Constipation in pregnancy, haemorrhoids and anal fissures

About 40% of pregnant women experience constipation in pregnancy (Cullen and O’Donoghue, 2007). It can be uncomfortable and can lead to other conditions, so it’s a good idea to do what you can to try to prevent it.

Making sure you eat a healthy and balanced diet, drinking plenty of water and keeping active will help prevent constipation (NICE, 2017).  Read on to find out more about constipation, what causes it and other conditions that might follow constipation.

What is constipation?

Constipation is when you go for a poo less often than usual and have difficulty having a poo. You may experience discomfort, excessive straining and feel like you have not completely emptied your bowels (Moriarty, 1992; Bradley, 2007).

Signs of constipation include:

• Poo that is harder to push out and larger than is normal for you.
• Going for a poo less than three times a week.
• Often dry, hard or lumpy poo.

(NHS Choices, 2016)

What causes constipation?

The hormonal changes in pregnancy, which encourage parts of your body to relax and make room for the baby, also make constipation more likely. Constipation during pregnancy might also be caused by reduced physical activity and changes in dietary habits (NHS Choices, 2015a). As your baby grows and your uterus stretches, it can also press on your intestines and cause digestive delays or obstructions (NHS Choices, 2015a).

How do I prevent constipation?

Make sure you are eating a healthy and varied diet, drinking enough water and keeping physically active (NHS Choices, 2015a). Read our article on five ways to help prevent constipation in pregnancy.

What other treatments are there for constipation?

If changes to your lifestyle don’t help with constipation, laxatives may be an option (NHS Choices, 2016). Talk to your pharmacist about which ones are suitable for you during pregnancy (NHS Choices, 2016).

Laxatives help you poo more regularly and usually take effect within a few days. But useful as you may find them, you should only use them for a short amount of time (NHS Choices, 2016).

Laxatives that stimulate the bowel, like senna, might be more effective in relieving constipation than bulk forming laxatives, like bran. However, using stimulant laxatives may cause more abdominal discomfort and diarrhoea (Jewell and Young, 2001; Rungsiprakarn et al, 2015; NICE, 2017).

Speak to your GP if you are regularly constipated and it lasts a long time, if it’s not improving, or if you have blood in your poo (NHS Choices, 2016).

What is the difference between haemorrhoids and anal fissures?

Constipation can lead to haemorrhoids (piles) or anal fissures (NHS Choices, 2016).

Haemorrhoids, also called piles, are swollen blood vessels that form in the anus.

• They can be itchy, sore and make it uncomfortable for you to go for a poo.
• You may also notice a small amount of bright red blood on the toilet paper.
• Evidence suggests that ointments and creams will ease symptoms, such as discomfort and itching, but they don’t provide a cure. Pregnant women should consult their midwife or GP about suitable ointments before use.

(NHS Choices, 2015b; NICE, 2016a)

Anal fissures are small cracks or tears in the lining of the anus.

• Symptoms of an anal fissure include a sharp pain when you are pooing, often followed by a deep burning pain. You might also notice a small amount of bright red blood.
• Sitting in a shallow, warm bath a number of times a day, especially after having a poo, may help relieve your pain.
• If you think you may have an anal fissure, talk to your GP. Anal fissures are a common problem and they will be able to help advise you on the best treatment.

(NHS Choices, 2016; NICE, 2016b)

The current guidance to help manage haemorrhoids (piles) and anal fissures includes the same lifestyle changes as for constipation (NICE, 2016a; 2016b). So it’s important to maintain a healthy and balanced diet, drink plenty of water and keep active during pregnancy.    

If you are concerned about any symptoms you have during pregnancy, speak to your midwife or GP.

This page was last reviewed in July 2017

Further Information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

Find out more about constipation, haemorrhoids and anal fissures from NHS Choices.

Read our article about preventing constipation in pregnancy.