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Constipation and haemorrhoids: A midwifery perspective for the childbearing continuum

02 March 2015
Clinical Practice
02 March 2015
Volume 23 · Issue 3

Abstract

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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Constipation
Haemorrhoids
Piles
Midwifery management
Pregnancy
Puerperium