When I became pregnant with my daughter, I was prepared for the numerous changes that pregnancy can have on your body; I'd been thoroughly warned about swollen ankles and an achy back. What I didn't know was that the digestive system issues I experienced in the days after having my baby—constipation, diarrhea, and hemorrhoids—would continue long after I gave birth. No one had cautioned me about that.
However, all three issues plagued me for months. I knew my meals were not the cause, as I had always eaten a high fiber diet full of grains and vegetables. But I found myself making multiple (and highly uncomfortable) trips to the bathroom each day.
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Why do bowel movements sometimes change after having a baby?
A change in bowel movements is very common after giving birth. "There are several reasons why women have alterations in bowel movements after having a baby," Rita Knotts, MD, gastroenterologist and assistant professor of medicine at NYU Langone Health, tells Health. "In the immediate period there is of course soreness and pain, which limit the ability to bear down and therefore the ability to evacuate."
Dr. Knotts says that certain medications meant to alleviate postpartum pain can add insult to injury. "Pain medications are also frequently used during and after birth, which can make your bowels slower, resulting in constipation," she explains.
Keep in mind that your pelvic floor muscles just squeezed out another human, and they need a lot of recover time. "Your bowel movements greatly depend on the integrity of your pelvic floor, which just went through something major," she says.
Hormones play a role as well. "Progesterone levels are higher during pregnancy, which helps maintain the pregnancy but also slows down your entire GI tract," says Dr. Knotts. "This also leads to pelvic floor changes."
Those pelvic floor changes often result in constipation, which in turn causes hemorrhoids during and after birth, Gabrielle Sandler, MD, ob-gyn and clinical assistant professor of obstetrics and gynecology at NYU Langone Health, tells Health. Hemorrhoids can also be a side effect of diarrhea, which can cause anal irritation and discomfort.
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How many women does this affect—and why is nobody talking about it?
Upon further research, I was relieved to see that I wasn't alone in my postpartum digestive issues. According to Dr. Sandler, FI (fecal incontinence, or the inability to control your bowels) affects approximately 7% of all women after a delivery, with 50% of women experiencing constipation immediately after delivery and 24% continuing to experience it at 3 months postpartum.
In an ideal world, your ob-gyn should be warning you about these issues. While some women (myself included) might be embarrassed to bring them up, it's very important that we do. The good news is, Dr. Knotts says these bowel changes tend to go away fairly quickly: "Most of the time, the symptoms aren't chronic. Most resolve after a few weeks as your body recovers from childbirth."
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How doctors treat bowel issues after childbirth
With attention, time, and patience, bowel changes after childbirth should disappear. Here's what doctors recommend:
Hemorrhoids
Dr. Knotts suggests treating hemorrhoids by increasing dietary fiber and water intake, as well as using stool softeners (such as Colace or Senna). Hydrocortisone creams and suppositories, as well as sitz baths, can reduce the swelling, discomfort, and itching.
Constipation
General recommendations for postpartum constipation prevention include eating a high fiber diet and drinking plenty of water, according to Dr. Sandler. Some additional treatments that can be helpful include fiber supplements, stool softeners, and/or a laxative (such as Miralax). However, stool softeners and laxatives should not be taken for an extended period, which can lead to dependency and decreased bowel function. Follow the instructions on the package when it comes to how long to use.
Fecal incontinence and diarrhea
Treat these issues with fiber supplements/bulking agents, like psyllium, and anti-diarrheal agents, such as loperamide, says Dr. Sandler. Starting pelvic physical therapy at four to six weeks after delivery (and continuing for least five months) has also been shown to be effective, Dr. Sandler adds.
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What you need to know
Being a new mother is challenging enough, but when we know what to expect, it makes for a smoother transition. Had I known about these issues, I would have been better prepared.
But after I educated myself about their treatment, I found relief. For my first few months after giving birth, I relied heavily on fiber supplements and laxatives, which made going to the bathroom much more comfortable. I also treated my hemorrhoids with pain relief creams and the use of a sitz bath.
Before you head to the store to buy over-the-counter treatments, you should have a conversation with your doctor about what might work best for you. Your doctor might point out some lifestyle changes that can help, Dr. Knotts says, explaining that decreased physical activity after delivery can contribute to digestive system problems.
That said, it's important to speak up if you're uncomfortable, says Dr. Sandler. "Yes, this an issue that you and your doctor should discuss prior to birth, given how prevalent it is. If your doctor does not bring this up, you should feel empowered to start the conversation."
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