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!
- Stool softeners: In some cases, a stool softener is needed to relieve constipation. Obstetricians often recommend that patients use Docusate. Docusate works as a surfactant to decrease the wall tension between the stool and the colon. It is not habit forming and acts mainly to keep the stool soft for easy, natural passage. It is well tolerated, it comes in 100 mg capsules, and Docusate can be taken 1-3 times every night.
- Alternating hot and cold: Drinking cold fluids or eating ice chips, then drinking warm fluids, like decaffeinated tea, helps to stimulate and tone the bowel, and also helps to pass gas.
- Incentive spirometer: If you are on bed rest during your pregnancy, an incentive spirometer (a device into which you inhale deeply, either raising balls or creating bubbles depending on the model) will be essential to keep your bowels moving and to keep your lungs clear. The incentive spirometer cannot be over-used. Every ten minutes is perfect.
- Nursing: After the baby is born, nursing can actually help to alleviate constipation. Stimulation resulting from the baby's sucking causes the uterus to contract, and helps to move the bowels.
- Enema: An enema is an effective way to empty the colon. It is, however, a rather invasive measure, and may be uncomfortable for women who have had cesarean deliveries, or episiotomies.
Unsafe constipation remedies
I do not recommend senna, the herbal remedy for constipation. This substance, although advertised as natural, causes cramping and secretion of electrolytes and water from the colon. This is called a secretory diarrhea, which at best is unpleasant and at worst causes an electrolyte imbalance in the blood. Some patients drink prune juice for constipation, but I do not recommend this either since its active ingredient is phenolphthalein, which can also cause a secretory diarrhea as well as bowel dependence.
If you have any constipation or abdominal discomfort during or after your pregnancy, you should consult with your doctor. Sometimes a medical condition such as a thyroid problem (hypothyroidism) may develop during pregnancy and cause constipation.
Dr. Christine Frissora is board-certified in Internal Medicine and in Gastroenterology. She is currently a faculty member in the Division of Gastroenterology and Hepatology at the Weill Medical College of Cornell University and is an Assistant Attending at The New York Presbyterian Hospital.
Copyright © Dr. Christing Frissora. Permission to republish retained by Pregnancy.org, LLC.