Why We’re Focused on Treating Pregnant Women
You’re going to hear us talking to pregnant and postpartum women quite a lot here at Bummed. That’s because pregnant people often deal with anorectal issues because of what their bodies are going through, but it’s not always the easiest for them to get the care they need, for a whole host of reasons. We’re digging into all that here.
The Stats
According to one study out of Canada, “Pregnancy and vaginal delivery predisposes women to develop hemorrhoids because of hormonal changes and increased intra-abdominal pressure. It has been estimated that 25% to 35% of pregnant women are affected by this condition.
In certain populations, up to 85% of pregnancies are affected by hemorrhoids in the third trimester.”
Our Chief Medical Officer, Carmen Fong, MD writes in her book Constipation Nation,
“Constipation in pregnancy affects 11 to 38 percent of women (up to 40 percent in some studies). I would say more people are affected with constipation and don’t even realize it and don’t seek medical attention.
Maybe they had underlying constipation and felt that their pregnancy constipation was no worse than baseline. Maybe it was just another thing people felt they had to deal with during pregnancy, ‘par for the course,’ so to speak.
I have seen many, many women who saw me because their hemorrhoids got worse during pregnancy and after childbirth. This is because all of the reasons hemorrhoids worsen are magnified during pregnancy and childbirth—the trifecta of constipation, inactivity/sitting, and increased intra-abdominal pressure or straining.”
Why Pregnant Women are More at Risk for Anorectal Issues
Considering pregnancy-related constipation affects most women, which, in effect, is half the population, people are often surprised by it.
The top reasons constipation and hemorrhoids can occur during pregnancy:
1. The most obvious factor is pregnancy-related weight changes and girth. This doesn’t usually happen until the third trimester, when the weight of the fetus-filled uterus actually sits on the colon, impeding some passage of stool contents
2. Most pregnant women require more water intake at baseline to accommodate the 50 percent increase in circulating blood volume (up to three liters a day). Pregnant women increase water absorption from the intestines to help with that. If you’re already not drinking enough water pre-pregnancy, and you have a higher water requirement during pregnancy, and you’re vomiting a lot of it up, you’re already behind on water!
3. Most women have food intolerances during pregnancy—certain smells or tastes that make them vomit. Some women tend to stick with bland, simple-carbohydrate foods, such as rice, toast, and potatoes. There is little fiber in these foods but a lot of starch, leading to further constipation.
4. Some women become anemic during pregnancy because of the increase in circulating blood volume. Doctors prescribe iron supplements for this. Iron is notorious for being constipating (and turning stools black). Lastly, when you don’t feel good, you tend to sit or lay around. Inactivity leads to more constipation.”
The Current Experience
So for all the reasons above, pregnant women experience constipation at very high rates, which leads to them getting hemorrhoids at high rates. However, pregnant women are not traditionally able to access the same solutions that non-pregnant women have.
According to the same Canadian study, “[For pregnant people] The treatment is mainly symptomatic for most patients. Most forms of the condition can be treated by increasing fibre content in the diet, administering stool softeners, increasing liquid intake, and training in toilet habits.
Although none of the topical antihemorrhoidal agents commonly used have been assessed for safety in pregnancy, it is unlikely that the constituent parts (anesthetic, corticosteroids, and anti-inflammatory agents) will harm the third-trimester infant. In most women, most symptoms of the condition will resolve spontaneously soon after giving birth.”
You heard it there, “none of the topical antihemorrhoidal agents commonly used have been assessed for safety in pregnancy.”
Lack of Research
Because of a lack of research, doctors are reluctant to prescribe these effective prescription medications to pregnant people. We’ve heard this same experience echoed from OBGYNS. While women tend to have frequent access to their OBGYN while pregnant, their OBGYN will often refer them out to a specialist, like a gastroenterologist or a colorectal surgeon, to treat their hemorrhoids.
These specialists are often reluctant to prescribe to pregnant women because of the lack of research. It has been well documented that there are many challenges when including pregnant women in clinical research. The lack of research, however, does not always deter women from using a medication they need, as “Up to 90% of women are estimated to be exposed to at least one medication during pregnancy, and at least 60% of women who ultimately give birth take one or more medications to treat a chronic medical condition or a condition that arises during the pregnancy.”
How Telehealth Can Help
So how are we helping the problem of getting pregnant people safe, effective care?
We’re doing the work of gathering all of the specialists in one room:
- OBGYNs
- Colorectal Surgeons
- Gastroenterologists, and more
Each of these specialists have carefully reviewed the ingredients in our special custom compounded formulas, and, reviewing what literature is available, have deemed them appropriate for use while pregnant. We’re also careful to provide all of our patients with paths for escalation, in case we do think you are best served by seeing a doctor IRL.
We also make it a whole lot easier for you to get your speciality prescriptions, by shipping you your meds in discreet, secure packaging. No more running around town to the nearest compounding pharmacy (which are pretty hard to find).
Telehealth provides a crucial solution for pregnant women experiencing anorectal issues, offering access to specialists who have carefully reviewed and approved treatments for pregnancy. This approach bridges the gap in care and addresses the lack of research on traditional treatments during pregnancy.
Our pregnancy-safe medications include:
Long-Acting Hemorrhoid & Fissure Rx Cream
Sensitive Care Hemorrhoid & Fissure Rx Cream
Anti-Itch Pruritus Ani Rx Cream
Bummed content is for general education and should never replace professional medical advice that considers your individual health. If you think you’re experiencing a medical emergency, call 911 or head to the nearest emergency department.
