TREATMENT OF HAEMORRHOIDS (PILES) IN PREGNANCY

Haemorrhoids (piles) occur due to prolapse of the anal cushions. They are often asymptomatic; however symptoms can manifest if the haemorrhoidal veins undergo enlargement and swelling. Both over-the-counter and prescription-only topical haemorrhoid preparations are available and may contain antiseptic agents, astringents, lubricants, local anaesthetics, corticosteroids, and heparinoids in various combinations.

None of these products are licensed for use in pregnancy, although many are used routinely on the basis that the active ingredients will likely only reach the fetus in small amounts and their use is generally only recommended for short periods. Haemorrhoids usually do not manifest in pregnancy until after the first trimester and use of these products beyond this stage of pregnancy would not be expected to increase risk of structural teratogenicity. However, to allow informed choice, women wishing to use these products should be made aware of the lack of data regarding pregnancy outcomes.

Exposure to topical haemorrhoid treatments at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.