Constipation and Hemorrhoids (Nursing)

00:01 Constipation and I almost want to say that with like some kind of sound effect but I won't do that.

00:06 And when would that happen? Well, that can happen great, throughout the entire pregnancy.

00:11 It's so wonderful. And what's the physiology? Well, it's the hormones.

00:16 So, remember when I told you progesterone relaxes everything, and then I said it again, that it relaxes everything? I meant everything and it also relaxes the intestines which need peristalsis to move stool through because when it doesn't move and it gets stuck, it gets big and it gets hard and then it gets really hard to push out and then we end up constipated.

00:41 So, what's the problem with that? Well, there are lots of problems I'm sure we can think of but the biggest one is that if you have hard stool and you push really hard to get it out, you can get hemorrhoids which are then, doubly uncomfortable.

00:55 So, constipation is not something we want to experience, it's not going to hurt the baby but it can be very uncomfortable for the pregnant client, so we definitely want to talk about ways to make it better.

01:05 First thing is going to be to increase the fluids.

01:08 So, sometimes I'll ask the client, I'll ask them how much do you drink? How much water do you have, or how many liquids do you have? And the answer is a lot. Well, I need a quantification of a lot so that we can really decide whether they're getting at least 64 ounces of liquid a day.

01:25 Now, for some people, 64 ounces is not going to be enough and they're going to need a little bit more.

01:30 So, really trying to work with them on what's the magic amount of fluids is going to be important.

01:35 Now, just because your bowels aren't moving very well, doesn't mean you shouldn't move.

01:40 So, getting involved in some kind of exercise would be really helpful in terms of keeping things moving.

01:46 We can also increase the fiber so thinking about dietary supplementation, it's not that you've necessarily have to go out and get something over the counter but really look at the food composition.

01:57 There's always the option of doing something like Benefiber or Metamucil or something like that.

02:02 That works but you can also just take a look at the diet, there may be ways to sneak that fiber in without adding another medication but if you need it, it's there.

02:12 We definitely want to avoid the creation of hemorrhoids through constipation or gas which is incredibly uncomfortable. Both for the person who has it, and everybody else in the room.

02:24 Okay, I mentioned hemorrhoids, so let's talk about them.

02:28 When might we expect them? Second and third trimester, especially.

02:33 When we think about the physiology, we already understand the influence of hormones on the intestines, and on the rectum, and anus and how it can cause everything to relax.

02:42 Remember, we have Cletus the fetus who is now getting larger and larger as we move into the second and third trimester, who is then pushing down, right? And so that effect sort of relaxation and the weight of the fetus may also contribute to the hemorrhoids, in addition to the constipation that we were already having.

03:03 Now, when is it a problem? Unlike constipation which is just uncomfortable, hemorrhoids can be problematic because they can become thrombosed.

03:10 So, we can actually have a vein that makes its way into that hemorrhoid and that can be a problem or they can become infected.

03:17 Sometimes, they tear or they leak or they bleed and we think about the possible impact of feces near the hemorrhoid.

03:24 You start to get the picture.

03:25 So, we definitely want to check out those hemorrhoids and make sure that neither one of those things is happening.

03:30 In terms of treatment, if there's any constipation, we have got to get it to go away.

03:35 We can use compresses on the hemorrhoid to help make it better, warm or cool, whichever one feels better. We're going for feeling here. Whichever one works is fine.

03:44 When we think about the weight wearing that support belt can actually decrease the pressure of the fetus on the lower extremities and particularly the bowels, so a support belt is a great idea.

03:56 And then also medications, so, medications both to treat the constipation that caused the hemorrhoid but also to place on the hemorrhoid to decrease some of the pain.

04:05 Because if you can imagine trying to have a bowel movement with the hemorrhoid in the way makes it harder which then increases the chances of constipation which then gives you more hemorrhoids. You see where I'm going. Medication might be necessary.