Constipation & Hemorrhoids in Pregnancy | how to manage at home!

Constipation in pregnancy:

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.

So what is constipation?

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!!

So why is constipation so much more common in pregnancy?

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! 

So how do we manage constipation?

Well as you can probably guess we try to deal with the causes of constipation to help manage it!

1. Stay well hydrated!  Drink lots of water, if you are nauseous, drinking a lot of water at once is not going to go well, but you can certainly drink small amounts throughout the day.  How much do you drink?  There is no specific amount that you should drink, the goal is to quench your thirst.
2. Get your bowel muscles working more effectively!! We can do this in a couple of ways.  Movement helps movements….so get out walking every day, this will help your bowels to be more effective in their function.  Caffeine also helps increase the muscle activity of your bowels, so 1-2 cups of coffee or tea can certainly help improve how they function. 
3. Soften up your stools…sounds easy right?  Well, it is actually…we can use fibre to help bulk up our stools and draw water into them so that they are softer and easier to pass.  This should be the mainstay treatment of anyone with constipation.  Now we aren’t talking about one apple a day fiber…we are talking about good amounts of fibre!! Food can be a great source of fibre, and high fibre options include:
1. Beans
2. Fruits and veggies
3. Whole grain cereals
4. Bran (bran buds are a great way to do this!)

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:

• Poo, when you need to poo…don't hold it in!
• sit with your knees higher than your hips (use a footstool or other flat, stable object if necessary)
• lean forward and put your elbows on your knees
• relax and bulge out your stomach
• straighten your spine.
• Now for the pushing part, you are going to practice for labour! We actually discuss how to push in our online prenatal course, but here is a quick sneak peak for ya!
  • Take a deep breath and fill the bottom of your lungs
  • keep your mouth open
  • relax your anal sphincter (pelvic floor)
  • use your deep breath to really help push down
  • bracing but not tightening your abdominal muscles
  • some people make a ssss, grrr, or moo sound to help from putting too much pressure on their pelvic floor. 
  • Again..if not successful after a few pushes, get up and try again later (unfortunately this part does not apply to labour!!)
• If you go to drop a deuce, and it's been a couple of minutes and you can’t….get up and try again later!  Straining for longer periods of time can increase the risk of hemorrhoids
• When you are done…get up!! Don’t spend more time than you need scrolling your phone or reading on the toile…this can contribute to hemorrhoids!
• If you have hemorrhoids, it’s better to tap your bottom with toilet paper than wipe..be gentle on yourself!
• And please please please….wash your hands afterwards!

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!

Now with constipation also can come hemorrhoids!

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!

How Common are Hemorrhoids?:

It is estimated that 30-40% of women suffer from symptoms of hemorrhoids during pregnancy.

What are the symptoms of hemorrhoids?

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.

What can we do to treat hemorrhoids?

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! 

To Recap:

Constipation and hemorrhoids are very common in pregnancy and are managed in similar ways

1. hydration - drink to thirst
2. Movement - stay active in your pregnancy
3. Fiber Fiber Fiber…if you struggle to get enough in your diet then add in some extra with bran buds or metamucil…but remember those both act by pulling water into your stools…so if you are not staying hydrated they are not going to help!
4. If you are suffering from constipation or hemorrhoids please talk to your care provider we can help!