Constipation, haemorrhoids, and heartburn in pregnancy


Constipation: Some women will have experienced chronic constipation prior to becoming pregnant, and in others constipation develops for the first time during pregnancy.[1] For a full definition of constipation, see review on constipation in adults. The diagnosis of constipation is mainly clinical, based on a history of decreased frequency of defecation, as well as on the characteristics of the faeces. An extensive evaluation is usually unnecessary for women who present with chronic constipation, or if constipation develops for the first time during pregnancy.[2] Haemorrhoids: Haemorrhoids (piles) are swollen veins at or near the anus, which are usually asymptomatic.[3][4] Haemorrhoids can become symptomatic if they prolapse (the forward or downward displacement of a part of the rectal mucosae through the anus) or because of other complications such as thrombosis. Associated anal fissures (a break or slit in the anal mucosa) can also lead to symptoms.[5] Haemorrhoids can be classified by severity:[6] first-degree haemorrhoids bleed but do not prolapse; second-degree haemorrhoids prolapse on straining and reduce spontaneously; third-degree haemorrhoids prolapse on straining and require manual reduction; and fourth-degree haemorrhoids are prolapsed and incarcerated. Diagnosis of haemorrhoids is based on history and examination. Symptoms include bleeding, mucosal or faecal soiling, itching, and occasionally pain.[3][6] Fourth-degree haemorrhoids may become "strangulated" and present with acute severe pain. Progressive venous engorgement and incarceration of the acutely inflamed haemorrhoid leads to thrombosis and infarction. The diagnosis of haemorrhoids is confirmed by rectal examination, and by inspection of the perianal area for skin tags, fissures, fistulae, polyps, or tumours. Prolapsing haemorrhoids may appear at the anal verge on straining. It is important to exclude more serious causes of rectal bleeding. Assessment should include anoscopy to view the haemorrhoidal cushions.[7] Haemorrhoidal size, and severity of inflammation and bleeding should be assessed.[6] more. Heartburn: Heartburn is defined as a sensation of "burning" in the upper part of the digestive tract, including the throat.[8][9] It can be associated with oesophagitis.[1] One study reported the results of endoscopy on 73 pregnant women with heartburn, and found endoscopic and histological evidence of oesophagitis in most women.[10] As complications associated with heartburn during pregnancy are rare (e.g., erosive oesophagitis), upper endoscopy and other diagnostic tests are infrequently needed.[9][11] Therefore, the diagnosis of heartburn is mainly clinical, based on the history.