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

Women Birth. 2018 Aug;31(4):e272-e277. doi: 10.1016/j.wombi.2017.10.003. Epub 2017 Oct 18.


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 20g 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 2g glycerin suppositories per rectum 20min before defecation as lubricant and Metamucil bulk-forming fiber (a mix of one dose (sachet) within 240ml (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: Conservative treatment; Glycerin suppositories; Hemorrhoids; Metamucil bulk-forming fiber; Sitz bath.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Analgesics / therapeutic use
  • Baths / methods*
  • Conservative Treatment / methods*
  • Constipation / diagnosis
  • Constipation / etiology
  • Constipation / therapy
  • Defecation
  • Female
  • Glycerol
  • Hemorrhoids / diagnosis
  • Hemorrhoids / therapy*
  • Humans
  • Middle Aged
  • Pregnancy
  • Prospective Studies
  • Psyllium / administration & dosage
  • Psyllium / therapeutic use
  • Saudi Arabia
  • Suppositories / administration & dosage
  • Suppositories / therapeutic use
  • Treatment Outcome


  • Analgesics
  • Suppositories
  • Psyllium
  • Glycerol