Pregnant women are prone to hemorrhoids or constipation due to worsening of perianal blood flow or intestinal hypomotility caused by progesterone during pregnancy. However, not all pregnant women experience constipation, and some pregnant women experience diarrhea. Both constipation and diarrhea have a bad effect on hemorrhoids, so it is important to regulate bowel movements. Adequate dietary fiber intake is essential. However, pregnant women may eat less due to compression of the stomach by the uterus or for weight control. In such a case, a drug may be used for anal problems.
Other than diet, it is important to go to the toilet when you have a sensation of urgency to defecate. Stools will become hard if not evacuated when the bowels are ready to move, so it is ideal to go to the toilet as soon as you feel urgency to defecate. The time for defecation is up to 3 minutes. Even if the sensation of inadequate defecation is noted, do not try to empty your bowels but leave the remaining stools. There will be no concern about cleansing of the perianal region if a warm water washing toilet seat is available. Furthermore, warming the anal region is important.
With regard to the use of OTC drugs for hemorrhoids, there is usually no problem with topical drugs even during pregnancy; however, pregnant women who are concerned may consult a pharmacist on OTC drug use. If an OTC drug is used, follow the specified dosage and administration. However, when a patient purchases an OTC drug at their own discretion, it is most important to choose a drug appropriate for the patient’s symptoms. Patients often use an inappropriate dosage form of an OTC drug and say, "It worked before," because they felt it had been effective before. However, this might not have been the case and there may have been other reasons for the cure which the patient was unaware of. If there is no alleviation of symptoms after the use of an OTC drug, the drug may be inappropriate or used incorrectly. In such a case, a specialist must be consulted.
With regard to the effects on fetuses, there may be no problem with the application of topical medications for hemorrhoids. Oral medications may have some effects on fetuses, so it is recommended to have such medications prescribed at a hospital. The same precautions apply to breast-feeding women. However, at present, it is said that breast-feeding women can take antibiotics and analgesics, and the number of oral drugs that can be used for breast-feeding women is increasing compared with the past. Following the advice of a physician and taking prescribed drugs will give the patient a sense of security.
It is often difficult to clearly identify the cause of constipation because there is a limit to the kind of tests that are covered by insurance or that can be performed only at specialized facilities. However, drugs for constipation can be prescribed at most clinical departments if patients consult about their symptoms of constipation. Therefore, it is recommended to consult your family physician and to receive follow-up examinations. It is recommended that patients with functional constipation first consult their family physicians and then consult or be referred to a specialist if the constipation is not cured. This does not apply to patients with organic constipation in whom bowel diseases are suspected. Constipation may occur due to side effects of drugs being taken at that time, such as cold or cough medications, and antihistamines used for pollinosis. It should also be noted that elderly people may suffer from constipation due to side effects of drugs because persons of more advanced age are often taking more medications.
For constipation, drug therapy is the main conservative therapy, in which non-irritant drugs, such as stool softeners, are used. Since irritant laxatives are used in cases urgently requiring bowel evacuation, long-term use of such laxatives is not recommended. Although the use of Kampo laxatives is increasing, caution must be exercised because such laxatives contain irritating ingredients. It is also recommended to use bifidobacteria to regulate the intestinal environment. Drugs to be used for constipation vary depending on symptoms. If stools reach the anal canal but do not pass through the anus, a suppository or enema is used because taking oral medications is less effective in such cases. If it is difficult for you to select an appropriate drug, consult an internist, gastroenterologist, or proctologist for treatment with prescription drugs.
The incidence rate of hemorrhoids resulting from constipation is not clearly known. There is no clear understanding about the relationship between the duration of constipation and the development of hemorrhoids; however, from my experience, many patients with hemorrhoids appear to have been suffering from constipation for a long time. If any such symptoms as anal bleeding, prolapse, or pain occur during defecation, consult a proctologist. Especially, patients with anal bleeding must consult a proctologist because bowel diseases may be present. Recently, patients receiving fecal occult blood tests regularly have been increasing. It is also recommended that people above 50 years of age undergo a colonoscopy examination. Even if there are no symptoms of anal disorders, a colonoscopy examination is recommended.
The treatment of constipation in patients with hemorrhoids is the same as routine treatment for constipation. However, for patients with anal pain, stool softeners will be first used and then a painkiller will be used. Especially, patients with anal fissure may be trapped in a vicious circle in which it takes time for them to pass stools due to firm stool consistency and painful defecation, leading to less frequent bowel movements and blocked evacuation. For such patients, it is important to eliminate the fear of bowel movements first by use of stool softeners, laxatives, painkillers and such.
The basic treatment for constipation in pregnant women is improvement of lifestyle as with that in non-pregnant women. Improving eating habits by adequate dietary fiber and fluid intake has positive effects not only on constipation but also on overall health. Pregnant women should eat a well-balanced diet. Due to various factors associated with pregnancy, pregnant women tend to be constipated. There is no problem with bowel movements occurring only once every 2 to 3 days if the patient can pass stools smoothly. Wait until the urgency to defecate comes naturally.
Drugs prescribed by an obstetrician-gynecologist are acceptable. OTC drugs can also be used after consultation with a physician. However, since some ingredients may induce labor, it is recommended to use drugs prescribed only by an obstetrician-gynecologist. It is also recommended to check with your doctor about drugs you have been taking since before becoming pregnant. This will give you assurance. Most of the patient information leaflets for drugs describe that pregnant women should consult a physician about the use of the drugs, which may be a cause for concern. However, most topical drugs, such as ointments and suppositories, may be used without any problem. However, the use of an inappropriate drug during pregnancy can result in regrettable circumstances. If there is any concern about drug use during pregnancy, pregnant women should consult a physician without making a judgment for themselves.
