Pregnancy and Constipation, Causes, Prevention, and Relief

Pregnancy and Constipation: Causes, Symptoms, Prevention, and Relief

What is Constipation?

Experiencing constipation during pregnancy can be worrisome, especially when you’re not only caring for yourself but also for the well-being of your unborn child. Normal bowel function varies from person to person, however if you find yourself having bowel movements less than three times a week, with dry, hard, lumpy stools that are difficult to pass, you’re likely dealing with constipation.

How Common is Constipation During Pregnancy?

Constipation is a common issue during pregnancy, and although it can occur outside of pregnancy, expectant mothers might experience it more frequently than the general population. According to a recent review, up to 40% of pregnant women face constipation, a rate nearly double that of non-pregnant individuals of a similar age, where it affects only 21%.

So, if you’re pregnant and struggling with hard-to-pass stools, take comfort in knowing that you are not alone in facing this common challenge.

When Does Constipation Start in Pregnancy?

Constipation can start at any point during pregnancy and after childbirth. When considering different stages of pregnancy, the rates of constipation are relatively consistent between the second and third trimesters.

In the second trimester, about 61% of pregnant women experience constipation, while it becomes less common in the third trimester, affecting approximately 55% of pregnant women during this time. It’s worth noting that iron and calcium supplements, often recommended during pregnancy, might contribute to worsening constipation.

Understanding the timing and prevalence of constipation during pregnancy provides valuable insights into managing and addressing this common issue. In the following sections, we will explore the causes, symptoms, prevention, and relief measures for constipation during pregnancy.

Causes of Constipation During Pregnancy

Constipation during pregnancy can be attributed to various factors. As your body undergoes significant changes to prepare for childbirth, hormonal fluctuations, particularly the rise in progesterone, play a crucial role in initiating these transformations.

Progesterone, a hormone essential for pregnancy preparation, has additional effects that can contribute to constipation. One such effect is its ability to relax smooth muscles in the gut, resulting in a slower bowel movement. This can make the process of passing stool more challenging than usual.

The physical space within your digestive system is also compromised as your baby grows. The developing fetus may exert pressure on your gut, further slowing down the bowel movement process. However, whether pregnant or not, several non-pregnancy-related factors can lead to constipation:

1. Dietary Habits: A low-fiber diet can contribute to constipation. Fiber plays a crucial role in softening stool and aiding its movement through the gut.
2. Medications: Certain medications, such as iron pills and others used for allergies, blood pressure, seizures, and psychiatric health problems, can have constipation as a side effect.
3. Daily Routine: Everyday habits like insufficient water intake, infrequent exercise, stress, and irregular bowel movement schedules can increase the likelihood of constipation.
4. Underlying Disorders: Pre-existing conditions like irritable bowel syndrome (IBS) or celiac disease (gluten allergy) that affect digestion can persist during pregnancy, contributing to constipation.

Is Constipation During Pregnancy a Serious Concern?

While constipation is a common issue during pregnancy, it can significantly impact your quality of life and, in some cases, indicate an underlying condition that requires medical attention.

Straining during bowel movements due to constipation may lead to hemorrhoids and rectal bleeding. To ensure your well-being during pregnancy, it’s advisable to consult with a doctor if you experience the following symptoms while being constipated:

1. Blood in your stool
2. Unintentional weight loss
3. Extremely painful bowel movements
4. Prolonged duration of constipation beyond what is usual for you.

Taking these symptoms seriously and seeking medical advice can help address any potential concerns and ensure a healthier pregnancy experience.

How can You Relieve Constipation During Pregnancy ?

Dealing with constipation during pregnancy involves adopting lifestyle changes, starting with preventive measures. While there isn’t a specific pregnancy-centric plan for reducing constipation, making adjustments to dietary habits is a good initial step.

Consulting with healthcare professionals can provide insights into pregnancy-safe options to facilitate smoother bowel movements until the crucial birth date arrives. To alleviate constipation, it’s essential to modify your eating habits, increase water intake, and engage in regular physical activity.

Incorporate a High-Fiber Diet: Ensuring an adequate intake of fiber is crucial for keeping constipation at bay. Gradually enhance your fiber consumption by including more of the following in your diet:

• Fruits and vegetables
• Whole-grain foods
• Legumes

It’s advisable to introduce additional fiber gradually, allowing your body to adapt to the increased quantity. Rapidly increasing fiber intake may lead to excess gas, bloating, and worsen constipation.

Stay Hydrated: During pregnancy, the increase in blood supply necessitates higher water intake. A sufficient fluid intake is integral to a healthy lifestyle and can aid in preventing constipation.

Incorporate Moderate Physical Activity: Engaging in moderate physical activity is an enjoyable and accessible way to reduce the risk of constipation. While it’s crucial to avoid overheating during pregnancy, maintaining an active lifestyle can benefit various aspects of your health.

Regular movement not only helps relieve constipation but also supports overall well-being throughout pregnancy.

Listen to Your Body’s Signals: Establishing a routine where you attend to bowel movements at the same time each day can promote regularity. Allocate dedicated time every day for bathroom breaks, and pay attention to your body’s signals indicating when it’s time to go.

By adopting these lifestyle changes and remedies, you can take proactive steps to manage and alleviate constipation during pregnancy.

Medications for Constipation Treatment in Pregnancy

Laxatives are commonly used to address constipation during pregnancy and breastfeeding. These medications are generally poorly absorbed from the mother’s gut into her bloodstream, posing minimal risk to the unborn or breastfed baby.

The treatment goal is to restore a normal bowel habit, and laxatives are typically tried in the following order:

1. Bulk-forming laxatives (psyllium, ispaghula, sterculia): Increase bulk and moisture in stool, usually effective within 24 hours but may take 2-3 days with regular use.
2. Osmotic laxatives (macrogol, lactulose, sorbitol): Draw water into the bowel to expand and soften the stool, effective in 2–48 hours when taken on an empty stomach.
3. Stimulant laxatives (senna, bisacodyl, cascara): Act locally to stimulate the gut, effective in 6-12 hours and best taken at bedtime. During pregnancy, stimulant laxatives can potentially induce uterine contractions, leading to a risk of miscarriage and premature birth. These should only be used on a one-off basis after consulting with a doctor.
4. Stool softener laxatives (docusate): Often ineffective unless combined with an osmotic or stimulant laxative.
5. Other products: Liquid paraffin, magnesium salts, suppositories, and enemas may be used occasionally to treat fecal impaction but are not for regular use.

For specific brand names of these medicines, consult with your midwife, doctor, or pharmacist. Overusing any laxative can lead to a lazy bowel and occasional electrolyte imbalances.  As a general rule, seeking advice from a healthcare professional is recommended for pregnant  individuals experiencing constipation before making decisions on relief methods.

What remedies should not be used for constipation in pregnancy?

Certain remedies should be avoided for treating constipation during pregnancy due to potential risks:

1. Laxative Pills: It is strongly discouraged to use laxative pills for constipation during pregnancy. These pills may stimulate uterine contractions, posing a risk to the developing fetus, and can lead to dehydration.
2. Mineral Oils: The use of mineral oils is not recommended during pregnancy. These oils can reduce nutrient absorption, potentially affecting the well-being of both the mother and the baby. Therefore, it’s best to avoid their use as a remedy for constipation during pregnancy.

When Constipation typically Subside during Pregnancy?

Constipation may persist for some women throughout their pregnancy due to elevated progesterone levels. However, adopting changes in diet and exercise often helps improve the situation. Fortunately, steps can be taken at any stage of pregnancy to address and alleviate constipation.

Constipation after Childbirth

After childbirth, women who undergo a caesarean section often experience constipation for a few days until their gut motility resumes. Those with stitches following vaginal births may delay bowel movements due to fear and discomfort.

The administration of strong painkillers after birth can also contribute to post-pregnancy constipation. Busy new mothers may unintentionally neglect proper nutrition, emphasizing the importance of consuming abundant fruits and vegetables while increasing fluid intake, especially during breastfeeding.

Author

Dr Sobia Mohyuddin

MCPS, FCPS, MRCOG, Consultant Obstetrics & Gynaecology

Doctor Sobia Mohyuddin is a highly skilled and experienced Obstetrician and Gynecologist, with 25 years of training and experience in renowned, large institutions. She holds the position of Associate Professor and Fellow at the College of Physicians and Surgeons Pakistan. She is also a member of the Royal College of Obstetricians and Gynecologists (UK).