Advertisement
Research Article| Volume 31, ISSUE 4, e272-e277, August 2018

Download started.

Ok

Hemorrhoids during pregnancy: Sitz bath vs. ano-rectal cream: A comparative prospective study of two conservative treatment protocols

Published:October 18, 2017DOI:https://doi.org/10.1016/j.wombi.2017.10.003

      Abstract

      Background

      Hemorrhoids are a very common ano-rectal condition affecting pregnant females worldwide and representing a major medical and socioeconomic problem. In this paper, we aim to compare the effectiveness of the Sitz bath method with an ano-rectal cream as part of a conservative management protocol to treat hemorrhoids among pregnant Saudi Arabian females.

      Methods

      A prospective comparative study of the results of two conservative treatment protocols of 495 pregnant females diagnosed to have hemorrhoids during pregnancy between January 2010 and December 2014 was done. The first conservative protocol consisted of three times per day salty warm Sitz bath (using 20 g of commercial salt) for 284 patients. The second protocol consisted of topical cream twice daily for 211 patients. Both protocols included the supportive treatments of 2 g glycerin suppositories per rectum 20 min before defecation as lubricant and Metamucil bulk-forming fiber (a mix of one dose (sachet) within 240 ml (8 oz) of cold liquid) once daily after breakfast for constipation.

      Results

      Complete healing was achieved in all patients 284 (100%) in the Sitz bath group, compared to 179 (84.8%) in the cream group. Sitz bath was found to represent a statistically significant difference in achieving complete healing for hemorrhoids in pregnant Saudi Arabian females compared to an ano-rectal cream (p-value < 0.05).

      Conclusion

      A conservative treatment protocol for hemorrhoids during pregnancy, in which Sitz bath is an essential modality, showed very promising outcomes compared to an ano-rectal cream.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Abramowitz L.
        • Sobhani I.
        • Benifla J.L.
        • Vuagnat A.
        • Daraï E.
        • Mignon M.
        • et al.
        Anal fissure and thrombosed external hemorrhoids before and after delivery.
        Dis Colon Rectum. 2002; 45: 650-655
        • Longo S.A.
        • Moore R.C.
        • Canzoneri B.J.
        • Robichaux A.
        Gastrointestinal conditions during pregnancy.
        Clin Colon Rectal Surg. 2010; 23: 80-89
        • Gojnic M.
        • Dugalic V.
        • Papic M.
        • Vidaković S.
        • Milićević S.
        • Pervulov M.
        The significance of detailed examination of hemorrhoids during pregnancy.
        Clin Exp Obstet Gynecol. 2005; 32: 183-184
        • Bradley C.S.
        • Kennedy C.M.
        • Turcea A.M.
        • Rao S.S.
        • Nygaard I.E.
        Constipation in pregnancy: prevalence, symptoms, and risk factors.
        Obstet Gynecol. 2007; 110: 1351-1357
        • Wald A.
        Constipation, diarrhea, and symptomatic hemorrhoids during pregnancy.
        Gastroenterol Clin North Am. 2003; 32 (vii): 309-322
        • Avsar A.F.
        • Keskin H.L.
        Haemorrhoids during pregnancy.
        J Obstet Gynaecol. 2010; 30: 231-237
        • Staroselsky A.
        • Nava-ocampo A.A.
        • Vohra S.
        • Koren G.
        Hemorrhoids in pregnancy.
        Can Fam Physician. 2008; 54: 189-190
        • Abramowitz L.
        • Benabderrhamane D.
        • Philip J.
        • Pospait D.
        • Bonin N.
        • Merrouche M.
        Haemorrhoidal disease in pregnancy.
        Presse Med. 2011; 40: 955-959
        • Tytgat G.N.
        • Heading R.C.
        • Müller-Lissner S.
        • Kamm M.A.
        • Schölmerich J.
        • Berstad A.
        • et al.
        Contemporary understanding and management of reflux and constipation in the general population and pregnancy: a consensus meeting.
        Aliment Pharmacol Ther. 2003; 18: 291-301
        • Alonso-Coello P.
        • Mills E.
        • Heels-Ansdell D.
        • López-Yarto M.
        • Zhou Q.
        • Johanson J.F.
        • et al.
        Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis.
        Am J Gastroenterol. 2006; 101: 181-188
        • Shafik A.
        Role of warm-water bath in anorectal conditions. The “thermosphincteric reflex”.
        J Clin Gastroenterol. 1993; 16: 304-308
        • Vazquez J.C.
        Constipation, haemorrhoids, and heartburn in pregnancy.
        BMJ Clin Evid. 2008; 2008
        • Giral A.
        • Memisoglu K.
        • Gültekin Y.
        • Imeryüz N.
        • Kalayci C.
        • Ulusoy N.B.
        • et al.
        Botulinum toxin injection versus lateral internal sphincterotomy in the treatment of chronic anal fissure: a non-randomized controlled trial.
        BMC Gastroenterol. 2004; 4: 7
        • Quijano C.E.
        • Abalos E.
        Conservative management of symptomatic and/or complicated haemorrhoids in pregnancy and the puerperium.
        Cochrane Database Syst Rev. 2005; CD004077
        • Kaidar-person O.
        • Person B.
        • Wexner S.D.
        Hemorrhoidal disease: a comprehensive review.
        J Am Coll Surg. 2007; 204: 102-117
        • Lohsiriwat V.
        Hemorrhoids: from basic pathophysiology to clinical management.
        World J Gastroenterol. 2012; 18: 2009-2017
        • Loder P.B.
        • Kamm M.A.
        • Nicholls R.J.
        • Phillips R.K.
        Haemorrhoids: pathology, pathophysiology and aetiology.
        Br J Surg. 1994; 81: 946-954
        • Welling D.R.
        • Wolff B.G.
        • Dozois R.R.
        Piles of defeat. Napoleon at Waterloo.
        Dis Colon Rectum. 1988; 31: 303-305
        • Tejirian T.
        • Abbas M.A.
        Sitz bath: where is the evidence? Scientific basis of a common practice.
        Dis Colon Rectum. 2005; 48: 2336-2340
        • Greenspon J.
        • Williams S.B.
        • Young H.A.
        • Orkin B.A.
        Thrombosed external hemorrhoids: outcome after conservative or surgical management.
        Dis Colon Rectum. 2004; 47: 1493-1498
        • Bharucha A.E.
        • Pemberton J.H.
        • Locke G.R.
        American Gastroenterological Association technical review on constipation.
        Gastroenterology. 2013; 144: 218-238
        • Fargo M.V.
        • Latimer K.M.
        Evaluation and management of common anorectal conditions.
        Am Fam Physician. 2012; 85: 624-630
        • Dodi G.
        • Bogoni F.
        • Infantino A.
        • Pianon P.
        • Mortellaro L.M.
        • Lise M.
        Hot or cold in anal pain? A study of the changes in internal anal sphincter pressure profiles.
        Dis Colon Rectum. 1986; 29: 248-251
        • Gupta P.J.
        Effects of warm water sitz bath on symptoms in post-anal sphincterotomy in chronic anal fissure — a randomized and controlled study.
        World J Surg. 2007; 31: 1480-1484
        • Mcconnell E.A.
        Giving your patient a sitz bath.
        Nursing. 1993; 23: 14
        • Gupta P.J.
        Warm sitz bath does not reduce symptoms in posthaemorrhoidectomy period: a randomized, controlled study.
        ANZ J Surg. 2008; 78: 398-401
        • Acheson A.G.
        • Scholefield J.H.
        Management of haemorrhoids.
        BMJ. 2008; 336: 380-383
        • Madoff R.D.
        • Fleshman J.W.
        American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids.
        Gastroenterology. 2004; 126: 1463-1473
        • Pumtong S.
        • Boardman H.F.
        • Anderson C.W.
        A multi-method evaluation of the Pharmacy First Minor Ailments scheme.
        Int J Clin Pharm. 2011; 33: 573-581
        • Association of the British Pharmaceutical Industry
        ABPI Compendium of Data Sheets and Summaries of Product Characteristics, Medicines Compendium.
        Datapharm Communications, London2001