Constipation and Hemorrhoid during Pregnancy

The difficulty of defecation or constipation is one of the most common gastrointestinal disturbances with the prevalence is up to 20%. Constipation is the disorder characterized by persistent difficult or seemingly incomplete defecation and/or infrequent bowel movements (once every 3 days or less). Generally, less fiber and fluid intake with physical inactivity can cause constipation and if it left untreated can lead to complication such as hemorrhoid. Hemorrhoid is enlargement or swelling of the blood vessel in the anus. It can manifest as a prolapse mass or tumor from the anus, feeling incomplete evacuation of stool, itchy or pain around the anal area, or rectal bleeding. Hemorrhoids not only cause by constipation, blood vessel (vein) abnormality, and other diseases may also lead to this condition.

            Constipation occurring in a quarter of a pregnant woman. These conditions may appear during pregnancy although no history of constipation previously or before pregnancy. There some risk factor that predisposes a pregnant woman to had constipation during pregnancy such as changing diet habits, hormonal change, the pressure of large bowel by enlargement of uterine, vitamin and mineral supplementation such as an iron tablet. During the first trimester of pregnancy, the pregnant woman may have hyperemesis conditions that may lead to a decrease in appetite and changing of diet type. In the third trimester of pregnancy, the uterine become larger and suppress the stomach and intestine that make the pregnant woman decrease of intake and hard to passage stools. The effect of hormonal changes during pregnancy including slowing the bowel movement and increasing the water absorption may predispose pregnant women to have constipation. Hemorrhoids may affect 25-35% of pregnant women, mostly during the third trimester. Besides constipation, the other factors like hormonal changes and increased intra-abdominal pressure may predispose a pregnant woman to develop hemorrhoids.  

Generally, the treatment for constipation and hemorrhoids is divided into pharmacology and non-pharmacology treatment. The pharmacology treatment was unfavorable during pregnancy because of the risk of fetal harmed by the given medications although some of this medication had categorized as B class (no harmed were find on fetal in the animal study) by the United States food and drug administration (FDA). For example, the medications that can be used to increase bowel movement can also affect uterine contractions that can harm the fetus. Non-pharmacology treatment is preferred as therapy of constipation and hemorrhoids during pregnancy, such as an increase of fiber consumption, increase fluid intake, daily physical activity, and toilet training. The daily needs for fiber in pregnancy were equal to the daily needs of a normal person about 20-30 gr per day, which can be found in many foods like wheat, red rice, nuts, cereals, vegetables, and fruits. Pregnant women are adviced to drink water in the morning after woke up to induce the bowel movement and consume minimal 8 glass water per day. Routine daily activity is recommended to improve metabolism and normal bowel movement.

In summary, constipation and hemorrhoid are common gastrointestinal disturbances that affect pregnant women. Increasing fiber consumptions, increasing fluid intake, and daily physical activity is recommended to prevent and treat these conditions.