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The information provided is taken from various reference sources.  It is provided as a guideline.  No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used.  Clinical decisions remain the responsibility of medical and breastfeeding practitioners.  The data presented here is intended to provide some immediate information but cannot replace input from professionals.

Haemorrhoids (piles) occur frequently as a result of increased abdominal pressure during pregnancy or a prolonged second stage of labour. Anyone experiencing haemorrhoids should eat additional fruit and fibre and drink plenty of fluid in order to avoid constipation.  If necessary a bulk laxative such as Fybogel®,  lactulose or a stool softener such as docusate (which are all safe to be used whist breastfeeding – see information sheet on constipation) can be useful on a temporary basis.

For further information see http://www.patient.co.uk/showdoc/23068749/

Creams, ointments and suppositories do not cure haemorrhoids but do help with the symptoms of pain and irritation. They often contain a local anaesthetic which limits use to seven days after which time increased sensitisation from the ingredient may occur.

Ice packs, or the application of bags of frozen peas suitably wrapped, can also help to relieve swelling. Care should be taken not to burn the skin by using frozen agents directly to the skin.

Prescribed creams  and suppositories may include a corticosteroid to reduce inflammation – this will not produce clinically significant levels in breastmilk.

Painkillers (analgesics) may be needed in cases of severe pain –products containing codeine should be avoided as they cause constipation which results in additional straining and further irritation of haemorrhoids. Paracetamol is an ideal choice taken regularly at normal doses.

Products to treat haemorrhoids can be used by breastfeeding mothers without affecting breastfeeding. The absorption of the ingredient drugs from the rectum will not produce significant levels in breastmilk and can be used as necessary for the mother’s comfort (morning and night and after bowel motions).

There are a variety of commercially available creams, ointments and suppositories all compatible with breastfeeding : Anusol®, Anusol HC®, Proctosedyl®, Germoloids®, Hemocane®, Preparation H®, Xyloproct®, Ultrproct® Scheriproct ®

Anal fissures

In severe cases mothers may develop anal fissures which do not heal and produce severe pain. This may be treated with glyceryl trinitrate ointment 0.2% or 0.4%. The mother may experience a headache but there are no reports of adverse effects in babies whose mothers have applied it (Taylor 2008, UKMI).  Use during breastfeeding is unlicensed.  It is assumed that diltiazem cream would similarly not affect the baby but no research has been identified.

Bibliography

• British National Formulary
• Hale TW Medication and Mothers Milk
• Jones W Breastfeeding and Medication Routlege 2018
• LactMed database http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACTMED
• Specialist Pharmacist Service. Safety in Lactation Drugs for rectal and anal disorders. 2016 sps.nhs.uk/articles/safety-in-lactation-drugs-for-rectal-anal-disorders
• Taylor T, Kennedy D. Safety of topical glyceryl trinitrate in the treatment of anal fissure in breastfeeding women. Birth Defects Research Part a-Clinical and Molecular Teratology. 2008;82:411. Abstract.

©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network May 2020