Constipation

Constipation is one of the most common health issues during pregnancy. Though as familiar and universal as it is, constipation still remains one of the least talked about aspects of pregnancy. Embarrassment, combined with our general reluctance to talk about bowel functioning, means that many women are unsure if their experience is unique.

It is worth remembering that constipation is a symptom rather than a disease. It is often the result of another condition such as pregnancy, a sedentary lifestyle, inadequate diet or other illness.

What is constipation?

Constipation refers to the passage of small, hard bowel motions. It relates to the consistency of the motions or poo , rather than the frequency they are passed. The longer that poo sits in the large intestines, the more water is reabsorbed back into the body and the harder the poo becomes.

One of the major functions of the large bowel is to reabsorb water back through the lining of the bowel. In some individuals, the poo remains for so long in the bowel that most, if not all the water is leeched back out, leaving the poo almost devoid of any fluid.

Another role of the large intestine is to push the bowel motion along the bowel wall towards the rectum. When there is some interruption in this process and the poo sits for longer than it needs to, constipation occurs.

A certain amount of water is necessary to help form bowel motions and give them shape. When there is little fluid left, this leads to pain when having a bowel motion, anal tenderness and sometimes tearing of the tissues. Other common symptoms are abdominal pain and a feeling of fullness and bloating. Constipation can also lead to problems with bad breath and a general feeling of sluggishness and fatigue.

Why is constipation during pregnancy so common?

There seems to be a number of contributing factors which lead to constipation during pregnancy and these include:

• Progesterone. This hormone plays a role in softening the ligaments in preparation for childbirth. But it can also lead to a degree of laxity and relaxation within the bowel walls.
• Changes in movement, dietary intake, nausea and vomiting. Reducing the amount of fluid circulating in the body has an effect on overall bowel function.
• The weight of the baby within the uterus, sitting on the intestines and the impact this has on abdominal space.
• Decreased small bowel activity. This influences the transition of food from the stomach, along the small bowel and how it enters the large bowel.
• A general slowing down of bowel motility and peristalsis.
• In some people some foods tend to exacerbate constipation such as milk, dairy foods, cheese and excessive amounts of red meat. Protein dense foods can be harder to digest than fibre based plant foods and cereals. Many women have a change of diet when they are pregnant.
• Iron supplements can lead to constipation. Black motions are also common. Some women find they cannot continue taking iron supplements as they become too constipated. Alternative intakes of high iron foods such as green leafy vegetables, red meat, eggs, and legumes are other options.
• Constipation is more common in women who have become dependent on laxatives to poo, or who have abused laxatives in the past.
• Ignoring the signs of needing to go to the toilet. Overriding the urge to poo, putting it off, delaying and just ignoring the body's signals can all lead to constipation. Over time, doing this can lead to changes in the tone of the bowel wall and rectum which means the body is less receptive to the normal evacuation signals.

What is the treatment for constipation during pregnancy?

• A healthy diet which is high in both soluable and insoluble fibre and roughage. Soluable fibre dissolves in the gut when it is around water. It ends up like a soft gel which is easily passed from the body. Examples of soluable fibre are found in potato and pumpkin. Insoluble fibre is evacuated from the body looking much the same way as when it enters, e.g. corn kernels, carrots.
• Drinking plenty of water really helps to avoid and treat constipation.
• Have regular exercise and move your body. Swimming, walking, yoga and gentle weight training are all ideal exercise options during pregnancy.
• Some women may need to take medications which are known as stool softeners. These reduce the transition of water out of the poo so it remains soft and easier to pass. It is essential to check with your maternity care provider or a pharmacist before taking any medication during pregnancy. Check the Royal Women's Hospital Melbourne Website for specific advice.
• Castor Oil or other mineral based oils are not safe to take during pregnancy and should be avoided. Likewise enemas and suppositories should only be used under medical supervision and guidance.

It is important to rule out other medical conditions which may be causing constipation during pregnancy. Gestational Diabetes, Hyperemesis Gravidarum, haemorrhoids or hypothyroidism can all influence the likelihood of constipation occurring.

What foods help with constipation?

• Any type of fresh fruit or vegetables.
• Leafy vegetables such as lettuce, broccoli, Chinese greens or salad leaves are ideal.
• Carrots, pumpkin, sweet potato and corn.
• Dried fruit and nuts especially almonds, Brazil nuts, sultanas, apricots and prunes.
• Berries such as raspberries, strawberries, cranberries and blueberries.
• Wholegrain cereals and breads, brown rice, pasta and lentils.
• Breakfast cereals, especially those with unprocessed bran and oats. Avoid eating cereals which are flaked, popped or toasted. These tend to be more highly processed and separate from their original state. The more manufacturing and processing which goes into food preparation, the more removed it is from its origins.
• Eat raw food where possible, while maintaining careful food hygiene.

What should I avoid?

Mineral oils, harsh aperients such as castor oil and laxative tablets can be risky during pregnancy. When taken in the extreme they can lead to premature labour.

What else can help with constipation?

• Make some time to sit on the toilet undisturbed every day. After breakfast, lunch or dinner and try not to be rushed. Take a book with you, read the paper, lock the door and try to relax.
• Avoid straining and sitting for long periods. Aim for more of a squatting position when sitting on the toilet; leaning forward with the elbows on your knees may help.
• Avoid an excessive intake of caffeine. This can have a diuretic/dehydrating affect which compounds constipation. Water, fruit juices and mineral/soda water are reasonable alternatives.
• Some medications contribute to constipation. Check with your maternity care provider or pharmacist if there are alternatives which you could take.
• Avoid ignoring the cues your body gives you that you need to go to the toilet. Work commitments, lack of privacy and self consciousness, and feeling tense can all lead to holding on for longer.
• Bulk forming laxatives are sometimes used during pregnancy. They often come in individual sachets or containers and are mixed with water before drinking. They work by reabsorbing water in the bowel and increase the size of the bowel motion. They also soften the poo so it is easier to pass.

Remember

Constipation is not uncommon after childbirth. In the early weeks following vaginal delivery, pain around the perineum and anus is common, especially when a mother has had an episiotomy or stitches. When breastfeeding, it is important to drink plenty of water otherwise, constipation is more common.

Constipation during pregnancy can lead to problems with haemorrhoids (piles) developing. These can be very painful and cause real discomfort after childbirth. Find out what works for you in maintaining regular and comfortable bowel habits. Many women take their own supply of bran, nuts, seeds and stool softeners to the maternity hospital. Just remember to check with your maternity care provider if any of these are contraindicated with breastfeeding.