Ask the Midwife Kathleen McClelland has been a midwife since 1990. Prior to that she was a Family Nurse Practitioner, with an emphasis on Women's Health Care, working mainly with the Deaf and Native American populations. As a midwife she has worked in large and small health care settings, from a a large health maintenance organization to a small private practice in a rural community to a medium size hospital caring for indigent women. She has attended one home birth, as the birth assistant to the midwife, of a very dear friend. The birth of her son was at a free-standing birth center in Alexandria, Virginia, attended by two of her midwifery classmates as well as her husband, sister, and father.		Midwife Kathleen McNellis Ask Kathleen a question

Question submitted March 12, 2002.

Will all women get hemorroids? What is the first sign when getting them?

Certainly not all women will get hemorrhoids, but they are a common discomfort of pregnancy and the early post-partum period. Hemorrhoids are weakened and enlarged blood vessels inside and outside the rectum. One of the hormones of pregnancy, progesterone, relaxes smooth muscles which contributes to weakening the rectal vessels. Progesterone relaxes the bowel, so the food you eat moves through your colon more slowly, and more water is absorbed from your feces. This can lead to constipation. The
increased pressure from bearing down as you try to pass hard, dry stools as well as pressure from the growing uterus on the veins around the rectum and anus causes enlargement of the rectal vessels.

Prevention of constipation and hemorrhoids means adequate water and fiber intake through out your lifetime, and is especially important during your pregnancy and in the early weeks after you have had your baby. Find out what ever it takes for you to have a nice, big, soft bowel movement everyday. It may be a glass of warm prune juice. It may be a bowl of oatmeal, raisins, and wheat germ every morning for breakfast. You might prefer to take a natural bulk powder, such as Metamucil or Citricel, with orange juice once a day. Not straining to move your bowels is important in the prevention of hemorrhoids.

How do you know you have hemorrhoids?? Blood in your stool or on the toilet paper after you wipe may be the first thing you notice. You may feel a
small, soft mass in your rectal area, which may or may not be painful. You may have some rectal itching or burning. There are a number of treatments for hemorrhoids, once they develop, depending on their severity.

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Read a transcript of a chat with Kathleen McClelland and Pam Cass about Midwives and Doulas: How They Support the Birthing Woman.

Kathleen McClelland | Pam Cass | Cindy Curtis