Constipation During Pregnancy and After the Birth

By Christine L. Frissora, MD, FACP

The experience of pregnancy and childbirth has long been described as miraculous. A pregnant woman's body grows and changes, preparing for the pending birth. Constipation is one of the gastrointestinal problems commonly associated with pregnancy and the period directly after the birth, or the post-partum period. This problem, although part of the miracle of birth, can make you feel less than miraculous.

Constipation means different things to different people. Some people feel as though they have to strain during a bowel movement, or they are bloated, or passing pebble-like stools. In the world of medicine, constipation is defined as fewer than three bowel movements per week.

Constipation is a very common problem in pregnancy and in the days after delivering a baby, or the post-partum period. If a mother has an episiotomy (repair of torn rectal tissue), having a bowel movement can be very painful, and she may unconsciously hold on to her stool. Also, after a cesarean section delivery, the bowel can be temporarily paralyzed. This is called an ileus. There are some very simple things one can do to help alleviate constipation during pregnancy and in the post-partum period.

What Can I do About Constipation?

• Exercise: Early in pregnancy exercise is very helpful to prevent constipation. Even walking will help to loosen your bowels, and will help you feel less bloated.
• Fluids: During pregnancy, the amount of water that is absorbed from your intestine into your blood increases. You will need to drink even more water than usual to keep your intestine and your baby healthy. Drinking at least ten, 8-ounce glasses of water will be essential for you and for the baby. If you are pregnant during the summer and it is hot or humid, you may need even more water. Drinking more water during pregnancy will help to prevent constipation.
• The right calcium and vitamin supplements: Calcium supplements and vitamin pills, essential for your baby's development, can cause bloating and constipation. The following are some suggestions for calcium and vitamin supplements that are less constipating.

  The best calcium supplements are those that can dissolve in the pH of vinegar (also called acetic acid). Easily digested calcium supplements, which cause less constipation, include TUMS and Calcitrate. Usually I recommend TUMS because they supply calcium and they help to alleviate heartburn and bloating. Each TUMS contains 200 mg of elemental calcium. Taking five or six a day, in addition to a well-balanced diet, provides an excellent source of calcium. Be careful to avoid antacids that contain aluminum, which can be very constipating.

  A "prenatal" vitamin, which is specially designed for pregnant women, is the best digested. My patients prefer Stuart Natal Plus or Materna. The generic is also acceptable. These vitamins are bio-available, which means they are well absorbed from the gut and will cause less nausea and bloating. They have the extra iron, folate and B vitamins that you need when you are pregnant. Don't forget, if possible you should start your folate 1 mg supplements 6 months before you become pregnant!