Surgery Needed for Some Hemorrhoids in Pregnancy.

ORLANDO, FLA. -- Hemorrhoids that bleed, thrombose, prolapse, or cause extreme pain and are unrelieved by conservative measures may justify surgery in a pregnant or puerperal patient, colorectal surgeon Dr. Fidel Ruiz Healy said during a meeting of the One Kilo Club.

The hemodynamics of pregnancy, such as vascularization of the genitoperineal area and gradual pressure of the uterus on pelvic and lower extremity venous systems, create conditions conducive to hemorrhoidal disease, as do pregnancy-associated constipation, heredity, and, in mothers who delay childbearing, aging itself.

Hemorrhoids should be diagnosed only after a proctologic examination has been performed, said Dr. Ruiz Healy, chief of the cola-proctology surgical service at Centro Hospitalario Sanatorio Durango in Mexico City.

He displayed slides of patients whose conditions had been misdiagnosed as hemorrhoids when they in fact had chronic pruritus, protruding polyps, condylomata, a perianal hemangioma, rectal prolapse, or an epidermoid cancer, respectively.

When an accurate diagnosis is made, bed rest, sitz baths, a high-fiber diet, and topical medications are prescribed and generally relieve patients' symptoms.

In most cases, symptoms diminish or improve after labor and delivery he noted at the meeting held in conjunction with the 37th International College of Surgeons' North American Federation Congress.

Nonetheless, some patients' symptoms are so profound during pregnancy or shortly after delivery that surgery is recommended. In such cases, ob.gyns. ...