Common Bowel Problems After Pregnancy

Postpartum diarrhea and constipation are not uncommon.

Becoming a new parent is an extraordinary and life-altering experience, but it comes with its fair share of challenges. Understanding what to expect during this transformative period can significantly ease the transition into parenthood. One aspect of post-pregnancy life that many individuals may not anticipate is the potential for changes in bowel habits, which can encompass a range of issues such as hemorrhoids, constipation, fecal incontinence, and diarrhea. While these changes can be unsettling, it’s important to know that they are not unusual, and most individuals can expect their bowel movements to return to normal shortly after giving birth.

The dynamics of bowel movements can undergo noticeable changes after childbirth, primarily attributed to a combination of factors including uterine contractions, pelvic floor issues, and hormonal fluctuations. These alterations can sometimes manifest as postpartum diarrhea, constipation, or other bowel-related problems. In this comprehensive exploration, we will delve into the intricacies of postpartum bowel issues, their causes, potential treatments, and when it is crucial to seek professional medical advice.

The Normalcy of Postpartum Bowel Problems

It’s essential to recognize that changes in bowel habits are not uncommon following childbirth. Fecal incontinence, which is characterized by the inability to control bowel movements, affects a significant percentage of postpartum individuals, ranging from 5% to 26%1. While this statistic might be daunting, it’s reassuring to note that these bowel changes often tend to resolve relatively quickly.

According to Dr. Rita M. Knotts, a respected gastroenterologist and assistant professor at the NYU Grossman School of Medicine, these symptoms are typically not chronic and often subside within a few weeks as the body undergoes the process of recovery from childbirth. However, it is crucial to remember that what is considered ‘normal’ can vary widely from person to person, as each individual’s experience during and after pregnancy is unique.

Root Causes of Postpartum Bowel Problems

The immediate aftermath of childbirth can bring about discomfort and pain in the perineal area, the region between the vagina and the anus. If perineal stitching was necessary following birth, this can also contribute to soreness, which may impact regular bowel movements2. Dr. Knotts identifies several factors that can lead to changes in postpartum bowel habits:

1. Uterine Contractions: During pregnancy, the uterus expands significantly, and after childbirth, it contracts to return to its pre-pregnancy size. These contractions can sometimes result in loose stool.

2. Pelvic Floor Changes: The pelvic floor consists of a network of muscles and tissues that support the bladder and bowels. Alterations in the pelvic floor can lead to constipation and the development of hemorrhoids. In some cases, hemorrhoids can also occur as a consequence of diarrhea, causing discomfort and irritation.

3. Hormonal Fluctuations: Elevated levels of progesterone during pregnancy play a role in maintaining pregnancy and slowing down the gastrointestinal (GI) tract3.

Additionally, the mode of delivery, whether vaginal or via C-section, can influence bowel movements postpartum. Individuals who give birth vaginally may experience perineal tearing, stitching, and straining, all of which can contribute to constipation5. In contrast, those who undergo a C-section may be exposed to certain medications, dietary restrictions during labor, supplements, or perineal stitching, which can result in diarrhea or constipation.

Dr. Knotts highlights the impact of pain medications often used during and after birth, which can slow down bowel function, potentially leading to constipation. Some antibiotics may also have the side effect of causing diarrhea.

Managing Postpartum Bowel Issues

With patience and proper attention, postpartum bowel changes should gradually resolve on their own. Depending on the specific nature of the bowel changes, the following treatments may offer relief:

• Hemorrhoids: Increasing dietary fiber intake and staying well-hydrated are recommended strategies for managing hemorrhoids, as advised by Dr. Knotts. Stool softeners, such as Colace (docusate sodium), can also be beneficial. For reducing swelling, discomfort, and itching associated with hemorrhoids, hydrocortisone creams, suppositories, and sitz baths are potential remedies.
  
• Constipation: Dr. Gabrielle Sandler, an OB-GYN and clinical assistant professor of obstetrics and gynecology at NYU Grossman School of Medicine, suggests adopting a high-fiber diet and maintaining adequate hydration to alleviate postpartum constipation. Fiber supplements, stool softeners, or a laxative, such as MiraLAX (polyethylene glycol 3350), can also be effective. However, it is important to avoid prolonged use of stool softeners and laxatives, as over-reliance on these medications can lead to reduced bowel function. Always adhere to the recommended usage instructions on the packaging.
  
• Fecal Incontinence and Diarrhea: Postpartum diarrhea is relatively common among individuals who experience stretching or tearing of their rectal muscles during labor. One potential solution is to focus on the rehabilitation of the pelvic floor. Initiating pelvic physical therapy four to six weeks after delivery, and continuing for at least five months, can be effective in addressing this issue, according to Dr. Sandler. Additionally, fiber supplements, bulking agents like psyllium, and anti-diarrheal medications like Diamode (loperamide) may help manage postpartum diarrhea.

When to Consult a Healthcare Provider

Before considering over-the-counter (OTC) treatments, it is advisable to consult a healthcare provider to determine the most suitable course of action for your specific situation. An OB-GYN may provide valuable insights and recommend lifestyle adjustments that can contribute to improved digestive health. For instance, reduced physical activity following childbirth can be a contributing factor to digestive system issues, as noted by Dr. Knotts.

While changes in bowel movements after pregnancy are a common occurrence, it is essential to promptly seek medical attention if you notice any alarming symptoms. Indications that may suggest an infection include:

• Severe abdominal pain
• Fever
• Tears in perineal stitches or near the anus (anal fissures)
• Pain, discharge, or swelling near perineal stitches

Dr. Sandler emphasizes the importance of proactive communication with a healthcare provider, stating, “Yes, this is an issue that you and [a healthcare provider] should discuss prior to birth, given how prevalent it is. If [a healthcare provider] does not bring this up, you should feel empowered to start the conversation.” Open and honest communication with healthcare professionals is key to addressing any concerns or discomforts related to postpartum bowel issues.

Conclusion

In summary, the journey of becoming a new parent is a profound and transformative experience, marked by numerous changes and challenges. One of the aspects that individuals may encounter in the postpartum period is alterations in their bowel habits, encompassing issues such as hemorrhoids, constipation, fecal incontinence, and diarrhea. These changes, while potentially discomforting, are generally expected and often resolve as the body recovers from childbirth.

The underlying causes of these postpartum bowel issues can be attributed to a combination of factors, including uterine contractions, pelvic floor changes, hormonal fluctuations, and the mode of delivery. Fortunately, there are various treatments and strategies available to alleviate these symptoms and promote a return to regular bowel movements.

It is of utmost importance to consult with a healthcare provider before embarking on any treatment regimen, especially when considering over-the-counter medications. Additionally, if you experience any alarming symptoms, such as severe abdominal pain, fever, or issues with perineal stitches, seeking immediate medical attention is advised.

In closing, while the challenges of postpartum bowel problems may be daunting, they are a natural part of the post-pregnancy journey. By understanding the potential causes and seeking appropriate medical guidance, individuals can navigate this phase with confidence and ensure their overall well-being during this transformative period of parenthood.