Constipation during pregnancy – what happens and what to do?

Dear Dr. Mo: What to do for constipation during pregnancy?

Fresh fruits and vegetables are among the best remedies for constipation.
I took this photo on an Adriatic island of Vis last summer

Dear reader: Constipation (infrequent bowel movements or having difficulty in passing stools – waste  products of digestion), is a common gastrointestinal problem and also a common complaint in pregnancy, usually affecting women during the first and/or last trimester of the pregnancy.

Normally, food is passing through intestines via muscle contractions, which slowly push it in the forward direction. In the colon (the large intestine), most of the water and salt content from digested material is reabsorbed into the body and this process is essential for keeping our bodily functions balanced and normal.

First of all, what’s considered ‘normal’ frequency for passing stools varies widely. You’ve probably heard that ‘only every day is good enough’ and this would be an ideal case but in general, let me tell you that one is probably experiencing constipation if one passes fewer than three stools a week, and these stools are hard and dry. This can happen for any number of reasons, most commonly when there is not enough fluid or fiber-rich food in a diet or the colon muscle contractions are slow and/or uncoordinated.

Other reasons could be ignoring the urge to have a bowel movement or delaying it until later, lack of physical activity, misuse of laxatives, irritable Bowel Syndrome, and some other illnesses, injuries and problems and of course, changes in your lifestyle like travel, aging and to go back to your question – pregnancy.

During pregnancy, constipation is thought to happen because the hormone progesterone, which is in high concentration, slows the movement (or ‘motility’) of the bowels. This causes food to stay in the intestines for longer periods of time and the longer it sticks around, the more water is reabsorbed from it back into the body, making it harder to pass. This is likely the cause of constipation in the early part of pregnancy.

During late pregnancy, constipation can also (and most likely to) result from direct pressure on the intestines from the growing baby. This can also slow down the passage of food through the bowel.
For some women, being constipated also contributes to causing hemorrhoids so it is very important to take your time and not to strain because straining largely adds up to building pressure in the vein system in and around anus and formation of hemorrhoids.

What to do?

Simple lifestyle changes, such as getting more exercise (except in late pregnancies where, if possible, walks, or climbing a few stairs could be the exercise you need), drinking more fluids and eating a high-fiber diet, can be very helpful toward alleviating constipation.

These are the immediate things you can try:

  • Drink plenty of water and other fluids – prune juice and fresh vegetable juice can prove to be very helpful. Drinking some warm water with a squeeze of lemon (basically a warm lemonade) first thing in the morning will stimulate the bowels.
  • Dietary changes – A diet with at least 20 to 35 grams of fiber each day helps your body form soft, bulky stools, which are much easier to pass. A high-fiber diet includes whole grains, beans, fresh fruits and vegetables.  Dried fruits such as prunes, dates, figs and apricots are especially effective.
  • Be active – physical activity can help stimulate intestinal activity – you may wish to try yoga or some walking and swimming.
  • Be patient – take your time when you go to the toilet.  Try not to delay going there when you feel the urge and do not strain yourself.
  • Iron supplements – Iron supplements may also contribute to constipation so talk to your doctor about it, if you think it’s making you constipated – there are other brands to switch to.
  • Laxatives – If nothing helps, your doctor may prescribe you a supplement to help relieve constipation. During pregnancy, the two safest are:

A glycerin suppository (with nothing else added) – These are inserted into anus and held for 10 – 20 minutes. It will soften the stool so it becomes easier to pass.

Fiber supplements (bulk laxatives) – These are generally the only recommended laxatives in pregnancy as they tend to stay in the intestine and are not absorbed into the body. They must be mixed (or followed) with plenty of water.

Things to avoid

Avoid other laxative supplements such as mineral oils (i.e. Liquid paraffin), oral preparations and suppositories containing stimulating chemicals (i.e. senna, castor oil, bisacodyl, sodium-sulphate etc) as these can cause cramps, loss of fluids and premature labor and avoid salts of sodium, potassium and magnesium as these could be absorbed by the body and adversely affect your baby’s kidneys.

Stay positive

Of course, there could be situations in which nothing seems to work quite well enough – here, I recommend thinking about that wonderful moment, which is right around the corner and the beautiful baby whose smiles and cries will make all the troubles worthwhile.

Yours in health,

Dr. Mo