Constipation

What is constipation?

Constipation is infrequent and difficult bowel movement of hard stool and sensation of incomplete evacuation or straining⁽⁴⁾ and is a common problem during pregnancy (30% in the third trimester).^(23,24)

What is the link between pregnancy and constipation?

Constipation can cause or aggravate hemorrhoids and anal fissure due to heavy straining while having a hard bowel movement. Two studies reported an incidence of approximately 30% in the third trimester.^(23,24) Constipation may occur the first time during pregnancy, or chronic (persistent) constipation may increase in severity during pregnancy. In part, this occurs because of physiologic changes or coexistent conditions associated with pregnancy, as summarized in next table.⁽⁶⁾

Factors contributing to constipation during pregnancy

Dietary

• Poor fluid intake with nausea and vomiting
• Supplements with high iron content (prenatal/postnatal vitamin supplements)

Behavioral

• Decreased physical activity
• Stress

Hormonal changes (The digestive tract slows down)

• Increased progesterone^a
• Increased estrogen^b
• Decreased motilin^c

Other

• Enlarging pregnant uterus
• Painful hemorrhoids

A low fibre diet may be a cause of constipation in general population.

Also, taking drugs including blood pressure medications, antidepressants, pain medications, and antacids or overusing laxatives (rebound effect) may contribute to constipation.⁽⁴⁾

Prevention and treatment

Maintain normal bowel movements:

• Increase fluids (6 to 8 glasses per day) and fibre intake
• Quickly respond to the urge for stool evacuation
• Establish a regular toilet time: 15 to 20 minutes after breakfast is a good opportunity because bowel motility is optimal during this time.
• A footrest will provide support and decrease straining.
• Drink prune juice as a natural substitute to laxatives.

Do not take enemas and over-the-counter (OTC) drugs; ask your pharmacist for advice. Moderate exercise, such as walking, helps to maintain healthy bowel patterns.

Increase your intake of high-fibre food to 20-30 g/day (see Table). The daily amount should be increased gradually (by 5 g per week for example) to minimize side effects.

Eat fibres from whole grain cereals and vegetables. As you increase the amount of fibre in your diet, it is important to drink more water. Patients with poor dietary habits may start with 2 tablespoons of bran in each meal, followed by a glass of water or another beverage. Bran can be added to juice, yogurt or soup, for example. The laxative effect may be delayed for three to five days. Relief of chronic constipation may require several weeks. Pregnant women should be warned that consuming a large amount of bran can cause abdominal bloating or flatulence. Again, it is important to take more fluids when increasing fibre intake. As well as it is recommended to start with small amounts of fibres and gradually increase to attain the desired effect and alleviate these symptoms.

Avoid all laxatives unless your health care professional recommends one.

a) Progesterone: A female steroid sex hormone.

b) Estrogen: Any of various natural steroids (as estradiol) that are formed from androgen precursors.

c) Motilin: A hormone secreted by the small intestine that increases bowel motility.