Constipation and hemorrhoids during pregnancy

Constipation is common during pregnancy. Up to 40 percent of pregnant women experience constipation. Hemorrhoids are also prevalent, especially during the second and third trimesters of pregnancy. Approximately 30 to 40 percent of pregnant women develop hemorrhoids.

Causes

Constipation

Constipation occurs when stools are dry and difficult to pass. In general, having fewer than three bowel movements per week means you’re constipated.

The increase in hormones, especially progesterone, during pregnancy slows the movement of food through the intestines and increases water absorption. Later in pregnancy, the expanding uterus compresses the large intestine, which can also slow digestive movements.

In addition, many pregnant women change their diet because of nausea. Some even have difficulty drinking as much water as usual or become dehydrated due to vomiting in early pregnancy. Pregnant women are often less active during pregnancy, which can lead to constipation.

Iron supplements can also cause constipation in some women.

Hemorrhoids

Hemorrhoids are swollen veins in and around the anus. Constipation is the main cause of hemorrhoids. In addition, as pregnancy progresses, the uterus expands and puts pressure on the veins in and around the anus, causing them to swell. Hemorrhoids can be very uncomfortable. They can cause itching and mild bleeding.

Prevention

There are several ways to relieve constipation. Since hemorrhoids often develop after a period of constipation, they can also be avoided by following these recommendations.

Diet

Fibre facilitates intestinal function. Some types of fibre bulk up your stool, which speeds up its passage through the intestine. Other types attract water to the stool. In both cases, the fibre makes your stool softer and easier to pass. As such, pregnant women should increase their fibre intake by 2 to 3 g per day for a total of 28 g.

The following foods are high in fibre:

• Whole-grain cereals (wheat bran, oat bran, barley)
• Legumes (kidney beans, lentils, chickpeas)
• Fruit (apples, citrus fruit, strawberries, pears) and vegetables (cabbage, broccoli, asparagus, green beans, peas, Brussels sprouts, carrots)
• Nuts and seeds (flaxseeds, chia seeds)
• Dried fruit, especially prunes. Prune juice can also be a good option.

You can also take commercial fibre supplements (e.g., Metamucil®, Prodiem®, Benefibre®).

However, consuming large amounts of fibre can cause bloating and gas. To avoid these annoying side effects, it’s best to gradually increase the amount of fibre in your diet.

In addition, if you increase your fibre intake, you must also increase your water consumption. Otherwise, your stools will be larger but remain dry, making your constipation worse. It’s recommended that you drink between 1.5 and 2 litres (6 to 8 glasses) of water per day.

Exercise

Exercise regularly to work the abdominal muscles and improve bowel movements. Pregnant women are advised to do 30 minutes of moderate physical activity about 3 or 4 times a week. Walking and swimming are good options.

Intestinal hygiene

Certain lifestyle habits can help make bowel movements more regular.

• Try to go to the bathroom at the same time every day.
• Go to the bathroom in the morning when you get up or after a meal.
• Go to the bathroom when you feel the urge and avoid holding it in.
• Sometimes it can be easier to pass stools in the following position: put your feet on a small bench so that your knees are slightly higher than your hips and rest your forearms on your thighs, keeping your back straight.
• Massaging your stomach in a circular motion to the left can also help.

Relieving discomfort

If you develop hemorrhoids despite taking all precautions, the following tips should reduce your discomfort.

• Avoid standing for too long.
• Try to sleep on your left side.
• Apply cold compresses to your hemorrhoids.
• Don’t strain when trying to pass a stool.
• After having a bowel movement, wipe the anal region with a wet wipe rather than dry toilet paper. Pat rather than rub.
• Take a warm sitz bath 3 to 4 times a day, immersing the anal region for about 20 minutes each time.

Medication

Constipation

If these measures don’t help, you could use a stool softener (e.g., Colace®, Surfak®) or a glycerin suppository. These over-the-counter products are safe for pregnant and breastfeeding women. If your constipation persists, contact a health care professional.

Hemorrhoids

For hemorrhoids, zinc ointment (e.g., Anusol®) or over-the-counter witch hazel–glycerin compresses (e.g., Tucks®) can be applied. However, zinc ointments that contain an analgesic (e.g., Anusol Plus®) or suppositories that contain esculin (Proctosedyl®) are not recommended during pregnancy. If your hemorrhoids are painful, take acetaminophen (e.g., Tylenol®, Atasol®). If the pain remains severe despite these measures, talk to your doctor. They may prescribe a more effective ointment.

Things to keep in mind

• Constipation and hemorrhoids are common during pregnancy.
• A high-fibre diet, exercise, and a good bowel routine can reduce the discomfort associated with constipation and hemorrhoids.
• If none of these strategies are effective, or if you experience bleeding, contact a health care professional.

Scientific review: Dr. Chantal Ouellet, physician Research and copywriting: The Naître et grandir team Updated: January 2020

Photo: 123rf/6786890