New to this talk thing so here goes...
Having experienced the worst haemorrhoids ever over the last 5 days (with a little improvement in the last 24hrs), it would be wrong of me not to put a few thoughts down for others to consider. I do have knowledge in this area, I'm a nurse specialist (particularly of bottoms!!) but suffice to say was not able to prevent, nor successfully treat (or at least obtain adequate pain relief) these nasty suckers.
I'm now 38+5 weeks pg with 2nd and had similar problem (though not as bad) with first. Throughout this pregnancy I avoided constipation through regular laxatives (movicol/mag hydrox (milk of magnesia), high insoluble fibre diet and fluids. These laxatives were my choice following discussion with my consultant but GPs often prescribe lactulose. This is an appropriate choice but all laxatives work better when you increase yr fluid intake too.
So, despite not getting constipated and "straining at stool" I got 'em. About 4 external, thrombosed piles. Very, very painful. My bum looks like the Himalayas (climbed my explorers wearing crampons!). All thanks to the weight and pressure of my long awaited unborn child and hormones some of which can cause blood vessels to thin. These are sooo painful, excruciating in fact. And despite my knowledge, I started trawling the Internet for remedies.
I used the usual I would prescribe: proctosedyl ointment and frozen peas. But tears and hysteria ensued when nothing helped and panic set in. A surgical colleague (again specialist field) advised NO surgical treatment. The pain wouldl be intolerable, but (with sympathy) advised continuing with the above. This wasn't what I wanted to hear. I wanted them removed/lanced/injected but no. And using my professional head, I could understand this. The cause is not being removed and the wound wouldn't heal before "d-day". And no, they won't do a c section for painful piles!
So as the pain continues, I'm having warm salt baths (no evidence for this but does seem to help), instillagel (a local topical analgesia from GP) and intermittent proctosedyl ointment. And of course wedging a bag of frozen peas between butt cheeks. I'm pretty much sofa/bed bound as walking is impossible. My dd (3.5yrs) is very aware that mummy has a sore bottom (difficult to hide!), my dh is amazing looking after my every day to day needs as well as putting instillagel on my bottom, covering it with damp cotton wool (the pain and need for relief far outweighed the embarrassment 'n' all) and my mum helping out (even holding my hand while I did a poo on one occasion!!).
So, points to note:
*don't be embarrassed - go to yr GP - the sooner the better. Steroid based ointments are ok in pregnancy (proctosedyl, etc) but do thin the skin over prolonged use (this is why it says don't use for longer than 7 days). They help reduce inflammation and contain stuff to help shrink the pile and numb it a bit.
*if you are really suffering, ask for some instillagel (local aneasthetic) and use damp cotton wool to keep the gel on the area. It may sting a bit but goes off quickly.
*Thrombosed piles tend to be self limiting. This means they'll resolve on they're own or at least shortly after delivery. If pregnant, they should NOT be surgically treated (cut and squeezed).
*although being mobile can help resolve rhoids (improving blood flow) and is promoted when pregnant, it may be too painful to even walk. Don't panic, employ yr family and friends and talk to yr midwife.
*DONT, whatever you do, sit on a ring cushion. This is a very old practice and will in fact, make yr piles worse. The blood pools down in the vessels in yr bottom as yr bottom sinks into the ring and can't return easily thus engorging the vessels more. And don't spend any longer than absolutely necessary on the loo - same concept as the ring cushion. Wait till you need to go, go and then get off.
*wash yr bottom after a poo, avoid using loo roll or perfumed wet wipes - use a shower head with your bum over the bath side -use no soap just luke warm or cool water, pat dry with soft towel, then apply yr ointment etc
*immediate, effective relief is unlikely to be achieved. Sorry to be bearer of bad news. Cry, be hysterical, lie still and push on through. It will improve albeit slowly. Keep putting those frozen peas on and numbing gel. I know, you wouldn't let an animal suffer like this.
*take regular paracetamol. This will help the deep, constant ache in your bottom. You can take a max of 4g in 24hrs - don't exceed this. If yr pregnant, this is really the only oral analgesia you can take. Ibuprofen/Nurofen (NSAID's) are a NO NO in pregnancy. In the third trimester they can cause problems with the baby's heart and circulation. Codeine is also effective however this can constipate you (not a good idea given the circumstances!!!) so best avoided.
*increase fibre and fluid intake, take approved laxative if needed.
*Dont get annoyed with the mw/GP/HCP that says "delivery of yr baby is the only treatment" - this is true but hard to hear.
I hope that this has been helpful. There's lots on the internet but for the most, everything you try either doesn't really work or works initially with no long term gain.
BTW, although you think you won't be able to do the whole labour/delivery thing with piles, you will. My contractions started last night although very intermittent and along with them came that surge of the "bring it on, I can do this" hormone, the baby's shifted down a bit and there is some (albeit it small) relief on said piles.
My greatest sympathy and empathy to all sufferers.
I will answer any questions to the best of my knowledge but know my limitations... So if I don't know, I won't guess but will endeavour to find out.
. Check germaloids etc ointments in chemist; I'm sure they say they are safe to use while pg and bfing. Poor thing.