestine. This happens when the position of the body changes. The nodes are painful, inflamed, dark red. The patient experiences pain during bowel movements, normal activities, walking, and rest.

The third stage is characterized by free sagging of the nodes without the possibility of repositioning. If the choroid plexus is pinched, the woman feels acute spasms in the anus, fever and hyperthermia may appear.

information The second and third stages of the disease (external hemorrhoids) occur in the 3rd trimester of pregnancy, when smooth muscle cells wear out under the weight of the uterus with the fetus, as well as as a result of regular constipation and a recumbent lifestyle.

Diagnosis of hemorrhoids during pregnancy

The presence of the disease is indicated by the primary symptoms: itching, discomfort and soreness during bowel movements, moist and bloody discharge from the anal canal, prolapsed vascular plexuses. As a rule, the disease occurs in women in the 3rd trimester, as well as after childbirth.

important The presence of sagging nodes allows you to accurately diagnose diseases and determine its stage. Additionally, the rectum is palpated through the anus. Thus, the doctor discovers the internal nodes, their structure, size, location and number.

An anal reflex test is also prescribed, which is carried out using a stroke stimulation of the perianal zone with a probe. For a detailed examination, an anoscopy procedure is prescribed, which allows you to view up to 12 cm of the anal canal.

Hemorrhoid treatment during pregnancy

Treatment of the disease is carried out depending on the stage of hemorrhoids, its form and characteristics of symptoms.

In the case of asymptomatic internal hemorrhoids, characteristic of the early stages, preventive measures are prescribed: adherence to a strict diet, frequent walks and active rest, baths for the anus after each bowel movement, taking herbs and laxatives to regulate the stool.

If acute symptoms occur in the first and second stages of the disease, treatment with ointments (for example, heparin), and (proctoglyvenol and others) is prescribed. Local treatment allows you to get rid of most of the symptoms: itching, burning, redness, inflammation, reduce pain, heal and regenerate tissues in the anus.

At the third stage of the disease, if the nodes fall out, urgent hospitalization is required, followed by surgical treatment. Excision of nodes is prescribed for the 2nd and 3rd trimester, or, if possible, for the postpartum period. The operation is highly undesirable to carry out, since it requires the use of anesthesia, and is accompanied by severe stress for the expectant mother.

Early treatment of hemorrhoids

In the early stages, the treatment of the expectant mother is carried out using natural preparations (for example, homeopathic or herbal suppositories, ointments, creams, oils and baths). These agents also have antimicrobial, anti-inflammatory and healing properties, and can reduce pain. Effective for the treatment of suppositories Natalsid and Relief, which eliminate bleeding and stop the inflammatory process. More information about the treatment of hemorrhoids with suppositories can be found in a separate detailed article.

Neo-anuzole is an astringent bactericidal drug, and Posterisan increases the protective properties of the rectal microflora, which helps to stop inflammatory processes. All of these methods are effective for internal hemorrhoids.

information Additionally, drug therapy is prescribed with the help of homeopathic preparations (Fleming's ointment), tablets (Detralex, etc.). They allow you to stop the acute symptoms of the disease.

Hemorrhoid treatment during pregnancy: 2 trimester

In the second and third trimester, drug treatment of the disease with drugs that are safe for the fetus is permissible. Toxerutin strengthens the walls of the capillaries, reduces stagnation of blood in the vessels, and stops inflammatory processes. Escin derivatives increase vascular tone, relieve swelling of hemorrhoidal plexuses, reduce blood viscosity and prevent the formation of blood clots in the area.

How and what to treat hemorrhoids in the later stages

Treatment of hemorrhoids in the 3rd trimester should be as effective as possible, since the approaching birth will require certain efforts from the expectant mother. In the later stages, local treatment is used, drug therapy, traditional medicine can be prescribed.

If necessary, surgical intervention is prescribed (only for the 2nd trimester and for 3 with the permission of the doctor). The operation is indicated for regular bleeding, swelling and prolapse of nodes, the presence of cracks, fistulas and polyps in the rectum, severe pain and an acute inflammatory process. Sclerotherapy (injections into the nodes) is a popular treatment.

Traditional methods of treating hemorrhoids during pregnancy

Hemorrhoids in expectant mothers are treated mainly with the help of medicinal herbs:

For oral administration, medicinal teas and decoctions are used. For example, we take the collection of medicinal lungwort (1 tbsp. L.) And pour 400 ml of boiling water. We insist the broth for 25-30 minutes, filter and take 1 tablespoon before meals.
Cold lotions will help to reduce the volume of nodes and eliminate painful sensations. Apply cool compresses to the inflamed area for 2-3 minutes, about 3 times a day.
For washing after emptying and before bedtime, herbal baths are used from the flowers of calendula, St. John's wort, clover, viburnum, etc.

It is also helpful to take medicinal ones. For the preparation of herbal baths are used collections of nettle, chamomile and plantain. A collection of oak bark, horsetail and steel is also used. The duration of the procedure is 10 minutes, once a day. The course of treatment is up to 2 weeks. Sitting baths are contraindicated for hypertonicity of the uterus and pregnancy complications.

Complications of hemorrhoids in pregnant women

In the absence of timely treatment in expectant mothers, complications of hemorrhoids are possible.

important With constant bleeding of the nodes, the patient loses blood, anemia occurs. In turn, a lack of hemoglobin can lead to oxygen starvation of the child, which will affect his development and growth. Infection of the node can lead to purulent processes and blood poisoning (sepsis), which can lead to fetal death. Thrombus formation in the area of inflammation is possible.

The choroid plexuses can become pinched and die off, causing internal infection. The patient experiences unbearable pain and, which can affect the development of the child and even provoke premature birth. One of the complications of the disease is paraproctitis. With advanced hemorrhoids, severe bleeding may open.

Prevention of hemorrhoids during pregnancy

As a preventive measure for washes, use a decoction of calendula, oak bark and chamomile.
Exclude spicy and spicy dishes from the menu, as well as fried, fatty, smoked, pickled and canned foods. Introduce as much plant food, dairy and fermented milk products into the diet as possible. Peristalsis and digestion are stimulated by cereals (buckwheat, rolled oats, etc.), whole grain bread.
Try to increase your physical activity. Do gymnastics every day, walk more often.
Fight constipation actively. To do this, introduce more fermented milk products into the diet. Drink 1 tablespoon on an empty stomach in the morning.

Preventive measures after childbirth

Prevention of hemorrhoids after childbirth should be started during pregnancy, especially in the last trimester. Prevent stagnation of blood in the pelvic area: exercise, attend aqua aerobics, change body position while resting. Also eat a high fiber diet.

Try not to wear tight bandages, belts and trousers during this period, choose the right underwear (natural, covering the buttocks, loose). For more information on the symptoms and treatment of the disease after childbirth, see our article "".

If you nevertheless noted symptoms of the disease, immediately make an appointment with a proctologist. Do not self-medicate, and in no case start hemorrhoids, as the disease is difficult to treat, it takes a lot of time and effort.

With the expansion of the cavernous bodies (venous plexuses) located in the rectum, blood stasis (stasis) occurs in them, due to which the vessels become dilated and convoluted, form hemorrhoids, which is called hemorrhoids.

Hemorrhoids are often diagnosed during pregnancy, and the likelihood of their occurrence depends on the number of births. So, in primiparous women, the disease occurs only in 20% of cases, and in multiparous women, its frequency increases to 40-50%, especially in the third trimester.

Views

Depending on the localization of hemorrhoids, external, internal and mixed (combined) hemorrhoids are distinguished.

With external hemorrhoids, venous nodes are located in the lower part of the rectum, and with internal hemorrhoids, in the upper part.

In the course of the disease, acute and chronic hemorrhoids are isolated, although in fact these are stages of the same process (for example, chronic hemorrhoids, when complications arise, become acute). Also, hemorrhoids can be complicated and uncomplicated.

Causes of pregnancy

The disease is caused by stagnation of blood in the veins as a result of increased intra-abdominal pressure. First of all, pregnancy itself contributes to an increase in intra-abdominal pressure.

As it grows, the pregnant uterus compresses large vessels, in particular the inferior vena cava, as a result of which the outflow of blood from the lower extremities and from the veins of the pelvis is disrupted, which provokes stagnation of blood in the legs and in the rectum.

In addition, as a result of hormonal changes during pregnancy (the production of progesterone increases), the myometrium and intestinal smooth muscles are in a relaxed state, which causes constipation and contributes to the onset or exacerbation (with existing hemorrhoids before pregnancy) of the disease.

Also, a sedentary lifestyle contributes to the weakening of intestinal motility. With an increase in gestation, a woman can no longer lead the same active lifestyle as before pregnancy or in the early stages, and spends most of the time at rest (lying or sitting).

Medical restrictions on physical activity (threat of interruption, placenta previa) also aggravate hypodynamia. Parity also matters. The more births there is in the anamnesis, the higher the percentage of exacerbation of hemorrhoids during gestation (multiple drops in intra-abdominal pressure during pregnancy and childbirth).

The predisposing factors for the development of the disease include:

hereditary predisposition;
inaccuracies in nutrition (a small amount of fiber in food, spicy food, a large amount of spices);
urological diseases (contribute to a systematic rise in intra-abdominal pressure);
small pelvis formation;
intense physical activity and weight lifting.

Hemorrhoid symptoms

With external hemorrhoids, which are milder, nodules appear in the anal area that look like warty formations or folds. They do not shrink with pressure and are dense. Internal hemorrhoids are characterized by the formation of nodes in the folds of the rectal mucosa. They are not visible, they are single or in the form of a corolla, fall off when pressed, but refill when coughing and straining. These nodules are painful and irritate the skin of the anus with mucus that is secreted.

Chronic hemorrhoids

It flows either asymptomatically or with a minimum of complaints and has 4 stages:

Stage 1 - enlarged internal hemorrhoids that do not go beyond the rectum during bowel movements (complaints of a feeling of incomplete emptying of the intestine, an unpleasant feeling in the anus, a small amount of bright, red blood at the end of emptying of the rectum).

Stage 2 - the nodes after a bowel movement go out (fall out), but they can independently adjust to the rectum (the discomfort is more significant, itching and burning after bowel movements appear, bloody discharge is significant, there is a feeling of sensation of a foreign body in the rectum).

Stage 3 - hemorrhoids cannot be reduced on their own, but manual reduction is allowed, pain occurs during and after each bowel movement.

Stage 4 - the nodes cannot be returned to the rectum, in addition to severe pain, there is incontinence of gases and feces, profuse mucus and bloody discharge from the intestine.

Acute hemorrhoids

There is nothing more than thrombosis of hemorrhoids. It occurs due to the formation of blood clots in the plexus of the veins and is characterized by an inflammatory process around the anus. It proceeds with severe symptoms:

significant bursting pains that increase during bowel movements,
enlargement and bulging of hemorrhoids from the rectum,
hyperemia in the perianal region,
bloody discharge from the anus.

Acute hemorrhoids have 3 degrees of severity of inflammation:

Grade 1 - thrombosis without an inflammatory reaction (moderate pain in the anus, appears after emptying).

Grade 2 - significant pain syndrome due to inflammation in the area of enlarged hemorrhoids, the temperature rises, the nodes come out and deform the anus, defecation becomes difficult, mucus flows out of the rectum, itching and burning occurs.

3 degree - inflammation spreads in depth, hyperemia of the anus, buttocks and perineum, pain intensifies, they become constant and are noted in the buttocks and perineum, the temperature rises to 39 ° C, the feeling of a foreign body in the rectum is constant, there is a feeling of fullness and pressure (the pain is so intense that movement and sitting are impossible).

Diagnostics

Differential diagnosis of the disease is carried out with:

anal fissure (there is bloody discharge and pain at the time of bowel movement and after it, but external or internal nodes are not palpable);
prolapse of the rectum or its mucous membrane (the formation of a cyafilindrical shape is palpable);
with rectal polyps (there is bleeding, but there is no pain, the formations are palpable even at rest, without straining).

The diagnosis is established on the basis of specific complaints, examination and digital examination of the rectum (external hemorrhoids visible to the eye, having a blue-purple color in thrombosis and palpation of internal nodes visible when the patient is straining, an assessment of their number, size and location).

From laboratory diagnostic methods are assigned:

a general blood test (a decrease in hemoglobin and hematocrit due to chronic post-hemorrhagic anemia, an increase in leukocytes and ESR during inflammation);
general urine analysis (detection or exclusion of urological pathology);
coagulogram (decrease in clotting time and bleeding, increase in prothrombin and prothrombin index);
blood group and Rh factor;
biochemical blood test, including urea and creatinine (excluding urological diseases);

From instrumental diagnostic methods are used:

sigmoidoscopy (examination of the rectal mucosa);
Ultrasound of the involved vein site, angioscanning when prescribing an angiosurgeon;
Ultrasound (echography) of the veins of the lower extremities.

Treatment during pregnancy

An obstetrician-gynecologist is involved in the treatment of hemorrhoids in pregnant women, if necessary, a vascular surgeon (coloproctologist) is connected.

Therapy of the disease begins with a correction of the diet (an increase in plant fiber in food, the prohibition of spicy, spicy and smoked foods).

daily walks,
therapeutic exercises for pregnant women (in the absence of contraindications),
establishing the frequency of emptying the rectum (at the same time),
washing away after each act of defecation with cold water.

With external hemorrhoids, warm baths with furacillin, medicinal herbs, potassium permanganate, suppositories and ointments with novocaine or lidocaine are prescribed to relieve itching and pain:

anestezol candles (conditionally recommended),
Venitan gel (recommended without restrictions).

In the case of acute hemorrhoids and in combination of the disease with an anal fissure, patients are hospitalized. Lead lotions, lotions with furacillin, heparin and butadion ointments, troxevasin-gel, hepatrombin-g, proctoglyvenol are prescribed locally to relieve inflammation and normalize blood flow in hemorrhoids.

For the prevention of complications of chronic hemorrhoids and in the acute process, drugs are prescribed internally that strengthen the vascular wall, improve venous outflow and have an anti-inflammatory effect:

escuzan (no data on safety during pregnancy),
venoruton (conditionally recommended from the II trimester),
Detralex (conditionally recommended),
troxevasin (no data on safety in the first trimester, conditionally recommended from the second trimester).

Treatment of acute hemorrhoids is 7-10 days.

Surgery during pregnancy

Surgical treatment of hemorrhoids during pregnancy is carried out with periodic heavy bleeding, prolapse of hemorrhoids and rectal mucosa, the presence of cracks and fistulas of the intestine (the decision is made by the doctor in conjunction with the pregnant woman).

During pregnancy, if possible, minor surgical operations are performed:

hardening of nodes;
ligation of nodes with a latex ring;
cryotherapy of nodes;
laser coagulation;
infrared photocoagulation.

Radical operations (excision of hemorrhoids) are postponed until the postpartum period.

Impact of hemorrhoids on the course and outcome of pregnancy

Hemorrhoids during pregnancy do not pose a serious danger and practically do not cause complications during pregnancy. But the aggravation of anemia of pregnant women due to recurrent bleeding from the rectum, the threat of termination of pregnancy and premature birth with emerging problems of defecation are not excluded.

The disease does not affect the choice of the method of delivery, the caesarean section is performed according to obstetric indications.

Complications of the disease during pregnancy and childbirth include:

thrombosis of hemorrhoids;
infringement and necrosis of the hemorrhoid;
severe bleeding.

The section is supervised by A.V. Sozinova, obstetrician-gynecologist. Professional experience since 2001.

Some studies during pregnancy

Diseases of the rectum in pregnant women are very common! And this is not surprising. The pressure on the vessels during this period doubles. What treatment for hemorrhoids during pregnancy is considered safe for the fetus?

Doctors-proctologists identify several risk groups for the occurrence of hemorrhoids. One of them is pregnant women and mothers who have given birth.

The formation of such a specific group is not accidental and is dictated by medical practice. Hemorrhoids are diagnosed in 25 - 40% of girls in position, as well as in 30 - 70% of women in childbirth. The older the woman, the higher the probability of diagnosing a pathology.

Features of the course of hemorrhoids in pregnant women
Manifestation	The disease often manifests itself in the 3rd trimester of pregnancy and after childbirth.
Reasons for the appearance	Increased intra-abdominal pressure on the veins and vessels of the pelvis, an increase in the volume of circulating blood, an increase in the level of progesterone, constipation, a sedentary image.
Main complaints	Pain during bowel movements, itching and burning in the anal region, bleeding.
How to treat	Diet (dietary fiber, plenty of fluids, semi-liquid food). Depending on the duration of pregnancy, after consulting a doctor, it is possible to use creams, ointments, suppositories, phlebotropic drugs.
How to prevent	Avoid straining during bowel movements, empty your bowels every morning, replace toilet paper with warm water, eat more fruits, vegetables, cereals, drink plenty of water.

Symptoms of the disease appear suddenly, and the lump can come out after 1 bowel movement

Hemorrhoids during pregnancy must be treated in the early stages of development. The ideal option is considered therapy and prevention even before pregnancy!

Why is this happening

Varicose veins are the most common ailment in pregnant women

Pregnancy and childbirth are a powerful provoking factor.

While the fetus is growing, the uterus is constantly increasing in size. Its pressure on the internal organs and blood vessels of various organs is constantly increasing. It is the hemorrhoids that are most adversely affected.

The main causes of hemorrhoids during pregnancy

Enlargement of the uterus
Sedentary lifestyle
Impaired blood flow in the lower body
Frequent constipation
Chronic diseases: varicose veins and blood vessels, atherosclerosis, etc.

Constipation makes the disease worse

Signs of manifestation

Symptoms of hemorrhoids during pregnancy, which indicate the development of pathology:

Itching and burning after stool;
Traces of blood on underwear, toilet rim;
Feeling of incomplete bowel movement;
Pain when walking, prolonged sitting position;
Appearance.

What does pathology look like? In most cases, there are dense red-blue hemorrhoids that can burst over time.

Complication of hemorrhoids during pregnancy

Thrombosis of external hemorrhoids occurs more often. They become very enlarged, thick and painful. Thrombosis occurs suddenly, even without a long mention of yourself.

After going to the toilet, expectant mothers often have internal hemorrhoids after a bowel movement. They can be injured, causing bleeding.

Hard stools often become a source of blood flow after a bowel movement. It is necessary to avoid constipation and prolonged sitting in the toilet. Pregnant women often complain of the appearance of anal fimbria. It does not disturb, but creates an alarming signal about the acute course of the disease.

At the first symptoms of hemorrhoidal disease, you should contact your doctor.

A specialist should refer a woman who will conduct a thorough diagnosis and choose an individual treatment tactics.

Can Hemorrhoids Treat During Pregnancy? Depends on the stage of development and gestational age. In the early months of gestation, conservative therapy is required. In later stages, treatment can be carried out immediately after childbirth.

Effective treatment

How to get rid of inflammation? If hemorrhoids are diagnosed during pregnancy, treatment is prescribed by a proctologist. During the period of fetal formation, therapeutic therapy is selected on an individual basis. It depends on the general condition of the patient and the duration of the pregnancy.

Only a doctor can select effective drugs that will not harm

What is the best tactic of treating pregnant women today?

Research shows that a threefold approach yields optimal results:

Application of local remedies. These are rectal suppositories, anti-inflammatory cream and ointment, anesthetic gel.
Prescribing phlebotonics drugs that improve blood flow.
A diet based on foods high in fiber.

Such complex treatment of hemorrhoids gives excellent results in the initial stages of its development.

When a pregnant woman becomes a patient of a proctologist, the doctor must exercise the utmost caution when prescribing oral medications. Careful testing of the effect of any drug on the fetus is necessary. Indeed, even medicinal herbs can be harmful in such a situation.

Until now, natural local remedies prevail in the treatment of diseases of pregnant women. As a rule, these are suppositories based on sea buckthorn oil. However, there are also proven medicines for internal and external use.

All drugs for hemorrhoids during pregnancy should be used strictly after consultation with a gynecologist and proctologist.

More often, to stop the inflammatory process and the development of the disease, they are prescribed:

Ointments approved for use by pregnant women are necessary if hemorrhoids are detected in their external form. Usually doctors prescribe, as well as Posterisan, Bezornil or.

All of these funds are considered safe for the fetus and therefore can be successfully used in the treatment of hemorrhoids in pregnant women. However, each remedy must certainly be prescribed by a doctor. It is possible that the doctor recommends a certain combination of drugs to achieve the best effect.

Traditional medicine for expectant mothers

How to treat hemorrhoids during pregnancy if medications are contraindicated? Folk remedies will come to the rescue.

For minor pain and itching in the anus, it is recommended to wash off with cool water. Even better, if washing is done with infusions / decoctions of dandelion, chamomile, wormwood, nettle or snake mountaineer. If possible, lotion should be done with the listed herbs.

It is better to coordinate water procedures with a doctor.

They will quickly relieve itching and pain in the anus.

Compresses from raw potatoes or beets will help get rid of hemorrhoids. Vegetables must be coarsely grated, wrapped in gauze and applied to the anal area.

You can also make your own rectal suppositories. They are cut from raw peeled potatoes or molded from crystallized honey. In the second case, a homemade suppository must be kept in the refrigerator before administration.

Prevention of pathology

Daily Prevention Will Minimize Disease