Haemorrhoids and Constipation After Childbirth: Relief Without Risk

Three days since the baby was born, and still nothing. You dread going to the toilet, because of the stitches, and you have also discovered a small painful lump at the edge of the anus. Haemorrhoids after childbirth, like the constipation that keeps them going, are among the little troubles least talked about. Yet they are very common, and the UK's NHS describes them as very frequent after a birth.

The good news is that they usually disappear within a few days or weeks. Here is why they appear, how to make the first bowel movement less daunting, what you can do at home and what should make you seek care.

Why do so many mothers get haemorrhoids?

Haemorrhoids are dilated, swollen veins around the anus and rectum, reminds Naître et grandir. Pregnancy already encourages them, with the womb pressing on the pelvis and the frequent constipation of the last months; our article on the minor ailments of pregnancy covers it. The effort of pushing during labour often brings them out.

Constipation then keeps the problem going. NHS inform cites it as a common cause of haemorrhoids after birth. The MSD Manual sums it up: preventing constipation can avoid or relieve haemorrhoid flare-ups.

Why is the gut so slow after birth?

Several reasons add up: you ate little during labour, you move less, you often drink too little, and you hold back out of fear of pain. Some strong painkillers, the opioids, also slow the gut, as does anaesthesia, point out Naître et grandir and the MSD Manual.

The Quebec guide Mieux vivre gives reassuring reference points: not opening your bowels for two to three days after a vaginal birth, or up to three to five days after a caesarean, is normal.

The first bowel movement: how to make it less daunting

Fear of the first bowel movement is very widespread, especially after an episiotomy or a tear. Mieux vivre and NHS inform say it clearly: stitches do not give way when you go to the toilet.

1. Do not wait: go as soon as you feel the urge. Holding back hardens the stool.
2. Get set up with knees higher than the pelvis, feet raised, body leaning forward, as the HUG in Geneva advise. A small stool under your feet is enough. Squat toilets give this position naturally; if squatting pulls on your stitches, the stool is more comfortable.
3. Do not push: breathe out gently, mouth slightly open, and let it come.
4. Support your stitches with a clean pad or compress held against the perineum, as the NHS suggests.
5. Rinse rather than rub: a jet of lukewarm water, then pat dry, always from front to back.

Care of the stitches themselves is detailed in our article on episiotomy and tears. After a caesarean, remember to press a cushion against your belly: our guide to caesarean scar care explains why.

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What to eat to get things moving, the Moroccan way

The CNGOF recommends preventing constipation first through diet and lifestyle. The sources consulted agree: fibre, increased gradually, about two litres of water a day, fresh or lightly processed foods. Naître et grandir also mentions prune juice.

Moroccan cooking offers everything you need:

• Pulses: harira, bissara, lentils and the chickpeas of the tagine.
• Vegetables at every meal: vegetable tagine, cooked salads (zaalouk, cumin carrots), vegetable soup.
• Wholemeal bread or barley bread rather than white bread, at least at one meal in two.
• Fruit: fresh or dried figs, prunes, oranges, and the dates you keep a handful of by the bed.
• Water within reach during every feed. Mint tea is comforting, but it does not replace water.

The dishes of the nfissa, such as sellou or msemen, are rich and comforting. Keep them, but vary with these higher-fibre foods. If you are breastfeeding, our article on the diet of a breastfeeding mother sorts myths from real needs.

Move too: a few steps several times a day wake up the gut, reminds Mieux vivre.

How to ease haemorrhoids at home

• Cold, in the first days: an ice pack wrapped in a cloth reduces pain and swelling at the perineum, according to the MSD Manual. The HUG suggest 15 minutes, two to four times a day.
• Lukewarm sitz baths, afterwards: sitting for a few minutes in a few centimetres of clean lukewarm water soothes, according to the MSD Manual and Naître et grandir. Full baths are still best avoided while you are bleeding.
• Sitting without pressure: a cushion, or two rolled cloths either side, as the HUG suggest. Avoid the ring cushion, which congests the perineum.
• A suitable cream or suppository, chosen with your pharmacist or midwife. Tell them you are breastfeeding: the composition matters.
• A gentle laxative if dietary measures are not enough. Mieux vivre, the NHS and NHS inform direct you to a professional to choose it. Do not take a "natural" herbal laxative without advice if you are breastfeeding.

The dose and duration of any medicine are set by the doctor or pharmacist.

Haemorrhoids or something else: when to worry

Most postpartum haemorrhoids are simply a nuisance. A few situations call for an examination: a hard, bluish and very painful lump, which may be a thrombosed haemorrhoid; very sharp pain during and after a bowel movement, which suggests an anal fissure; blood in quantity, or black stools.

Leaking stool or wind that you cannot control is not something to keep to yourself either: the NHS asks you to mention it to the midwife or doctor. It can be treated, and our article on pelvic floor rehabilitation explains how. For the rest of the body after baby, see our guide to the first six weeks.