Constipation is a very common complaint in pregnancy, with an estimated 16 to 39 percent of pregnant patients experiencing constipation at some point in their pregnancy or postpartum.
The best way to avoid constipation altogether is to stay well-hydrated and consume plenty of fiber in your diet (in the form of fresh fruits and vegetables and whole grains). You can also take a daily probiotic supplement to promote healthy gut flora.
If you do find that you become constipated, there are several medications that are safe to take in pregnancy. Use a stepwise approach with the following medications until you are having regular bowel movements on a daily basis.
Metamucil, Citrucel, or Benefiber- these are called bulk-forming laxatives and work by absorbing water to help increase the frequency of stool and make it softer. Be sure to take it with a full glass of water
Colace – this is a stool softener and may be good for those of you who are having daily bowel movements that are hard and painful. You can take 100mg once or twice per day as needed.
MiraLAX – this should not be used daily unless you consult your healthcare provider, but is good for occasional severe constipation
Senokot – this is as stimulant laxative and should only be used on occasion for severe constipation
Magnesium Citrate – use sparingly for severe constipation only, as overuse can lead to electrolyte abnormalities
If you are concerned about the constipation you are experiencing in pregnancy, bring it up with your healthcare provider.
Hemorrhoids
Hemorrhoids are swollen and inflamed veins in the anus and lower rectum. They are a frequent pregnancy complaint, especially in the third trimester and immediately postpartum.
They are caused by local pressure and decreased venous return from the enlarging uterus or from pressure from pushing during labor and delivery. They are exacerbated by constipation that is common in pregnancy. Symptoms include discomfort, itching, and bleeding.
Treatment is aimed at symptomatic relief and prevention of worsening of hemorrhoids. Preventing constipation is imperative (see above).
Over-the-counter hemorrhoid creams containing a local anesthetic can temporarily soothe pain. Creams and suppositories containing hydrocortisone are also effective, but don’t use them for more than a week at a time, because they can cause the skin to atrophy. Witch hazel wipes (Tucks) are soothing and have no harmful effects. A small ice pack placed against the anal area for a few minutes can also help reduce pain and swelling. Finally, sitting on a cushion rather than a hard surface helps reduce the swelling of existing hemorrhoids and prevents the formation of new ones.
Most experts recommend a 20-minute sitz bath after each bowel movement and two or three times a day in addition. A sitz bath is a warm water bath for the buttocks and hips. It can relieve itching, irritation, and spasms of the sphincter muscle. Pharmacies sell small plastic tubs that fit over a toilet seat, or you can sit in a regular bathtub with a few inches of warm water. You can add epsom salt or witch hazel to the water if you desire. Take care to gently pat the anal area dry afterward; do not rub or wipe hard. You can also use a hair dryer to dry the area.
If you notice excruciating pain in the anal area, it may be the result of a blood clot in a hemorrhoidal vein. If this happens to you, call your healthcare provider. We may be able to perform a procedure to extract the clot and provide pain relief.