Many women experience hemorrhoids and constipation in the second or third trimesters of their pregnancy or during the postpartum period, although luckily there is a lot you can do to reduce the symptoms.
Pregnancy-induced hemorrhoids and constipation
Pregnancy-induced hemorrhoids are usually caused by the swelling of the uterus around the 25th week of pregnancy as well as an increase in pelvic blood to the area. Both of these factors can cause the veins in the rectal wall to swell and bulge, and this can make them feel itchy. Constipation can also cause hemorrhoids or aggravate pre-existing hemorrhoids due to straining to eliminate the stool and this then puts pressure on the rectal area.1
Constipation during pregnancy can be caused by minimal physical exercise, a low-fiber diet and, commonly, hormones – in particular the hormone progesterone. Progesterone relaxes the intestinal wall and this in turn means that food and waste travels much slower through your system. Like pregnancy-induced hemorrhoids, constipation during pregnancy can also be caused by the swelling of the uterus, resulting in increased pressure on the intestines.2
Another culprit can be iron supplementation during pregnancy – however, iron is important for you and your developing baby and so it is best to either keep taking it and to treat the constipation or to talk to your healthcare providing about swapping to a formulation that is kinder on your bowels.
Hemorrhoids or constipation following birth
Hemorrhoids are very common following birth, in particular vaginal births due to straining to push the baby out. Constipation following birth can be due to a number of factors. If you had a long labor without eating much or if you passed a stool during labor, your intestines will be empty and it may take a day or two for your bowels to return to their normal functioning. If you had a cesarean section, it may take up to three or four days for your bowels to start functioning normally again.3
In addition, taking systemic narcotics, such as morphine, hydrocodone/paracetamol (Vicodin), or oxycodone/paracetamol (Percocet), for pain during labor or for postpartum pain can slow down your digestive system. Having a sore perineum due to hemorrhoids, an epistomy or a tear can lead to constipation because the fear of more pain or putting too much strain on the stitches can lead to you holding in your feces.4
Symptoms of hemorrhoids
Signs and symptoms of hemorrhoids may include:
- Itching or irritation in your anal region.
- Painless bleeding during bowel movements — you might notice small amounts of bright red blood on your toilet tissue or in the toilet.
- Swelling around your anus.
- Discomfort or pain.
- A lump near your anus, which may be sensitive or painful (this may be a thrombosed hemorrhoid).5
Symptoms of constipation
Signs and symptoms of constipation may include:
- Having hard or lumpy stools.
- Passing fewer than three stools a week.
- Straining to have bowel movements.
- Feeling as though you can’t completely empty the stool from your rectum.
- Feeling as though there’s a blockage in your rectum that prevents bowel movements.
- Needing help to empty your rectum, such as using your hands to press on your abdomen and using a finger to remove stool from your rectum.6
- You can use a basin filled with warm water, also called a sitz bath, or a proper bath to soak yourself in warm water. If you do this two to four times a day, this will help your hemorrhoids to shrink.
- Apply witch hazel to the hemorrhoids to soothe them. Keep the witch hazel cool in the refrigerator, then apply with cotton balls.
- Increase the amount of fiber in your diet as well as your intake of fluids – this will help to prevent constipation.
- Sit on a waffle cushion or pillow to relieve pressure on the rectum. In addition, sitting in a rocking chair or recliner may also be more comfortable than sitting in a straight chair.
- Hemorrhoid creams, ointments, suppositories or sprays are available over-the-counter and can produce short term relief. Your health care provider can recommend a brand that is best for you.
- You may be prescribed a stool softener, and this may take a few days to work. Drinking extra water will also help keep your stools soft.3
If the pain does not go away within a few days, contact your health care provider for further assistance.
- Drink at least eight to ten large glasses of fluid a day.
- Try eating prunes – they are a natural mild laxative – and also try to eat foods such as bran, fruits, green vegetables and whole grain cereals and breads.7
- Avoid highly processed foods.
- Use the bathroom as soon as you feel the urge7
- Exercise routinely. Walking, swimming and other moderate exercise helps the intestines work by stimulating your bowels. Schedule exercise three times a week for 20-30 minutes each.3
- Get plenty of rest every day.
- Drink warm liquids each morning.
- A mild bulk-forming laxative or fiber supplement can be used if other measures do not work.8
- If bulk-forming laxatives and fiber supplements don’t work, osmotic laxatives which increase the amount of water in the intestines can be taken. However, it is recommended not to take these laxatives for a long time due to them causing changes in your body’s electrolyte levels.
- Another type of laxative that can be used is a stimulant laxative – these cause the intestines to contract and consequently stool is moved out of your intestines. They are effective but can have side effects such as diarrhea or stomach pain.7,8
- Stool softeners are another option, although the evidence for using them for constipation is not so strong.7
If you do not have a bowel movement by the third or fourth day after having your baby, call your healthcare provider.