About one in three pregnant women experiences constipation, and it becomes even more common after birth. It can be uncomfortable, sometimes painful, and a source of real frustration when you are already dealing with so much else. The good news is that there are many safe, evidence-based ways to find relief. This episode walks through why constipation happens during pregnancy, what research supports for relief, and how to navigate everything from fiber and hydration to probiotics, magnesium, and over-the-counter medications. Learn which foods have the strongest evidence for getting things moving, what doctors recommend as the laxative of choice during pregnancy, and how to manage the particular challenges of constipation after birth.

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Constipation during pregnancy can creep in pretty suddenly. You may have been completely regular before, and then all of a sudden, you are uncomfortable, bloated, and dreading your next bathroom trip. If you are dealing with this, you are not alone. Constipation is one of the most common pregnancy symptoms, and it is usually very manageable once you know what to do.

Being constipated means you have difficult or infrequent bowel movements, hard stools, or pain and discomfort when you go. It can make an already demanding time of life even more exhausting. The good news is that, like so many pregnancy issues, this one is temporary. The better news is that there are a lot of safe, effective options to help you find relief, and we are going to walk through all of them in this episode.

How Common Is Constipation During Pregnancy

A systematic review and meta-analysis of thirteen studies reported that about 32% of pregnant women experience constipation globally. By trimester, the prevalence is 21% in the first trimester, 34% in the second trimester, and 30% in the third trimester. The second trimester is typically when constipation peaks, likely because the hormonal changes are in full swing and a growing uterus is starting to put pressure on your digestive system.

Unlike most pregnancy symptoms, constipation does not always disappear once your baby is born. A different set of factors in the postpartum period, from hormonal shifts to recovery from birth, can keep it going or bring it back. We will cover postpartum constipation in more detail later in this episode. For now, you should know that one observational survey found that 52% of postpartum women experienced constipation, compared to 40% of pregnant participants.

Causes of Constipation During Pregnancy

Several changes in your body contribute to constipation during pregnancy, and understanding why it happens can help you target the right solutions. Early on, your body produces more progesterone, which relaxes your smooth muscles. That includes the smooth muscle lining your digestive tract. As digestion slows, your body has more time to pull nutrients from your food. That is great for your baby. The tradeoff is that slower transit can lead to constipation.

Increased iron levels can also contribute. During pregnancy, you need more iron to support the 45% increase in blood volume and to support your placenta and growing baby. Prenatal vitamins typically contain more iron than a standard multivitamin. If you are also on a separate iron supplement and find yourself constipated, it is worth a conversation with your doctor or midwife about how much iron you are actually taking.

Later in pregnancy, as your uterus grows, it puts physical pressure on your digestive tract and rectum. This mechanical change can make things even slower and more uncomfortable.

On top of the physical changes, there are lifestyle factors that often accompany pregnancy. You may be moving less because of fatigue or physical discomfort. Nausea or morning sickness early in pregnancy can limit what you eat and your fluid intake. One study identified several independent risk factors for pregnancy constipation, including a sedentary lifestyle, low fiber intake, low fluid intake, and a history of constipation before pregnancy. None of these are surprising, but they do point to what we have the most control over.

Starting with Diet and Lifestyle

Every major guideline, including ACOG’s recommendations and the American Gastroenterological  Association, agrees that the first line of defense for constipation is diet and lifestyle changes. Medications come second. That does not mean medications are off limits. It just means that simple changes are often effective, safer, and tend to address the root issue rather than just treating the symptom.

Increasing Fiber

Eating more fiber is the single most impactful change most people can make. Fiber comes in two forms. Soluble fiber dissolves in water and forms a gel that helps soften stool. It is in foods like oats, beans, apples, and citrus fruits. Insoluble fiber does not dissolve. It adds bulk to stool and speeds things through your digestive tract. Insoluble fiber is in whole grains, nuts, seeds, and most vegetables. You need both, and most whole plant foods contain a mix of the two.

ACOG recommends about 25 grams of fiber per day during pregnancy. Research shows that most pregnant women in the United States fall well short of fiber recommendations. The American Gastroenterological  Association suggests aiming closer to 30 grams per day. Whatever target you land on, the goal is a steady increase, not a sudden one. Jumping from 10 grams to 30 grams overnight will likely cause gas and bloating. Increase gradually and pair any increase with more water.

Fresh fruits and vegetables are your best sources of fiber, and ideally, you eat them whole. Juice from fruits and vegetables contains almost none of the fiber. Other fiber-rich foods include beans, lentils, nuts, seeds, and whole grains. Whole grains include brown rice, barley, buckwheat, bulgur, millet, oatmeal, quinoa, rolled oats, whole grain corn, and whole grain rye. If you follow a vegetarian or plant-based diet, you are likely already getting plenty of fiber.

Prunes, Kiwifruit, and Other Natural Options

Among fiber-rich foods, a few have particularly strong evidence for constipation relief. Prunes, which are dried plums, are the most studied. A randomized clinical trial compared prunes to psyllium, a common fiber supplement, in adults with chronic constipation. Participants ate about 50 grams of prunes twice a day, which is roughly 10 to 12 prunes. Those eating prunes had significantly more bowel movements per week and softer stools than those taking psyllium. A systematic review confirmed that prunes appear superior to psyllium for improving stool frequency and consistency. These studies were not specifically in pregnant women, but prunes are safe during pregnancy.

Prunes give you three things working together: fiber, sorbitol (a natural osmotic laxative), and polyphenols. Polyphenols are naturally occurring plant compounds found in many fruits, vegetables, and teas. In the gut, polyphenols act as prebiotics, feeding beneficial bacteria and supporting a healthy microbiome. They may also stimulate intestinal motility, helping move things along. With prunes, you get all three of these mechanisms working together, which is likely why they outperform psyllium even at equivalent fiber doses.

If whole prunes are not appealing, prune juice is a reasonable alternative. Whole prunes are generally more effective because they contain both fiber and sorbitol, so you get the full laxative effect. Prune juice has less fiber because much of it is lost during juicing, but it still contains sorbitol and polyphenols. Juice is easier to tolerate if you are struggling with nausea or find whole prunes too chewy or too sweet, and it works quickly. Between the two, whole prunes are the stronger choice. Juice is a decent backup.

Kiwifruit is another option with solid evidence. Green kiwifruit contains fiber, an enzyme called actinidin that aids digestion, and compounds that help retain water in the stool. A clinical trial compared green kiwifruit, prunes, and psyllium in 79 adults with chronic constipation. All three improved bowel frequency, but kiwifruit and prunes both outperformed psyllium for stool consistency, and kiwifruit was the best tolerated of the three. Eating two green kiwifruit per day is the amount used in most studies.

Other foods that can help include pears, apples with the skin on, berries, figs, and oats. Chia seeds are especially useful because they absorb water and form a gel that softens stool. A tablespoon or two a day, stirred into yogurt, oatmeal, or a smoothie, is an easy addition.

Flaxseed is another high-fiber food that works similarly, but there are some cautions during pregnancy. Flaxseed contains compounds called lignans, which are phytoestrogens that can mimic estrogen in the body. Animal research has shown hormonal effects in offspring from maternal flaxseed consumption during pregnancy, and the National Center for Complementary and Integrative Health, which is part of the NIH, notes that little is known about whether flaxseed is safe during pregnancy. If you are looking for a high-fiber seed to help with constipation, chia seeds offer the same water-absorbing benefit without the phytoestrogen question. If you have been eating flaxseed regularly and want to continue, talk to your doctor or midwife about what makes sense for you.

Staying Hydrated

Fiber only works well if you are drinking enough water. Fiber draws water into your bowel, and without adequate fluid, a sudden increase in fiber can worsen constipation.

ACOG recommends 64 to 96 ounces, or about 1.9 to 2.8 liters, of water per day during pregnancy. Your needs increase because you are supporting your own increased blood volume plus your baby. Staying well hydrated also helps with other pregnancy symptoms like Braxton-Hicks contractions, swelling, headaches, and skin issues.

A simple way to check your hydration is to look at the color of your urine. There is evidence that urine color is a reasonable marker of hydration status in pregnant and lactating women. Aim for a light yellow. Darker shades suggest you need more water. Lighting, vitamins, and a few other variables can affect the color, so do not overthink it. For a deeper dive, see the full episode on hydration during pregnancy.

Exercise and Movement

Movement helps your digestive system move. Exercise during pregnancy shortens the time it takes food to pass through your digestive tract. This means less water is pulled out of the stool, making it easier to pass. Exercise also reduces stress, improves sleep, supports healthy weight gain, and lowers the risk of gestational diabetes and preeclampsia. It really is one of the most effective interventions we have for constipation and a whole host of other issues.

You do not need intense workouts for this to make a difference. Walking is one of the best things you can do. A brisk 20 to 30-minute walk most days of the week is enough to see a meaningful effect on constipation. If you have been largely sedentary, start small and build from there.

Eating Smaller, More Frequent Meals

Some women find that eating smaller meals more often, rather than three larger meals a day, helps with constipation. This may also improve other pregnancy symptoms like heartburn and nausea. The theory is that your digestive system, which is already slowed by progesterone, handles smaller volumes more efficiently. The evidence specifically for constipation relief from meal size is not strong, but there is no downside to trying it. Instead of three meals a day, experiment with five or six smaller ones.

Toilet Positioning

This is a small, free, evidence-supported change that most people never think about. When you sit on a standard Western toilet, your body is not in an ideal position for a bowel movement. Your puborectalis muscle, which loops around the rectum, stays partially contracted when you are seated. Propping your feet on a small stool raises your knees above your hips, mimicking a squatting position and relaxing those muscles. The result is easier, less strained bowel movements. If you don’t have a small stool, you may consider the Squatty Potty, the best-known product, but any small stool will do. It is cheap, risk-free, and useful long after pregnancy.

Probiotics

There is evidence that probiotics and gut health can positively affect bowel function in people with constipation. A study found that the probiotic strain Bifidobacterium lactis significantly reduced gut transit time and increased stool frequency, with no serious side effects.

Research specific to pregnancy is also promising. A triple-blind randomized controlled trial gave pregnant women with constipation either regular yogurt or yogurt enriched with Lactobacillus acidophilus and Bifidobacterium lactis. The participants who ate yogurt consumed it three times a day from weeks 24 to 28. Symptoms improved significantly in both groups, suggesting that yogurt, in general, can help with constipation during pregnancy. Another study found that probiotic supplementation, primarily with Lactobacillus strains, significantly reduced nausea, vomiting, and constipation and improved the quality of life for pregnant women.

You can get probiotics from food or supplements. Probiotic-rich foods include yogurt, kefir, kombucha, sauerkraut, kimchi, miso, and natto. If you prefer a supplement, the strains with the strongest evidence for constipation are Bifidobacterium lactis and Lactobacillus species, particularly Lactobacillus acidophilus. Many broad-spectrum probiotics contain both. If you simply want a recommendation, here is my favorite probiotic for pregnancy.

Magnesium

Magnesium is a mineral that supports hundreds of processes in your body and can also help relieve constipation. It draws water into your intestines, softening stool and making it easier to pass. This osmotic effect is the primary reason magnesium helps with constipation. There are several forms of magnesium, and they behave differently in the body.

Magnesium glycinate is bound to the amino acid glycine. It is highly absorbable, gentle on the stomach, and often recommended for sleep, relaxation, and muscle cramps. Its laxative effect is mild, so if your main goal is relief from constipation, this may not be the strongest choice. On the other hand, if you want broad magnesium benefits without dramatic bowel effects, glycinate is very well tolerated.

Magnesium citrate has a stronger laxative effect because it draws more water into the intestines. As a result, it is effective for constipation, but it can also cause loose stools or diarrhea if the dose is too high.

Magnesium hydroxide is the active ingredient in Milk of Magnesia. It is a saline laxative and works quickly. It is generally considered safe for occasional use during pregnancy, but it should not be used routinely or long-term.

Magnesium oxide is commonly found in supplements and is often used as a laxative as well, though it is less bioavailable for general magnesium needs.

Most prenatal vitamins contain little to no magnesium. However, before reaching for a supplement, consider your diet. Foods that are rich in magnesium include pumpkin seeds, almonds, cashews, spinach, black beans, edamame, dark chocolate, avocado, and whole grains like brown rice and oatmeal. Many of these are also good sources of fiber, so they pull double duty for constipation relief. If you would like to take a magnesium supplement, it is generally considered safe during pregnancy. Please discuss the specific form and dose with your care provider.

When Iron Is the Culprit

If constipation started shortly after you began taking a prenatal vitamin or a separate iron supplement, iron could be contributing. Iron is a well-known culprit, and the form of iron makes a big difference.

Ferrous sulfate is the most common form in cheaper iron supplements and many prenatal vitamins. It is also the form most associated with constipation and other GI side effects. Gentler alternatives include ferrous bisglycinate, sometimes called chelated iron, which is bound to an amino acid and tends to cause far fewer digestive issues. Carbonyl iron and heme iron polypeptides are other options that are usually easier on the stomach.

If your prenatal contains ferrous sulfate and you are struggling with constipation, consider switching to a prenatal vitamin with a gentler form of iron, or taking a separate iron supplement with a more absorbable form. A higher-quality prenatal typically uses a better form of iron to begin with. For a deeper dive on iron forms, dosing, and absorption, see the full episode on iron during pregnancy.

As with any vitamin or nutrient, your primary source of iron should be your diet. Foods rich in iron include lean red meat, poultry, fish, beans, lentils, tofu, spinach, iron-fortified cereals, and dried fruits like apricots. Pairing iron-rich foods with vitamin C, such as citrus fruit or tomatoes, helps your body absorb more iron. If you can meet more of your iron needs through food, you may be able to reduce your reliance on a supplement that is contributing to constipation.

Over-the-Counter Options

If you have tried diet and lifestyle changes and you are still struggling, an over-the-counter laxative is a reasonable next step. Always talk to your doctor or midwife before taking any medication, even if it is available over the counter.

The safety of laxatives in pregnancy generally relates to how much your body absorbs. If a medication stays in your digestive tract and you do not systemically absorb it, very little reaches your baby. As a result, most laxatives are considered low risk, and the available research has not linked their short-term use to an increased risk of congenital issues.

A Cochrane review on constipation in pregnancy included two trials with a total of 180 women. The review found fiber supplementation was effective, and stimulant laxatives worked better than bulk-forming laxatives but caused more side effects. The sample size is small, which tells you that there is a real gap in pregnancy-specific research here.

Newer evidence has helped fill some of that gap. A 2024 randomized controlled trial compared polyethylene glycol, also known as PEG or the active ingredient in MiraLAX, to lactulose in 360 pregnant women with chronic constipation. Both worked well for improving bowel movement frequency. However, PEG had significantly fewer side effects, including less diarrhea and fewer loose stools.

This aligns with what ACOG recommends. ACOG’s clinical guidance explicitly names polyethylene glycol, the active ingredient in MiraLAX, as the laxative of choice during pregnancy. The 2024 AGA practice update reaches the same conclusion.

With that context, let’s walk through each category of over-the-counter laxatives so you know your options.

Bulk-Forming Laxatives

Bulk-forming laxatives absorb water in the intestine and expand, adding bulk to stool and helping it move through. They are generally considered very safe during pregnancy because they are not absorbed systemically. Common brand names include Metamucil, FiberCon, Citrucel, and Benefiber. The active ingredient may be psyllium, polycarbophil, methylcellulose, or wheat dextrin.

It is critical that you drink plenty of water with these products, or they can actually make constipation worse. Common side effects include bloating, gas, or cramping, especially when you first start. It is generally recommended to start with the lowest recommended dose and increase gradually.

Osmotic Laxatives

Osmotic laxatives draw water into the colon to soften stool and make it easier to pass. This category includes polyethylene glycol (MiraLAX), lactulose, and magnesium hydroxide (Milk of Magnesia).

Based on the newer research and ACOG’s guidance, polyethylene glycol is the strongest evidence-based choice in this category during pregnancy. It is minimally absorbed, generally well-tolerated, and effective. Like other osmotic laxatives, it works by pulling water into the intestines, so you need to drink plenty of water with it. Possible side effects include bloating, cramping, or nausea, and overuse can lead to loose stools.

Stool Softeners

Stool softeners add moisture to stool to soften it. The most common brand names are Colace and Surfak, and the active ingredient is docusate sodium or docusate calcium. These come in pill form and are minimally absorbed.

Stool softeners are generally considered safe during pregnancy. In addition, doctors often recommend them postpartum, especially if you had a perineal tear, episiotomy, or a cesarean birth. Many hospitals routinely provide them after birth. Possible side effects include stomach pain, diarrhea, or cramping.

Stimulant Laxatives

Stimulant laxatives work by triggering contractions in the bowel to move stool through more quickly. Common brand names include Dulcolax (bisacodyl) and Senokot (senna). These are effective, but they can cause more side effects than other laxatives, including cramping, diarrhea, and electrolyte imbalances.

ACOG cautions that stimulants should be used with care during pregnancy and only for the short term. Overuse can cause your bowel to rely on them for normal function. As a result, these are best reserved for when nothing else has worked and used for the shortest time possible. Again, please run any over-the-counter medications by your care provider before taking them.

Constipation and Hemorrhoids

Constipation and hemorrhoids are closely connected during pregnancy and after birth. Straining with hard stools is one of the biggest contributors to developing hemorrhoids, and hemorrhoids can make an already uncomfortable bowel movement even worse. As a result, managing constipation is one of the most important things you can do to prevent hemorrhoids from developing or getting worse. If you are already dealing with both, the strategies in this episode should help with both.

Constipation After Birth

Unlike most pregnancy symptoms, constipation does not automatically resolve once your baby arrives. About half of postpartum women experience constipation, and for some it persists for weeks or even months.

Several factors contribute. Hormones are still shifting, and you have had significant physical changes to your pelvic floor, abdomen, and digestive organs. If you had a vaginal birth, your perineum may be healing from a tear or episiotomy, and the thought of pushing for a bowel movement can be anxiety-inducing. If you had a cesarean, surgery plus opioid pain medications often slow the digestive system significantly. Research shows that postpartum constipation is more common after a cesarean than after a vaginal birth.

A 2020 Cochrane review on preventing postpartum constipation included five trials with over 1,200 women. The review found limited high-quality evidence overall. Most hospitals routinely offer stool softeners after delivery because they are considered safe, minimally absorbed, and can make a first bowel movement easier.

A few practical things can make the first postpartum bowel movement less intimidating. Drink plenty of water, especially when you are breastfeeding. Consider taking stool softeners if your doctor or midwife offers or recommends them. Do not hold it when you feel the urge, because waiting makes the stool drier and harder. Use a small stool like the Squatty Potty to get into a better position. If you have stitches, you can press a clean pad against your perineum while you go to provide counter-pressure and reduce anxiety about straining. A lot of women have anxiety about that first postpartum bowel movement, and it is almost always much less of a big deal than you expect. The longer you put it off, the worse it will be.

When to Call Your Doctor or Midwife

Most constipation during pregnancy and postpartum is uncomfortable but not dangerous, and it resolves with the interventions we have covered. Your doctor or midwife can help you figure out what is going on, rule out complications, and get you on a treatment plan that works for you. Constipation is often dismissed as a minor annoyance, but it can significantly affect your quality of life during a really important time. You deserve real relief, and you should not feel like you have to suffer through it.

There are some situations where you should reach out to your care provider. These include severe abdominal pain that is not typical pregnancy discomfort, blood in your stool, constipation that persists despite multiple interventions, inability to pass stool or gas at all, or any symptoms that worry you. In the postpartum period, if you have not had a bowel movement within three or four days of delivery, check in with your care provider. Constipation during pregnancy is extremely common, but it is also very manageable. You have a lot of options, from simple changes like eating more fiber and drinking more water to probiotics, magnesium, and over-the-counter medications if you need them. The most important thing is to start somewhere rather than just enduring it. Talk to your doctor or midwife about what makes sense for you, especially if what you are trying is not working.

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