May occur during pregnancy, however, more often they are present prior to pregnancy and are aggravated by the pressure of the enlarging uterus.  Another common source of aggravation is constipation. Hemorrhoids may become very edematous with significant pain and bleeding most often during the postpartum period.

Recommendations:       

 

1.       Metamucil ® Psyllium or Colace as a stool softener and to prevent constipation

 

2.       Sitz baths

 

3.       Ice packs

 

4.       Anusol suppositories

 

5.       Tucks

 

6.       If there is considerable pain, bleeding, or edema, as with thrombosed hemorrhoids, surgical therapy may be indicated  

 

           

 

 

 

 

Prepared in conjunction with the

Division of Maternal-Fetal Medicine

Duke University Medical Center

 

 

 

                                                                                                                                  Director 

                                                                                                                                  Date 

 

Hemorrhoids

 

 

 

 

1.               Prenatal Care (Chapter 9) in Williams Obstetrics, 19th edition.  Cunningham G. editor.  Appleton and Lange, East Norwalk, Conn, 199

 

 

The Clinical Care Guidelines Development Committee of the Perinatal Improvement Board of Duke University Health System has developed a series of multi-disciplinary protocols to offer guidance to health care providers who are caring for pregnant women with high risk conditions.

 

These protocols are designed to assist health care providers in the management of a variety of problems that occur in pregnancy and the time of delivery. They should not be interpreted as standard of care, but instead represent only general guidelines for the care of pregnant women with high risk conditions.  We recognize that services offered by individual providers depend not only on their training, experience and institutional resources, but on the medical facts and circumstances of the specific care situation.

The protocols remain the intellectual property of the Duke University Health System.  They cannot be reproduced in whole or part without the expressed permission of the Health System.

 

These protocols are reviewed by the Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, the Department of Pediatrics Division of Neonatology and the Department of Anesthesiology Division of Women’s Anesthesia.  Please contact Andra H. James (andra.james@duke.edu), Chair, Clinical Care Guidelines Development Committee of the Perinatal Improvement Board with ideas for additional protocols.