Constipation and piles during pregnancy

Constipated woman goes to bathroom

The hormonal changes that pregnancy brings affect your digestive system. An increase in progesterone relaxes your muscles, which sadly doesn’t have the effect you might expect on bowel movements. In fact, it prevents the intestine moving waste along efficiently, meaning slower transit times. This causes discomfort and can lead to problems such as piles (haemorrhoids). Don't be embarrassed; this is all very common and there are lots of treatments available to get things, er, moving.

Constipation symptoms

Aside from the obvious difficulties going to the toilet, there are other symptoms of constipation that are worth looking out for, including:

  • back pain
  • abdominal pain
  • bloating
  • cramps
  • nausea
  • piles

You won't necessarily get all of these symptoms – it depends how badly you've got it. One thing's for sure though, constipation in pregnancy is very common – even if hardly anyone talks about it.

Is constipation a sign of pregnancy?

I couldn't go for over a week in trimester one, it was awful. I looked about six months pregnant instead of 10 weeks!

The digestive tract is affected by pregnancy hormones which are developed early on, so it is possible that you will feel constipated even in the first weeks of pregnancy. That said, constipation will be far from your only pregnancy symptom, and you are likely to experience more specific things, such as a missed period, first.

If you notice a number of these signs of pregnancy and you're constipated, but haven't yet done a pregnancy test – it's worth popping to the chemist and peeing on a stick (not actually IN the chemist, mind).

How to relieve constipation during pregnancy

There are a number of effective remedies and cures, as well as simple changes you can make to your diet and lifestyle to get some relief from constipation.

  • Drink plenty of water
  • Eat a healthy diet including fibre-rich foods such as wholemeal bread, fruit, vegetables, and beans and lentils. Pregnant woman eating dried fruit home constipation remedy
  • Try eating smaller portions of food more frequently during the day, rather than large meals, as this eases the strain on your digestive system.
  • Doing some light exercise if you feel up to it, such as walking or swimming, can also help to get things going.
  • Massage the small of your lower back in downwards-sweeping movements.
  • Try to go to the toilet first thing in the morning or half an hour after a meal, as this is when your bowels are at their most active.
  • Don't try and hold it in – when you have to go, you have to go.
  • And, when you do go, you might find it helps to rest your feet on a stool – no pun intended – or a pile of books when on the loo (apparently it's all to do with the angles).

Prunes or linseeds (sprinkling them on your morning muesli makes them more palatable!) are often the first additions to the supermarket shopping list in pregnancy because of their reputation for keeping everything moving.

Make sure that if you do increase your fibre intake, you do it gradually and drink more water as well – otherwise you may find your constipation gets worse due to the added bulk that a fibre-rich diet creates.

What is safe to take for constipation during pregnancy?

It is best to check with your midwife before taking over the counter laxatives during pregnancy. You may be prescribed a laxative by your GP that is safe to use if the self-care measures and home remedies you've already tried don't work.

The NHS advises that there are a lot of laxatives, including osmotic laxatives lactulose and macrogols, that are safe to use in pregnancy. These are not absorbed by the digestive system so won't affect your baby. It is not recommended that you take senna or other stimulant laxatives in the third trimester, as they can cause uterine contractions.

If you're having pain or discomfort associated with your constipation, then you can take paracetamol during pregnancy. It's recommended that you take the lowest dose that works, for the shortest possible time. And if you've only got ibuprofen in the house, then the advice is that you can't take it beyond 30 weeks, as it can lead to problems with the baby's heart and the amount of amniotic fluid you have.

Is constipation serious?

Constipation is more of an uncomfortable inconvenience than a serious problem, and if you try the above strategies then it should just be a temporary one.

If it goes on for a while, there is a risk of faecal impaction – where stools become dry and hard and collect in the rectum. The rectum can then become obstructed, making it very difficult to get things moving. You might also find that you suffer from overflow diarrhoea – where loose stools will leak around the obstruction and you can’t control them, which can be miserable to say the least.

If you have a faecal impaction, as diagnosed by your GP, then you’ll be prescribed a high dose of the osmotic laxative macrogol. After a few days of this, you may have to be put on a stimulant laxative if your GP deems it necessary.

If the laxatives don’t work or you have overflow diarrhoea, then you might be given a suppository (solid medicine that is inserted into your anus and which dissolves slowly) or a mini-enema (where liquid medicine is injected into your anus). But your GP will be able to help you out with all of this if you’re backed up and nothing works – so don’t be embarrassed.

Piles in pregnancy

If you've been suffering from constipation, all that straining on the loo plus the weight of your growing baby may lead to piles, which are varicose veins in your back passage. And even if you've had a smooth ride of things in the bathroom department, you can still develop piles during pregnancy because of all those lovely hormones which make your veins relax.

Piles are enlarged or swollen veins in or around your rectum. They might be painful, itchy or uncomfortable. You might also feel the lumpiness around your bottom. Going to the toilet can be uncomfortable – you might feel as though you haven’t fully emptied your bowels and there might be some discharge of mucus. They can also bleed – it’ll look fresh and red if it’s from piles.

Pregnant woman at the doctor

If you notice blood in your bowel movements, you should always get this checked by your GP – it's not always something to worry about, but only they can tell you if it's serious or not. Aside from the usual concerns, it might actually be an anal fissure you're suffering from, rather than piles. They aren't usually too serious but your GP will be able to give you advice and recommendations.

Don't be embarrassed about getting yourself seen – doctors see this kind of thing all the time and can also prescribe medication to help relieve your symptoms and speed up the healing process.

How to treat piles

Sufferers recommend the following to help ease some of your discomfort:

  • Witch hazel gel – particularly if you can keep it in the fridge.
  • Eat lots of fibre to avoid constipation, and thus minimise any straining on the loo.
  • Cold compresses.
  • Cypress oil in a warm soothing bath.
  • Pat, rather than rubbing the area after going to the toilet.
  • Use soft wipes instead of loo roll.
  • A cloth wrung out in iced water held against the piles might also help soothe the pain and itching.
  • You should also try to take the weight off the tender area by sleeping on your side (particularly if the weight of the baby is what's causing them).
  • Sit on a rubber ring and try not to stand or sit still for too long.
  • If you're up to it, exercise can really help to get your blood pumping.

The gels and ointments available for treating piles will only soothe the inflammation rather than get rid of them entirely. Check with your doctor, midwife or pharmacist before buying anything to make sure it’s ok for you to use during pregnancy.

“Unless you've suffered from piles, it all seems a bit of a snigger, but there are few things as painful. It got to the stage where I was crying with them, so forced myself to drive to the doctor, whilst attempting to hover above the seat. Heavily pregnant and obviously in pain, the receptionist took one look at me and assumed I was in labour. All hell broke loose. With the whole of the surgery looking on, I had to explain that I wasn't in labour – I had piles. Anyway, lots of Anusol cream and suppositories did the trick.”

Are piles a problem during labour and after birth?

Mine were unbelievably big post-delivery. But once all the weight was gone, ie. the baby, they slowly started to shrink and I don't notice them any more.

“The piles won't explode,” says one wise Mumsnetter who's also a midwife, “but your midwife might cover them with a sterile pad at the time of delivery if necessary. Consider delivering on all fours, to take some of the pressure off.”

Piles tend to get worse after pushing in labour, but most will disappear not long after you have given birth.