Overview

You may be completely regular as far as going to the bathroom before getting pregnant, and then suddenly, you are stopped up and have issues when you need to go #2. If you are constipated, you have difficult or infrequent bowel movements, your stools are hard, and you may have pain or discomfort in your stomach. The prevalence of constipation is 40% in pregnant women and 52% in women postpartum. Several changes in pregnancy can cause constipation. Like most pregnancy-related issues, constipation will disappear after you have your baby. In the meantime, there are a lot of things you can do to relieve constipation. This episode examines interventions to relieve constipation during pregnancy ranging from diet and lifestyle changes to supplements and over-the-counter medications.

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Constipation

You may be completely regular as far as going to the bathroom before getting pregnant, and then suddenly, you are stopped up and have issues when you need to go #2. If you are constipated, you have difficult or infrequent bowel movements, your stools are hard, and you may have pain or discomfort in your stomach. The prevalence of constipation is 40% in pregnant women and 52% in women postpartum.

Causes of Constipation in Pregnancy

Several changes in pregnancy can cause constipation. Early on, your body’s increased progesterone production relaxes your smooth muscles, including your digestive tract. As your digestion slows down, your body has more time to absorb the nutrients from the foods you eat. The good news is that you deliver more nutrients to your baby. The downside is that slow digestion can contribute to constipation. 

Increased levels of iron can also make you constipated. During pregnancy, you need additional iron to support the 45% increase in blood volume and support your placenta and your growing baby. Typically, prenatal vitamins contain more iron than a regular multivitamin. If your doctor or midwife has you on a separate iron supplement and you find yourself constipated, discuss the amounts of iron you are taking, your prenatal vitamin, and your diet. You may be able to increase iron in your diet and eliminate a separate iron supplement.

Later in your pregnancy, as your uterus grows, it can pressure your digestive tract and rectum, leading to constipation.

Constipation After Birth

Like most pregnancy-related issues, constipation will disappear after you have your baby. If your baby is born via cesarean, you may experience constipation after the surgery as a side effect of the narcotics during birth. If your baby is born vaginally, you may not have constipation after birth, but it can still be intimidating to have your first bowel movement. Everything in the area around your vagina and perineum can be sore and tender. You may be healing from a tear or an episiotomy. The methods to relieve constipation may be helpful so that you are not straining to have a bowel movement in the days after you have your baby. 

Relieving Constipation 

There are a lot of things you can do to relieve constipation. We always want to start with diet and lifestyle changes before taking medications. You may consider eating smaller, more frequent meals. The thinking behind this is that your digestive system will not be as taxed as it could with three bigger meals.

Increasing Fiber

Eating foods high in fiber is at the top of the list of things that will help constipation. There are two kinds of fiber – soluble and insoluble. Insoluble fiber helps constipation by speeding up food movement through your digestive tract. The American College of Obstetricians and Gynecologists recommends 25 grams of fiber per day during pregnancy to help with constipation.

Fresh fruits and vegetables are a good source of fiber. Juices from fruits or vegetables do not contain nearly the amount of fiber, so you want to be sure you are eating whole fruits and veggies. Other foods high in fiber include beans, nuts, seeds, and whole grains. Examples of whole grains are brown rice, barley, buckwheat, bulgur, millet, oatmeal, quinoa, rolled oats, whole grain corn, whole grain sorghum, whole oats, whole grain rye, and whole wheat. 

Staying Hydrated

Since you have increased nutrient requirements during pregnancy, you also need additional water for digestion and transport of additional nutrients. Drinking plenty of water is also critical when increasing your fiber intake because fiber draws water into your bowel. ACOG recommends drinking 64-96 ounces (1.9-2.8 liters) of water daily. Staying hydrated can also help symptoms like Braxton-hicks contractions, swelling, migraines, and skin health.

There is evidence that urine color is a valid marker of urine concentration, specifically in pregnant or lactating mothers. Variables can affect the color, like taking vitamins, whether you are urinating in a cup or a toilet, the lighting in the bathroom, etc. Don’t overthink this. You are looking for the color of your urine to be a shade of light yellow. If it is darker, it signifies that you need more water. See this episode for more in-depth information on staying hydrated and drinking water during pregnancy.

Exercise 

There are many benefits to exercise during pregnancy, one of which is improving constipation. Exercise decreases the time it takes for food to pass through your digestive system. This means less water is removed from stools, making them easier to pass.

Probiotics

There is evidence that probiotics can positively impact bowel movements for people experiencing constipation. A study found that the probiotic bifidobacterium lactis significantly reduced whole gut transit time and increased stool frequency. It also improved stool consistency, and there were no serious adverse events.

Gut health is important for many aspects of your overall health. To increase probiotics, you can add probiotic-rich foods to your diet. Probiotic-rich foods include yogurt, kefir, kombucha, sauerkraut, kimchi, or natto. You can also take a probiotic supplement. Most probiotics are broad-spectrum and combine different species in one supplement. The most common species you will see on the label for a probiotic are Lactobacillus and Bifidobacterium. To improve constipation, you want to look for a probiotic that contains the strain bifidobacterium lactis.

Over-the-Counter Remedies 

If you implement diet and lifestyle changes and are still constipated, you may be ready to try an over-the-counter remedy. Talk to your doctor or midwife before taking any medication, even if it is available over the counter. Ideally, you resolve your symptoms with diet and lifestyle changes, and medications should be the last line of defense.

Laxatives

Laxatives are over-the-counter medications to treat constipation. Different laxatives work in different ways. Bulk-forming laxatives are thought to be the safest laxatives during pregnancy. These absorb water and expand to increase moisture in the stool and make it easier to pass. Osmotic laxatives draw water into the colon to allow easier passage of stool. Stool softeners add liquid content to the stool to soften it. Stimulants use a chemical to increase bowel activity, which moves the stool through the intestines.

Research on Laxatives in Pregnancy

There are limited studies on pregnant women to examine the safety and efficacy of laxatives. The safety of most laxatives in pregnancy is inferred by how well your system absorbs the ingredients in the medication. The thinking is that if your body doesn’t absorb the drug, you don’t pass it through your placenta to your baby.

An article on PubMed covers some common over-the-counter medications. Overall the main conclusion of the research is that the first line of therapy should be increasing dietary fiber, hydrating, and exercise. Over-the-counter medications are the second line of treatment. Because most laxatives are not absorbed systemically, short-term use has not been, and is not expected to be, associated with an increased risk of malformations. However, as with the general population, it is recommended that osmotic and stimulant laxatives be used only in the short term or occasionally to avoid dehydration or electrolyte imbalances. 

A systematic review on constipation and pregnancy sounded promising, but only two studies with a total of 180 women contributed data to this review. Overall, they found insufficient evidence due to limited data. Compared to bulk-forming laxatives, stimulant laxatives appear to be more effective in the improvement of constipation (moderate-quality evidence) but are accompanied by an increase in diarrhea (moderate-quality evidence) and abdominal discomfort (low-quality evidence). Additionally, fiber supplementation may increase the frequency of stools compared to no intervention (moderate-quality evidence), although these results were of moderate risk of bias.

Common Over-the-Counter Laxatives

Let’s examine the common over-the-counter laxatives so you are more educated to make an informed decision and discuss your options with your care provider. You should always run any medication by your doctor or midwife before taking it.

Bulk-forming Laxatives

Bulk-forming laxatives are thought to be the safest laxatives during pregnancy. These absorb water and expand to increase moisture in the stool and make it easier to pass. Common brand names of bulk-forming laxatives include Metamucil, FiberCon, Citrucel, and Benefiber. They can be available in pill or powder form. The active ingredient can be psyllium, polycarbophil, methylcellulose, or wheat dextrin. Other ingredients include citric acid, maltodextrin, natural and artificial flavors, artificial coloring, sucrose, corn oil, corn starch, lecithin, fructose, molasses, stevia, and aspartame. You must increase your water intake with these medications, or they can worsen constipation. Other possible side effects include bloating, gas, or cramping.

Osmotic Laxatives

Osmotic laxatives draw water into the colon to allow easier passage of stool. Common brand names of osmotic laxatives include Phillips’ Milk of Magnesia and MiraLAX. These are available in liquid or powder form. The active ingredient in Milk of Magnesia is magnesium hydroxide, a saline laxative. Other ingredients include citric acid, sucrose, flavor, and artificial colors. The active and only ingredient in MiraLAX is polyethylene glycol, an osmotic laxative. Like bulk-forming laxatives, these also require increased water intake and may make you thirsty. Other possible side effects include bloating, cramping, diarrhea, and nausea.

Stool Softeners

Stool softeners add liquid content to the stool to soften it. Common brand names of stool softeners are Colace and Surfak. These come in pill form. The active ingredient in these is docusate, as docusate sodium or docusate calcium. Other ingredients include corn oil, artificial coloring, mineral oil, and sorbitol. Possible side effects include stomach pain, diarrhea, or cramping. Your care provider may recommend a stool softener postpartum to make your first bowel movement after birth easier.

Stimulant Laxatives

Stimulant laxatives use a chemical to increase bowel activity, which moves the stool through the intestines. ACOG cautions that laxatives, especially stimulants, should be used with caution. These are also short-term solutions, and you should stop using these products once your bowel movements become regular again. Overuse of stimulants can cause your bowels to depend on them.

Talking to Your Doctor or Midwife

Always speak to your healthcare provider before using over-the-counter medications. They are your trusted partner in prenatal care and can help you determine the best course of action to relieve symptoms and keep you and your baby healthy. They can also help you navigate what medications are safe during pregnancy.

For any expecting mom dealing with constipation, it can be very uncomfortable. It is frustrating that there isn’t great research on pregnancy and constipation. The good news is that this is temporary, like so many things pregnancy-related things. If you are experiencing constipation, start with increasing fiber, making sure you are hydrated and exercising. You may consider adding probiotic-rich foods to your diet or taking a probiotic. If those interventions do not improve symptoms, talk to your doctor or midwife about an over-the-counter laxative. I know constipation sucks, but your body is doing many amazing things, and patience and understanding can go a long way. 

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