What is constipation?

'Normal' bowel function differs from person to person, although some people find it difficult or painful to pass stools (poo).

If you suffer from constipation, your stools may become hard, dry and difficult or painful to pass. You may find you need to push or strain. Some people with constipation feel they have not fully emptied their bowels and that even after passing stools, they feel the need to pass more.

Constipation is particularly common during pregnancy. Up to 2 out of 5 people experience constipation at some point during pregnancy.

What causes constipation during pregnancy?

There are many possible causes of constipation during pregnancy.

Hormonal changes

The pregnancy hormone, progesterone, can cause your gut to work less efficiently and your food to move more slowly through your intestines, increasing your chance of constipation.

Medicines and/or supplements

Some medicines commonly used during pregnancy, such as those for nausea and vomiting, heartburn and strong pain, can contribute to constipation.

Supplements such as iron and calcium, as well as some multivitamins containing these minerals, can also trigger constipation.

If you take any of these during your pregnancy and are troubled by constipation, speak with your doctor. Sometimes a change in the brand or dose of your medicine or supplement can reduce your symptoms.

Diet

Low levels of dietary fibre in your diet can contribute to constipation during pregnancy — as they can at any other time.

Am I more likely to experience constipation if I had it before pregnancy?

If you have had constipation before pregnancy, you may experience recurrence or worsening of your symptoms.

If you have constipation and are planning a pregnancy, try to get into good habits before you become pregnant. Keeping to a healthy diet, drinking plenty of fluids, and doing regular exercise may help you maintain regular bowel motions.

It is better to prevent constipation early, rather than wait to treat it later.

How is constipation treated during pregnancy?

The first step in treating constipation is to increase the fluids and fibre in your diet. Eating wholegrain foods, fruit and vegetables can often resolve constipation.

Good toilet habits also help:

• Go to the toilet as soon as you get the urge — don’t wait.
• Eating and drinking, especially a hot drink at breakfast, can stimulate the urge to go. It’s a good idea to try sitting on the toilet about 20 minutes after meals, especially breakfast.
• Use a footstool and sit on the toilet in a leaning-forward position with feet apart and your back straight.
• Avoid straining by consciously relaxing your abdominal muscles (think about making them ‘bulge’ out).

If symptoms continue, your doctor may recommend fibre supplements or laxatives. Taking laxatives can sometimes cause side effects such as abdominal pain and diarrhoea. It’s a good idea to speak to your doctor about the best treatment for you, including any medicines.

Could it be a sign of something more serious?

While most cases of constipation are not a sign of illness, untreated constipation can cause complications such as:

• anal fissure
• haemorrhoids
• faecal impaction
• rectal prolapse

In rare cases, constipation can be caused by more serious conditions such as tumours.

Speak with your doctor if you are concerned, and especially if you notice blood in your stools.

Will it affect my baby?

If you’re pregnant, you don’t need to worry that constipation will affect your baby. The discomfort occurs in your own gut and bowels; and isn’t passed on to the baby.

Most laxatives are not well absorbed into the bloodstream and can be safely taken during pregnancy and breastfeeding. It’s still a good idea to always check with your pharmacist before taking any medicine while pregnant.

Will it continue after I’ve had the baby?

There are several reasons why constipation may continue after birth.

If you have had a caesarean, you may experience constipation for a few days.

If you have had stitches after a vaginal birth, you may feel hesitant to empty your bowels, which can cause constipation.

Any strong pain medicines you take after having your baby can also cause constipation.

New parents are often busier than usual in the first few weeks and months of parenthood. It may seem like taking care of yourself has become less of a priority, but your health is no less important now than it was during your pregnancy.

Be sure to have plenty of fibre-rich fruit, vegetables, and wholegrains as well as increase your fluid intake while breastfeeding to encourage healthy bowel movements, even when you are busy.

Resources and support

• Constipation can vary in severity. If changes to your diet do not help relieve your symptoms, ask your midwife, doctor or pharmacist for guidance on choosing and using a laxative.
• The Royal Hospital for Women has developed a leaflet on Constipation in Pregnancy and Breastfeeding, with suggestions on lifestyle changes as well as medicines to treat constipation.