Constipation in pregnancy is a major problem for many women.
Aside from the short term discomfort, constipation and straining in pregnancy increases the risk of long-term pelvic floor problems including:
- Prolapse and/or incontinence (bladder or bowel)1
The correct bowel emptying technique and strategies shown in the videos below help you overcome constipation without medication and reduce your risk of long-term pelvic floor problems.
What Causes Constipation in Pregnancy
When the stool becomes hard it is difficult to empty causing constipation and straining to empty. If your stool is a Type 1 or Type 2 it will increase risk of constipation (see the Bristol Stool Chart below).
Ideally your stool should be soft and well formed i.e. Type 3 or Type 4.
Factors that cause the stool to become hard in pregnancy:
- Pregnancy hormones (progesterone) slows the movement of stool through the bowel
- Physical size of the uterus slows stool to movement through the bowel
- Decreased physical activity
- Changed diet2
- Regular iron supplementation3
How to Overcome Constipation in Pregnancy
Reducing constipation involves increasing the speed of movement of your stool through your bowel and emptying your bowel completely.
These 5 strategies measures can increase the speed your stool moves through your bowel to help you overcome constipation in pregnancy.
1. Bowel Emptying in Pregnancy
This video shows you the correct position and technique for emptying your bowel without straining during pregnancy.
Emptying your bowel relieves constipation and promotes movement of your stool through your bowel. If you’re constipated your bowel becomes progressively backed up with hard stool which making constipation worse.
If you’re already constipated you may need to discuss the short term use of laxative medication to initially relieve constipation while including the interventions listed below to prevent ongoing constipation.
Correct Position for Bowel Emptying
- Sit on the toilet seat (never hover)
- Feet and knees positioned apart
- Back straight
- Lean forward and allow your baby and lower abdomen to relax forward
Correct Technique for Bowel Emptying
- Take 4-5 relaxed deep breaths
- Make your waist wide by bracing and by saying “S” sound (provides pushing power to empty your bowel and avoids straining through your pelvic floor)
- Bulge your baby and lower abdomen forwards saying “OO” sound (opens your anal sphincter to allow the stool to pass)
- Lift and squeeze your pelvic floor muscles when complete
2. Diet for Constipation in Pregnancy
Your diet plays a major role in improving movement of the stool through your bowel and keeping it soft.
If you’re not already constipated, maintaining a good fibre intake can help you keep your stool soft and well formed stool. The American Dietetic Association recommends healthy adults consume 20-35 grams/day.
This video shows you foods that soften the stool and foods that make the stool hard. If your fibre intake is too low, this information helps you understand how to (gradually) increase the amount of fibre you consume during pregnancy.
If you’re already constipated, increasing your insoluble fibre intake (e.g. whole grains, vegetable peels and skins and fruit) can worsen constipation. This is because filling the bowel with indigestible material slows bowel movement and hardens the stool. Some women report abdominal bloating and flatulence when increasing fibre in the diet4.
3. Fluid Intake During Pregnancy
Having a good fluid intake can maintain good movement of the stool through your body by softening the stool and reducing constipation5. Try to keep well hydrated by drinking at regular intervals throughout the day.
The ideal volume of fluid for most women to consume is around 8 cups of water, herbal tea, milk, vegetable and non sugar fruit juices throughout the day during pregnancy. Alternatively if you don’t like to drink a lot of water, you may try to eat foods with high moisture content such as melon, cucumber and soups5.
4. Physical Activity in Pregnancy
Regular physical activity during pregnancy helps prevent constipation6.
ACSM recommends pregnant women undertake 30 minutes of moderate physical exercise on most days of the week7.
Low impact exercises ideal for promoting bowel motility during pregnancy include:
- Stationary bike
- Water aerobics
5. Laxatives for Constipation During Pregnancy
If you’re already constipated you may find that the conservative (non pharmacological) strategies already outlined aren’t adequate to soften your stool. Speak with your doctor or medical caregiver regarding pharmacological strategies which usually involve laxative medication.
The order of priority for laxative medication for constipation in pregnancy is usually as follows:8,9
A. Bulking Agents
Bulking agents are dietary fibre supplements that combine with water to bulk and soften the stool. Some bulking agents are completely natural such as psyllium husks.
These are usually the first line of laxative intervention suggested for pregnant women and are usually well tolerated9.
- Psyllium husks (Metamucil)
- Methylcellulose (Citrucel)
- Calcium polycarbophil
Bulking agents may cause abdominal bloating and flatulence so it’s important to start these with a very small dose and increase your water consumption too.
B. Osmotic Laxatives
Osmotic laxatives draw fluid into the bowel and soften the stool in this manner e.g. Movicol or Miralax. Many pregnancy women take osmotic laxatives to address constipation in pregnancy.
These laxatives are the second line of intervention if bulking agents are not well tolerated or unsuccessful and its important to have good fluid intake when using these products. The manufacturers state these laxatives are safe for use in pregnancy however it’s noteworthy that some osmotic laxatives contain magnesium or sodium salts which may contribute to salt retention which can be a problem for some women during pregnancy9.
C. Stimulant Laxatives
When bulking agents and osmotic laxatives are unsuccessful, stimulant laxatives may be considered as a single dose treatment for use by some pregnant women9.
Stimulant laxatives can have various methods of action including stimulating the bowel wall to contract or acting on the amount of water and salts absorbed to and from the bowel9.
These laxatives can cause abdominal cramping and diarrhoea in addition to electrolyte disturbances when taken regularly or in high doses. Stimulant laxatives include Senna (Senokot) which may be mistaken as a safe ‘natural’ laxative medication.
1. Spence‐Jones C, et al. (1994). Bowel dysfunction: a pathogenic factor in uterovaginal prolapse and urinary stress incontinence. British Journal of Obstetrics and Gynaecology101(2):147‐52.
2. Cullen G and O’Donoghue D. (2007) Constipation and pregnancy. Best Practice & Research. Clinical Gastroenterology, 21(5):807‐18.
3. Tolkien Z, et al. (2015) Ferrous Sulfate Supplementation Causes Significant Gastrointestinal Side-Effects in Adults: A Systematic Review and Meta-Analysis PLoS One. Feb 20;10(2).
4. Jewell D, Young G. Interventions for treating constipation in pregnancy. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD001142. DOI: 10.1002/14651858.CD001142.
5. Prather CM. Pregnancy‐related constipation. Current Gastroenterology Reports 2004;6(5):402‐4.
6. Derbyshire E, et.al (2006) Diet, physical inactivity and the prevalence of constipation throughout and after pregnancy. Maternal & Child Nutrition 2006;2(3):127‐34.
7. Artal R. & O’Toole M. (2003) Guidelines of the American college of obstetricians and gynaecologists for exercise during pregnancy and the postpartum period. BritishJournal of Sports Medicine 37, 6–12.
8. Royal Pharmaceutical Society. British National Formulary. 60th. London: BMJ Publishing Group Ltd and Royal Pharmaceutical Society, 2010.
9. 9. Rungsiprakarn P, et. al (2014) Interventions for treating constipation in pregnancy. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD011448. DOI: 10.1002/14651858.CD011448.