Arnaud M Mild dehydration: a risk factor of constipation?. Eur J Clin Nutr. 2003; 57:S88-95

Ayaz S, Hisar F The efficacy of education programme for preventing constipation in women. Int J Nurs Pract. 2014; 20:(3)275-82

Basilisco G, Coletta M Chronic constipation: A critical review. Dig Liver Dis. 2013; 45:(11)886-93

Blinco A Optimum maternal nutrition for a healthy pregnancy. British Journal of Midwifery. 2008; 16:(1)55-7

Bradley C, Kennedy C, Turcea A, Rao S, Nygaard I Constipation in pregnancy: prevalence, symptoms and risk factors. Obstet Gynecol. 2007; 110:(6)1351-7

Cheng C, Chan A, Hui W, Lam S Coping strategies, illness perception, anxiety and depression of patients with idiopathic constipation: a population-based study. Aliment Pharmacol Ther. 2003; 18:(3)319-26

Chiarioni G, Bassotti G, Monsignori A Anorectal dysfunction in constipated women with anorexia nervosa. Mayo Clinic Proceedings. 2000; 75:(10)1015-9

Crea N, Pata G, Lippa M, Chiesa D, Gregorini M, Gandolfi P Hemorrhoidal laser procedure: short- and long-term results from a prospective study. Am J Surg. 2014; 208:(1)21-5

Cullen G, O'Donoghue D Constipation and pregnancy. Best Pract Res Clin Gastroentero. 2007; 21:(5)807-18

Derbyshire E, Davies J, Costarelli V Diet, physical activity and the prevalence of constipation throughout and after pregnancy. Matern Child Nutr. 2006; 2:(3)127-34

Donnelly E, Neville LExeter: Reflect Press; 2008

Drossman D, Corazziari E, Delvaux M, 3rd Edition. Degnon Associates: Yale University Section of Digestive Disease; 2006

Gal-Ezer S, Shaoul R The safety of mineral oil in the treatment of constipation—a lesson from prolonged overdose. Clin Paed. 2006; 45:(9)856-8

Glazener C, Abdalla M, Shroud P Postnatal maternal morbidity; extent, causes, prevention and treatment. BJOG. 1995; 102:(4)282-7

Haug T, Mykletun A, Dahl A Are anxiety and depression related to gastrointestinal symptoms in the general population?. Scand J Gastroenterol. 2002; 37:(3)911-6

Jewell D, Young G Interventions for treating constipation in pregnancy. Cochrane Database Syst Rev. 2012; 2

London: BMJ Group and Pharmaceutical Press; 2014

Jones C, Gardiner A Common gastrointestinal problems in pregnancy. Gastrointestinal Nursing. 2014; 12:(6)11-2

Kamm M Obstetric damage and faecal incontinence. Lancet. 1994; 344:(8924)730-3

Kyle G Constipation, part 1: Causes and assessment. Practice Nursing. 2009; 20:(12)611-5

Lacy B, Levenick J, Crowell M Chronic constipation: new diagnostic and treatment approaches. Therap Adv Gastroenterol. 2012; 5:(4)233-47

Lee-Robichaud H, Thomas K, Morgan J, Nelson R Lactulose versus Polyethylene Glycol for Chronic Constipation (Review). Cochrane Database Syst Rev. 2010; 7

Lim S, Yu C, Aw L Comparing topical hydrocortisone cream with Hai's Perianal Support in managing symptomatic haemorrhoids in pregnancy: A preliminary trial. J Obstet Gynaecol Res. 2014; 41:(2)238-47

Liu L Chronic constipation: Current treatment options. Can J Gastroenterol. 2011; 25:22B-8B

Liu N, Mao L, Sun X, Liu L, Yao P, Chen B The effect of health and nutrition education on women's postpartum beliefs and practices: a randomized controlled trial. BMC Public Health. 2009; 9

Lohsiriwat V Hemorrhoids: From basic pathophysiology to clinical management. World J Gastroenterol. 2012; 18:(17)2009-17

Longo S, Moore R, Canzoneri B, Robichaux A Gastrointestinal conditions during pregnancy. Clinics in Colon Rectal Surgery. 2010; 23:(2)80-9

Makrides M, Crowther C, Gibson R, Gibson R, Skeaff C Efficacy and tolerability of low-dose iron supplements during pregnancy: a randomized controlled study. Am J Clin Nutr. 2003; 78:145-53

Medich D, Fazio V Surgery in pregnant women [Cirugia en embarazadas]. Clinicas Quirurgicas de Norte America. 1995; 1:67-9

Mueller-Lissner S, Kamm M, Wald A Multicenter, 4-week, double-blind, randomized, placebo-controlled trial of sodium picosulfate in patients with chronic constipation. Am J Gastroenterol. 2010; 105:(4)897-903

Intrapartum Care: Care of healthy women and their babies during childbirth.London: NICE; 2014

Nazik E, Erylmaz G The prevention and reduction of postpartum complications: Orem's model. Nurs Sci Q. 2013; 26:(4)360-4

Nelson M, Forfar J Association between drugs administered during pregnancy and congenital abnormalities of the fetus. BMJ. 1971; 1:523-7

Paré P, Bridges R, Champion M Recommendations on chronic constipation (including constipation associated with irritable bowel syndrome) treatment. Can J Gastroenterol. 2007; 21:3B-22B

Peppas G, Alexiou V, Mourtzoukou E, Falagas M Epidemiology of constipation in Europe and Oceania: a systematic review. BMC Gastroenterol. 2008; 8

Perera N, Liolitsa D, Iype S Phlebotonics for haemorrhoids (Review). Cochrane Database Syst Rev. 2012; 8

Ponce J, Martinez B, Fernandes A Constipation during pregnancy: a longitudinal survey based on self reporting symptoms and the Rome II criteria. Eur J Gastroenterol Hepatol. 2008; 20:(1)56-61

Quijano C, Abalos E Conservative management of symptomatic and/or complicated haemorrhoids in pregnancy and the puerperium. Cochrane Database Syst Rev. 2012; 3

Rao S, Seaton K, Miller M Psychological profiles and quality of life differ between patients with dyssynergia and those with slow transit constipation. J Psychosom Res. 2007; 63:(4)441-9

Riss S, Weiser F, Schwameis K The prevalence of haemorrhoids in adults. Int J Colorectal Dis. 2012; 27:(2)215-20

Roberts J, Hansen L Best practices in second stage labour care: Maternal bearing down and positioning. J Midwifery Women Health. 2007; 52:(3)238-45

Shafik A, El-Sibai O Study of the levator ani muscle in the multipara: role of levator dysfunction in defecation disorders. J Obstetric Gynaecol. 2002; 22:(2)187-92

Siegel J, Di Palma J Medical Treatment of Constipation. Clinics Colon Rectal Surgery. 2005; 18:(2)76-80

Sielezneff I, Antoine K, Lecuyer J Is there a correlation between dietary habits and hemorrhoidal disease?. La Presse Medicale. 1998; 27:(11)513-17

Prolonged active phase of labour, 3rd edn. In: Simkin P, Ancheta R Chichester: Wiley Blackwell; 2011

Sinclair M The use of abdominal massage to treat chronic constipation. J Bodywork Move Ther. 2011; 15:(4)436-45

Sultan A, Kamm M, Hudson C, Thomas J, Batram C Anal-sphincter disruption during vaginal delivery. N Engl J Med. 1993; 329:(26)1905-11

Tack J Current and future therapies for chronic constipation. Best Pract Res Clin Gastroenterol. 2011; 25:(1)151-8

Tack J, Muller-Lissner S, Stanghellini V Diagnosi and treatment of chronic constipation a European perspective. Neurogastroenterology and Motility. 2011; 23:697-710

Tan E, Tan E Alterations in physiology and anatomy during pregnancy. Best Pract Res Clin Gastroenterol. 2013; 27:(6)791-802

Tiran D Self help for constipation and haemorrhoids in pregnancy. British Journal of Midwifery. 2003; 11:(9)579-81

Trottier M, Erebara A, Bozzo P Treating constipation during pregnancy. Canadian Family Physician. 2012; 58:(8)836-8

Turawa E, Musekiwa A, Rohwer A Interventions for treating postpartum constipation. Cochrane Database Syst Rev. 2014; 9

Twigg M, Holst L, Desborough J, Wright D Mediation-taking behaviour during pregnancy: is it appropriate?. British Journal of Midwifery. 2010; 18:(11)688-97

Wyness L Nutritional issues of vulnerable groups around pregnancy. British Journal of Midwifery. 2014; 22:(2)

Constipation and haemorrhoids: A midwifery perspective for the childbearing continuum

02 March 2015
Volume 23 · Issue 3


Minor disorders of pregnancy and the puerperium can be debilitating, and have an impact on a woman's physical and emotional wellbeing during her transition into motherhood. Constipation and haemorrhoids are among the most common of these disorders and can arise or worsen during pregnancy and the puerperium. Due to the embarrassing nature of these disorders, women may be reluctant to seek midwifery or medical assistance and may perceive constipation and haemorrhoids as something normal to be tolerated. However, if left untreated these disorders could progress and worsen, becoming pathological and potentially leading to chronic lifelong impairment. As frontline practitioners, midwives are key in ensuring gastrointestinal wellbeing through enabling disclosure, educating women, swiftly referring when required and ensuring appropriate management. This review of relevant literature explores both constipation and haemorrhoids from the viewpoint of the midwife, including the importance of midwifery knowledge, recognition and management of the disorders in both pregnancy and the puerperium.

Constipation and haemorrhoids are common disorders and women who have previously experienced these issues are at risk of recurrence during pregnancy and the puerperium; however, they may develop for the first time due to hormonal changes in this period. Constipation in the general population is reported to be around 27% (Tack, 2011) with an antenatal incidence between 11–38% (Jewell and Young, 2012). Postnatal rates are higher still, with reported incidences of 24–41.8% (Bradley et al, 2007; Ponce et al, 2008). Constipation is characterised by infrequent bowel movements, discomfort when passing stools, hard stool consistency, straining upon bowel evacuation and the sensation of not achieving complete bowel evacuation (Jewell and Young, 2012; Basilisco and Coletta, 2013; Turawa et al, 2014). However, these symptoms can indicate underlying pathologies, therefore, gauging a thorough clinical picture and differential diagnoses are essential when considering diagnosis (Cullen and O'Donoghue, 2007), especially as conditions including irritable bowel syndrome have overlapping presenting symptoms (Paré et al, 2007). Current literature suggests definitions of constipation are misleading and widely debated (Bradley et al, 2007) and women's perceptions of what constitutes constipation is broad ranging in relation to their normal bowel habits. Guidance such as the Rome III Criteria (Drossman et al, 2006) can therefore be useful as a diagnostic and patient communication tool. Rome III Criteria is not pregnancy-specific so midwives are required to define the woman's constipation based on their individual levels of satisfaction about effectiveness of bowel evacuation and frequency (Basilisco and Coletta, 2013).

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