Constipation in Pregnancy: How to Treat It and Prevent It

With up to 40% of pregnant women experiencing constipation, it’s definitely more common than most realise. This information is to help you treat your current constipation and/or prevent it from happening again. Rest assured that this can be a very normal part of pregnancy – and we can help you!

How to Treat Constipation

I recommend either psyllium (such as Metamucil from the supermarket) or Movicol (from any pharmacy). Choose one and stick with it!

• Start with one scoop of Metamucil or one sachet of Movicol daily
• After 2 or 3 days, assess whether the dose is adequate:
  • If you are using your bowels daily without straining, stick to the current dose
  • If you are still having difficulty using your bowels, or are using your bowels less than once daily, increase the daily dose by one scoop or one sachet
  • If you are using your bowels more than once daily, reduce the dose by ½
• Then reassess again after 2 or 3 days, and adjust the dose as above. What you are hoping to find is the regular dose required to keep your bowels working normally.
• The dose required is different for everyone. Once you find it, stick to it for at least a few months. That’s right, a few months!
• If you find yourself on high amounts of psyllium, change to Movicol
• If you are consistently using 4 sachets of Movicol daily without satisfactory results, contact your obstetrician or GP.

Why Am I Constipated?

Constipation can be common in early pregnancy and in fact into your second trimester, for a variety of reasons. Most commonly, an increase of pregnancy hormones such as progesterone can relax your bowel, causing it to become sluggish. The expanding uterus can also impact your digestion.

You may also be taking medication that can cause constipation, such as an anti-nausea drug like Zofran. Drugs used to treat heartburn and low iron (including vitamins) can also cause a change in bowel movements and lead to constipation.

How Will You Know You Are Constipated?

You may notice that you haven’t had a bowel movement either as frequently as usual, or perhaps none at all for some time. It’s a good idea to be aware of your usual habits and to take note of any changes.

Other signs include:

• Stools that feel quite hard and are therefore painful to push out
• Straining when going to the toilet, sometimes with a feeling that you haven’t been able to properly empty your bowel
• Stomach pain, cramps and nausea, which many women experience

Constipation in its later stages can be quite uncomfortable and is extremely important to treat, to prevent your bowel becoming impacted.

What Do I Do to Treat It?

There are two types of treatment to understand – aperients and laxatives. Aperients are used to soften the stools and increase your bowel movements, compared to laxatives, which actually work to move the stool and create a bowel movement.

Usually, you’d take an aperient in the early stages to loosen your stools, but use a laxative if you were already constipated and unable to pass a bowel movement despite your best efforts. However, most stimulant laxatives should be avoided in pregnancy.

Early stages of constipation

As well as following the dietary advice below, we recommend using the following over-the-counter (OTC) treatments from your pharmacy. These are all deemed safe to use pre-conception and during pregnancy and breastfeeding.

Although I recommend psyllium or Movicol, you can use other aperients instead depending on your preference and previous experience. The following can be used safely in pregnancy:

• Psyllium (eg. Metamucil powder) gives moisture to the stool. It is taken with water or juice and generally works within 24 hours to soften the stool, but may take 1–2 days of regular treatment
• Osmotic laxatives (eg. Lactulose liquid) draw water into the bowel, which expands and softens the stool. Can work within 2–48 hours
• Docusate (eg. Coloxyl tablets) – Coloxyl is a gentle stool softener that works to soften the stool within 12–48 hours
• Enema (eg. Microlax) is necessary when you are unable to pass the bowel motion despite the above treatments. Works within 30 minutes. Should always be used as a supplement to oral laxatives
• Stimulant laxatives (eg. Senna tablets) should be avoided during pregnancy

Later stages of constipation

When the hardened stool is stuck in the rectum or too high up to be moved, you may be impacted and require an enema. Signs of this can include stomach pain, bloating and leakage from the stool (that may appear to be small amounts of diarrhoea).

What Should I Do to Avoid Constipation?

If you are at risk of constipation, for example if you are taking medication that can cause it, we recommend actively preventing it by doing the following:

• Go to the toilet regularly, especially when you feel the urge. Try not to put off going!
• Increase the fibre in your diet with leafy vegetables and avoid simple carbohydrates (bread, pasta)
• Drink plenty of water – this is especially important for pregnant and breastfeeding women
• Exercise – exercise will help to keep things moving, literally!

When to Seek Help

If you have severe abdominal pain, mucus, or blood (beyond a slight mark from straining), you should contact your GP or obstetrician for assessment and advice.

Disclaimer

The information on this page is general in nature. All medical and surgical procedures have potential benefits and risks. Consult a healthcare professional for medical advice specific to you.