Constipation in pregnancy

Studies suggest that constipation occurs in roughly 11% to one third of pregnant women. It is more common in the second and third part of the pregnancy and can be influenced by a range of factors such as a change in diet and an expanding uterus. If the person has previously suffered from constipation, pregnancy can make it worse. For some women, pregnancy causes them to experience constipation for the first time.

Identifying what is safe to use during pregnancy can be confusing for a lot of women. This article will identify what factors contribute to sluggish bowels in pregnancy and safe ways to help relieve the problem.

What causes constipation during pregnancy?

Some contributing factors that lead to constipation in pregnancy include:

• Changes in dietary habits which could include a decrease in fibre rich foods such as vegetables and wholegrains and reduced fluid intake
• Lack of exercise, including a sedentary job
• Pre-pregnancy body mass index of more than 24
• Supplementation with certain types of iron or calcium
• Increase in stress levels
• History of constipation
• Reduced motility and function of the gastrointestinal system
• An expanding uterus
• Painful haemorrhoids

How to get things moving again

Here are some safe strategies to use to get relief of constipation during pregnancy.

Increase fibre intake

Both soluble and insoluble fibre are important to include in the diet. During pregnancy it is recommended that women aim for 28g per day. Fibre helps to bulk up the stool, increase the water content and improve the colonisation of healthy bugs that maintain a healthy digestive system.

A review of studies performed on fibre supplements taken during pregnancy found that it increased stool frequency, made them softer and easier to pass and increased the likelihood of having a ‘normal poo’. In comparison to stimulant laxatives they were less likely to cause abdominal discomfort and diarrhoea.

An example of safe fibre supplements to take include slippery elm, bran or psyllium husks. Slippery elm has the additional benefit of providing relief from reflux and haemorrhoids. Introduce any fibre supplement gradually to avoid abdominal bloating, flatulence and worsened constipation for a few days. Slippery elm and psyllium husks can be bought in their natural state and easily added to foods such as breakfast cereals, porridge and smoothies. Some people prefer to take fibre supplements as a flavoured drink, tablet or capsule, and there are lots of these available on the market.

Fibre in foods

As well as supplementing with fibre in the diet, the most important aspect is to increase fibre naturally through making better dietary choices. 

This includes eating plenty of fresh fruit, vegetables, lentils, legumes, nuts and seeds. Wholegrains that haven’t had the fibre removed are important to eat daily and include oats, barley, rye, bran and wholemeal bread and pasta. Consuming bitter herbs such rocket, radicchio, dandelion greens or any other bitter salad greens can help to improve digestive function and therefore improve bowel motility.

Lemon juice in water, is another traditional cure for constipation by helping to support liver function.

Removing refined and processed foods from the diet can make an enormous difference as these foods usually contain very little fibre. Examples of such foods include white bread, pastries, biscuits, chocolate, chips and fast food.

Keeping hydrated

Another important component is to increase your fluid intake and aim for 2.3 litres of filtered water each day. This is especially important if you are also supplementing with additional fibre. Extra fluids can be obtained by eating fresh fruit, vegetables, soups, stews and drinking milk. Insufficient water intake can lead to harder stools and reduced bowel motility.

It is important to note that fluid needs increase, especially in the later stages of pregnancy. A study that compared the fluid intake of pregnant women versus non-pregnant women found that pregnant women drank far less water and averaged 1675mls per day compared to 2036mls per day. Researchers suggested that pregnant women need to aim for 3000mls of fluid per day which can be obtained from drinking water and from food and other drinks. If you are drinking hot chocolate, tea, coffee and caffeinated drinks such as coke these could worsen constipation because they act as diuretics—increasing the removal of water from the body, leading to dehydration.

Exercise

Regular physical activity helps to stimulate regular bowel function and decrease stress. Factor in time each day for exercise, even if it is just keeping the body moving and active by going about your day to day activities.

Listening to your urges

Learn to listen to your body and don’t ignore any urges. Avoid ‘hanging on’ as sometimes the urge will go and this can lead to unhealthy bowel habits. Our bowels are more likely to want to go after breakfast so factor in some morning time for ‘doing your business’.

Supplements

One of the main side-effects of iron and calcium supplements is constipation, especially in large doses and with certain kinds. Speak to your doctor or naturopath whether these supplements are even necessary for yourself as they are not needed by every pregnant woman. If they are deemed necessary try a lower dose but taken more regularly and there are better forms such as iron in liquid or made from a type that has a better absorption rate such as bisglycinate. Calcium carbonate is a typical form of calcium that constipates, trying a lower dose and a citrate or hydroxyapatite form may be better tolerated.

References

1. Hechtman L (2014). Clinical Naturopathic Medicine. Churchill Livingstone, Australia
2. Shi W, Xu X. Epidemiology and risk factors of functional constipation in pregnant women. PLoS One. 2015 Jul 24;10(7):e0133521 https://www.ncbi.nlm.nih.gov/pubmed/26208169
3. Wald A. Constipation, diarrhea and symptomatic haemorrhoids during pregnancy. Gastroenterol Clin North Am. 2003 Mar;32(1):309-22, vii https://www.ncbi.nlm.nih.gov/pubmed/12635420
4. Rungsiprakarn P, et al. Interventions for treating constipation in pregnancy. Cochrane Database Syst https://www.ncbi.nlm.nih.gov/pubmed/26342714ev. 2015 Sep 4;(9):CD011448
5. Derbyshire E. The importance of adequate fluid and fibre intake during pregnancy. Nurs Stand. 2007 Feb 21-27:21(24):40-3 https://www.ncbi.nlm.nih.gov/pubmed/17345907