What are they?
During pregnancy, hormone production slows down the digestive and excretion processes of the body by relaxing the pelvic muscles and muscles surrounding the bowel. The pressure of the expanding uterus on the rectum also makes it harder for bowel movements to pass through the bowel. This means pregnant women will become more easily constipated.
Not only this, but the iron found in pregnancy supplements that is needed to replenish iron stores for all the extra blood being circulated in the body and to nourish the baby, can also increase the likelihood of constipation when it isn't absorbed properly.
Haemorrhoids (also known as piles) develop as a result of constipation, because the blood vessels become more strained due to this increased blood flow and the need to push to encourage bowel movements. They are basically varicose veins within the rectum that form in clusters and most commonly develop in the final trimester of pregnancy as the weight of the baby places more pressure on the bowel area or as a result of pushing during labour.
What are the symptoms?
- Discoloured, dark and/or hard stools
- Itching, discomfort, stinging or irritation in the rectum
- Rectal and/or abdominal pain
- Bleeding due to anal fissures, when the skin of the anus cracks due to straining during a bowel movement
- Veins protruding from the anus
- Bloating
- Fatigue
How is it diagnosed?
Constipation is usually diagnosed based on the symptoms doctors identify, but they may also take blood for testing or order a colonoscopy if they think the constipation may be related to another issue other than pregnancy.
Haemorrhoids are usually diagnosed by a general rectal exam, usually just by hand, or instruments such as proctoscope may be needed for a more thorough examination.
What's the treatment?
Treatment for constipation is simple and aimed at preventing the development of haemorrhoids, while encouraging bowel movement. Your doctor will suggest getting a higher intake of fibre through food sources such as wholegrains, fruits and vegetables and drinking more water, as water will help to soften stools. Fibre supplements, suppositories and laxatives should only ever be used under the advice of a doctor.
Other things such as frequently changing positions when sitting or lying down, as well as doing pelvic exercises to increase blood circulation, will help strengthen the muscles and lessen pressure on blood vessels. Maintaining a healthy weight will also put less pressure on the bowel area, and women should also not delay bowel movements as this can make them harder and more difficult to pass.
Once haemorrhoids have developed though, treatments available are designed at reducing discomfort, all of which should provide some relief and keep the area clean, such as:
- Applying ice or heat packs
- Witch hazel cream or other topical creams or pads
- Sitz baths where the affected area can be soaked in a solution of saline.
For women who develop postpartum haemorrhoids after giving birth, rectal pain may be felt in conjunction with vaginal pain due to tearing or an episiotomy, but these treatments can still be safely used.
In some rare cases doctors may refer women to a specialist after pregnancy, to undergo haemorrhoidectomy surgery to cut away and reduce the size of the haemorrhoids. Occasionally blood can clot within a haemorrhoid causing intense pain, and sometimes this will require minor surgery during pregnancy.
Does it affect the baby?
Constipation and haemorrhoids won’t impact on the health of your baby in any way, although the doctor will want to be sure certain symptoms, such as anal bleeding, aren’t being caused by other health problems.
Facts verified by Dr Andrew Zuschmann. Dr Andrew Zuschmann is a Miranda-based fertility specialist, obstetrician and gynaecologist.