Ask the Midwife

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Hemorrhoids, also known to some as piles, are painful dilated veins in swollen tissue at the margin of the anus. During pregnancy they can especially be a problem, due to several factors unique to pregnancy. The pressure of the growing baby puts more strain on the whole bottom of the pelvis, as we are upright creatures; and the combination of gravity and the hormonally changed laxity of tissues creates a weakness that easily reacts to certain cultural influences. I have been told that in countries where people do not use either chairs or toilets, they do not have hemorrhoids or varicose veins. Long periods of standing or chair sitting can amplify the pressure on our bottoms. Constipation (a common problem for those whose diet includes little fiber, too much fat, and not enough water) plus a life that makes relaxation for body functions difficult, with the addition of those prenatal poor-source iron supplements...and you have a recipe for the problem of hemorrhoids ready-made. The whole digestive process itself is normally slowed in pregnancy to help you to get more nutrients out of your food, but if your diet isn't good, you end up with a hard-to-pass result. If hemorrhoids are ever accompanied by bleeding, pain, or back pain, be sure to call your midwife or clinic.

Q. Is there anything I can do to try to avoid hemorrhoids?

A. Here are a few suggestions: Drink lots of water. Divide your weight (in pounds) in half-that's how many ounces of water you need a day. Note: Liquids with carbonation or caffeine will actually cause you to eliminate more fluid than the amount that you drink.

Eat lots of fresh, raw fruits and veggies.

Drink some hot herb tea in the morning before your normal bowel movement time; this helps to establish a regular pattern.

Often the lack of physical movement is part of the problem. I have known many women who have found that a daily walk has drastically decreased both problems: constipation and hemorrhoids.

DO NOT STRAIN or hurry in any way while moving your bowels.

Try to avoid long periods of time sitting down or standing without a change in position.

Avoid too much greasy, salty food, or too many sweets; in other words, eat real food instead of junk food. Often just the artificial colors in foods make the anal tissues sore.

Practice "pelvic floor exercises" or PFEs (the ones that some folks call "Kegel Exercises"). The conscious contracting and releasing of the pelvic floor muscles will do amazing things for control and support of the whole pelvic contents, plus it will help you learn how to release the "gates" inside to help the baby to get out. (By the way, this exercise was practiced all over the world before Dr. Kegel claimed to invent it and named it after himself.)

Q. How do I take care of my hemorrhoids once I've got them?

A. Do NOT use an over-the-counter hemorrhoid preparation while you're pregnant unless you are clearly told to do so by your midwife. (Look at the ingredients on the box; some of those things I do not consider safe for use during pregnancy. Remember, the rectum is lined with mucus membrane, which readily absorbs medicines that come in contact with it.)

In addition to following to the guidelines mentioned above, you can take Metamucil or a cheaper generic brand of fibrous bulking agent. This is different from a "laxative," which makes you "go" by drug influence and which your body can become dependant upon, thereby gradually reducing your own normal bowel functioning process. These bulking agents hold fluid and swell, so that the re-suit created is less hard and less small; this helps the body to squeeze thing along normally. Of course, enough fluid must be taken in, too, to make the process work effectively. You can use psyllium seed husks, wheat germ and/or bran, rice bran in juice or in a juice/water mixture, several times a day, if you have to. You can also either eat a bran cereal for breakfast or take 4 to 8 oat bran and/or alfalfa tablets a day. The alfalfa tablets are my favorite suggestion, as they have so many other benefits to pregnancy as well (that's another whole column in itself).

If you have bleeding gums -- and especially if you also bruise easily --in addition to hemorrhoids, this means that you have weak-walled blood vessels and will benefit from taking Vitamin C with biofiavinoids, 250 mg, 3 or 4 times a day. This will help to strengthen the walls of the vessels in your whole body, as well as those in your bottom.

Finally, be sure to clean your bottom very well after bowel movements, as any residue left there will greatly irritate this sensitive area. Try a squirt bottle with either warm or cool water (whichever feels best). Be sure to squirt from front to back to reduce creating bowel-bacterial contamination of the vagina or urethra (a common cause of vaginal and/or urinary tract infections). You can also use special medicated pads, like Tucks or the generic equivalents, or you can make your own pads.

Q. How can I make my own pads?

A. Here's how to make your own "Tucks"-type pads:

Collect a clean pint jar with a good lid, witch hazel, clean water, and either new, previously washed, cotton flannel, or clean cotton flannel rags (great use for worn-out flannel shirts).
Cut or tear the fabric into four-inch squares and put them into the jar.
In another container, mix 1 cup of witch hazel with 2/3 cup of water, add 1 tablespoon of glycerin (if you have it), shake well, and pour over the flannel squares in the jar.
Use as many of these saturated cloths as you need to gently wipe your tender bottom. If it burns, add some water to the jar and shake it.
This works even better if the cloths are quite cold, so store the jar in the fridge and take it with you on the way to the bathroom.
Drop squares into toilet or trash after use. (Many toilets don't digest them well.)
Note: You may find that using a squirt bottle to rinse off first works best. You can use water in it or the same mixture mentioned above.

You may also want to make your own "first-aid" hemorrhoid pads if things are bad. Here's how:

Cut an unscented, non-deodorant, commercial mini-pad into halves or thirds, depending on your need.
Pour some of the witch hazel, water, and glycerin mixture onto it. Again, it works best if the witch hazel is cold, so keep a bottle in the refrigerator.
Apply the wet side of the pad to the hemorrhoids; use the sticky side to keep the pad in place in your undies.
Change as often as needed.
For really bad hemorrhoids, like postpartum ones, use the same liquid on cotton balls carefully rounded, placed on a plate, and frozen in the freezer. Use one at a time right on the sore sport. The postpartum peripad (Kotex) will hold this tiny relief-bringer in place.

What works even better than this witch hazel-water-glycerin mixture is a remedy I make that we call "Green Goddess Butt Balm." (My stepdaughter Jennifer Seymour actually thought up this name, which was so funny we kept it.) It is made out of the leaves of the plant Plantain (not the banana relative, but the common lawn "weed" Plantago minor or Plantago major). This plant's leaves have wonderful properties, especially when added to witch hazel, to almost immediately reduce the pain and swelling of hemorrhoids.

Q. Is there anything else I can do?

A. Yes. Try spending a few minutes every day, several times a day, in either or both of the following positions. They both help to reduce pressure on the bottom part of your body.

Knee-chest: Kneel on the floor or on a bed, bending your chest down toward the floor and sticking your bottom up in the air. Use a pillow if it helps you to be more comfy. (Note: Do not do this if you are a postpartum mom, as there is a small but seriously dangerous risk of an air embolism into the placental bed of the uterus in this position!)

Legs-up: Lie on your back on the floor or in bed with your legs elevated on two or three pillows. You can use the seat of a couch for your legs if you're on the floor.

Q. Are homeopathic remedies useful for hemorrhoids?

A. Oh gosh, yes!! I have learned about a few of them that are almost miraculous! The first time I took a homeopathic remedy to a friend with really bad hemorrhoids, even I was a little skeptical that anything would help quickly. (It also still surprises me that a remedy taken by mouth can affect another part of the body so profoundly.) My friend had some beauts -- three about the size of grapes! and she was in a lot of pain. Two doses later, by the next morning, she was a different woman. Homeopathy is SO amazing!

Try the remedy that sounds the closest to your symptoms:

Aesculus: The rectum has a sensation of splinters. The hemorrhoids are purple, and there is awful rectal and back pain, with dryness, itching, and burning in the area. Even though very painful, the hemorrhoids seldom bleed.

Aloes: Helpful when the hemorrhoids protrude like grapes, bleed frequently, and feel much better when something cold is applied. Diarrhea is common, but this woman can also have times of constipation and sudden loss of bowel control. The anus and rectum have a scraped, burning sensation. This woman often has a dragging down feeling (as does the Sepia type), but also has low energy and the sensation that at any time the passing of gas can leak out with more than that. Understandably this woman doesn't feel comfortable going out around others with this problem and worry.

Alumina: This woman has years of constipation behind her, long before she ever got pregnant. Usually she has also taken years of over-the-counter treatment for the problem, which has further decreased her body's own capacity to work properly on its own in this way. Usually she drinks a lot of black tea and may have toxic accumulation of aluminum in her system due to antiperspirant use, soda drinking from cans, or use of aluminum cooking pots. Her poop may not even be very hard, she just has a lack of urge or capacity to "go," and has gotten used to her "normal" pattern of not having a bowel movement for weeks at a time.

Arsenicurn Album: This woman has burning pain and pressure in the rectum and anus, and a desire for warm things in the area. There is a meticulousness of personality. She has a dry mouth and wants sips of cold water. She generally feels chilly, however, and wants to be wrapped up to feel warm.

Bryonia: This woman has a bad constipation history, although not as bad as Alumina. Dry mucus membranes, mouth, nose, as well as anus. The poops are not very large but are hard to pass and cause sharp pain. The Bryonia woman has headaches when constipated, which get better right after she poops. This remedy is also usually considered a "grumpy type." This woman may have joint pain.

Calendula: This remedy can be taken orally, but it is also one of the classic homeopathic remedies in ointment form for splits in the rectum or for open, ulcerated places on the hemorrhoids that are exposed. Apply as needed. If all you have is the pellets, you can dissolve some in water and apply as a compress.

Carbo. Veg.: This woman is usually overweight with low energy and gets little if any exercise. She has poor circulation from her sedentary behavior and is often chilly. This is a remedy for poor digestion, lots of belching after eating, and passing of lower gas. Poops are usually very smelly from poor digestion. The hemorrhoids are big, blue, itchy, wet, often bloody, and they usually ooze caustic, thick, rectal discharge.

Collinsonia: One of the most valuable and well known hemorrhoid remedies, the plant it is made from is called Stone Root, and that's what it feels like: little rocks in the bottom. The woman has really bad constipation that causes the hemorrhoids. She goes for days without a bowel movement, then has a big, dry one, but still feels like she's not done. She strains but cannot do any more. This straining causes the protrusions, which feel better more from warmth than cold.

Hamamelis: This is the homeopathic form of witch hazel and can be used either in pellet form or in lotion or ointment form applied topically. It usually brings immediate relief. You can make your own lotion from the pellets by dissolving some in water (distilled is best). Apply as needed. This remedy is to be thought of especially if there is bleeding in the hemorrhoids and very often edema in the legs.

Nux Vomica: If the woman has associated indigestion, and waking at night from midnight to two o'clock, think of this one. The Nux woman has a critical nature and is often irritated easily by noises and music. There may be chronic constipation, often with periodic episodes of diarrhea. The hemorrhoids are large with burning and stinging pain, often with low back pain. Nux folks tend to overindulge, often with alcohol and/or coffee. There is this shy poop pattern: when she tries to strain down, it goes back down; when she relaxes, it comes out.

Opium: This woman often has hemorrhoids and constipation as a result of postpartum trauma to the rectal area. This nerve problem may affect the bowels and the bladder both. Poops are tiny, hard, and black (similar to one of the side effects of any opiate pain medication). She will act drugged, lethargic, and sleepy. She may seem like she never really got over the sedation used during the birth process or from a surgical delivery. Note: This remedy is not available in the United States due to an absurd ignorance of homeopathics. A pint of homeopathic Opium would not have enough drug in it to get anyone high. It's a shame that it is unavailable here, as this is a very useful remedy if indicated.

Podophyllum: This is a liver congestion remedy for constipation with dry, hard, pale poops. This woman has a terrible time getting out of bed in the morning and is slow to come around, even if up. She craves sweets, with lots of sour nausea, vomiting, and heartburn. There is often pain in the liver area and between the shoulder blades, especially on the right. Hemorrhoids will have come from lifting or straining while pregnant, or postpartum.

Pulsatilla: This remedy is characterized by lack of thirst and emotional symptoms that blow first one way and then, soon, in quite another direction. Troubles are worse from any heat in the environment. This woman feels better from fresh air and easy exercise. She often has varicosities of other parts of the body, like the feet or groin. Veins are engorged, blue, and very sensitive. She likes her out of the covers and her arms up over her head when in bed.

Ratanhia: I had never heard of this remedy until I read Sandra Perko's book Homeopathy for the Modern Pregnant Woman and Her Infant. She states: "Think of this remedy when stools can only be passed with a great straining and pushing effort which, of course, causes the hemorrhoids. The anus aches and burns both before and for hours after a bowel movement. Fissures often occur in the anus." Thanks, Dr. Perko.

Sepia: One of the keynote symptoms that I have seen for this remedy, no matter what the other symptoms are, is the classic sensation of a heaviness in the pelvis, as if a woman's insides were falling out. She may have prolapse, hemorrhoids, constipation, or other pelvic problems. She may experience these problems may during pregnancy, due to the pregnancy strain, or have them ever since a pregnancy. She usually has general muscle laxity but feels better if she can make herself get exercise. She is often exhausted and feels unappreciated for all her hard work. Her stomach may be bloated, even is she is otherwise slim. She was trouble getting poops out, straining without success.

Sulphur: Often helpful when the hemorrhoids are not bleeding, but there is a lot of anal itching and constipation. Foot odor (may often be a Pulsatilla symptom, too), skin rashes, and throbbing headaches are also common with this remedy. A Sulphur woman is usually heavily built with a rosy complexion, and is aggravated by heat, especially in pregnancy. She has nasty poops and gas -- give the bathroom time to air out after she's done. The hemorrhoids are oozing, burning, red, and itching, and they may bleed. Standing makes them, and her varicose veins, worse.

References: Sandra Perko's Homeopathy for the Modern Pregnant Woman and Her Infant (1997); Trevor Smith's Homeopathic Medicine (1989); and Lisa's own self-published books Childbirth Classes and Herbals and ` in Maternity Care.

Lisa Goldstein, CPM, CNM, whose three sons were born at home, has been attending homebirths since 1958. In 1983 she became North Carolina's only legal non-nurse midwife. In 1992 she went to nursing school and then to the Community-Based Nurse-Midwifery Education Program (CNEP), with help from the state of North Carolina, to be able to provide a broader range of women's healthcare services to her community.

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By Lisa Goldstein

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