As anyone who has been pregnant can tell you..your body changes so much with pregnancy and your bowels are no exception!
We estimate that at least 1/3 of women suffer from constipation during each trimester and in the fourth trimester, which is the 12 weeks post partum…that are a lot of women! This is compared to about 7% of women of the same age who are not pregnant.
Constipation is generally described as the infrequent (less than 3 times per week) passage of hard stool that is challenging to pass. We often describe this based on what is known as the Bristol Stool Chart! If you look at the chart below we are talking about 1 and 2 type poos!
If you get chronically backed up….the watery stool and the end of the line will start to seep around the hard-packed stools and you can get what we call overflow diarrhea….which then makes the whole problem more confusing….How can I have constipation if I’m having diarrhea!!
Well the first reason, and definitely the one that is most common in the first trimester is progesterone. This is the hormone we release that is pro gestation, which helps support our pregnancy. One of the many things it also does is cause abdominal bloating and constipation. We think that it does this slowing down the muscles around our small intestines that help our fecal matter move through. This allows more time for the moisture to be pulled our of our intestinal contents leaving them drier when it is time to come out! The slowing of the small bowel also means that we move things through more slowly and they just have a longer time to build up…gas for example, which is why women in their first trimester often complain of bloating.
During the first trimester, our blood volume naturally increases and so we need to stay more hydrated, however, many women struggle with nausea during this time, and find it incredibly challenging to get enough fluids in, which can also contribute to constipation.
As we move farther along in pregnancy, and our uterus grows, it can put pressure on our bowels, which can also factor into constipation.
During pregnancy, our babies use up our iron supply, and as a result, most women need to start on an iron supplement at some point. And for anyone who has taken iron can attest…they are a big culprit in constipation!
Well as you can probably guess we try to deal with the causes of constipation to help manage it!
Despite people’s best efforts sometimes they need more help than this and we recommend psyllium fibre daily - Metamucil daily in a big glass of water!
Let's talk a little bit about how to poop…. I know…seems like pretty basic stuff but here are some suggestions:
If despite doing all of this you are still suffering, many maternity care providers recommend PEG, which is also known as restoralax or laxaday. It is safe in pregnancy and can be bought at the pharmacy. If you are suffering from constipation it is important to have a talk with your care provider as well!
Hemorrhoids are outpouching of veins in the anal canal. These are generally caused by increased pressure in the abdomen from a variety of sources. These sources include straining to have a bowel movement when constipated, obesity, and of course pregnancy, especially as the uterus grows and puts more pressure on the veins returning blood from the lower half of your body!
It is estimated that 30-40% of women suffer from symptoms of hemorrhoids during pregnancy.
Some women don’t know they have hemorrhoids, but others experience symptoms such as itching, pain and bleeding. Some women can feel a small lump in the area.
Well if you are constipated we can treat constipation with hydration, activity and fibre! But if it is just because of the pregnancy then we treat the symptoms. We can use creams and ointments, suppositories or pads to help to relieve the swelling and discomfort.
It is really important to talk to your doctor about symptoms and to make sure that it is in fact hemorrhoids that are causing your symptoms. It is pretty rare, but sometimes other diseases can have similar symptoms, and we certainly don’t want to assume it is just hemorrhoids and not something else!
Most hemorrhoids will resolve after pregnancy, as long as we maintain our soft bowel movements ongoing, but they can recur if we have another time in our lives when we have increased pressures in our abdomen.
If hemorrhoids do not improve after pregnancy and with good maintenance of bowel habits, there can be a role for surgery, but this is generally the last resort!
Constipation and hemorrhoids are very common in pregnancy and are managed in similar ways