Constipation in pregnancy

Several factors contribute to constipation in pregnancy. The hormone progesterone increases, which causes the bowel to relax, slowing down the movement of stool through your gut. As food remains longer in the bowel, more and more nutrients and water get removed from it, making it harder to pass.

As your baby grows and takes up more room in the abdominal space, this puts pressure on your bowel, which is why constipation is most common in the third trimester.

Some people are less active during pregnancy and drink less water, which worsens constipation. Medications like iron tablets, which are commonly taken during pregnancy, can cause constipation as a side effect.

The good news is that while uncomfortable and sometimes painful, constipation does not harm the baby. Complications of constipation, like hemorrhoids and anal fissures, can make normal vaginal delivery more uncomfortable. But with the right steps, it’s perfectly possible in your birth plan to accommodate this.

Make sure you're packing in the fiber-rich food – the aim is 30 g of fiber per day, but it's hard to quantify, so aim for lots of fruit and vegetables, whole grains, lentils, and beans.

Drinking plenty of water, around eight 8-ounce glasses per day, especially during pregnancy, is essential. This softens your stool and keeps you feeling well. Keeping active helps to keep the bowel active – make sure any exercise is pregnancy-safe and matches your energy levels - walking, swimming can be good, or pregnancy yoga.

The good news is that for most women, constipation improves in the days and weeks after delivery. But keep going with the things you know can help while your body readjusts in the post-partum recovery.

Laxatives are a general term for constipation relief. They fall into different categories depending on how they work. Let's give you a rundown of each and let you know what's safe in pregnancy and what's to be avoided.

Osmotic laxatives work by osmosis and draw water with them as they move from the stomach and into the large bowel. They work best if constipation has been a problem for less than 3 days. They take about 24 to 48 hours to get to work. They have a gentle action and are safe to use for a few weeks. Miralax can be an excellent place to start – try taking one capful once a day in a glass of water. Movicol sachets containing macrogol powder are another option – dissolve one or two in a glass of water once daily.

Bulk-forming laxatives act by adding soluble fiber to stools to give them volume. This helps prevent or ease piles (hemorrhoids), which are common in pregnancy, and will help those who don't get enough fiber. They keep stools soft and loose, making them easier to pass.

Fybogel is mild enough to take routinely for a few weeks. Fybogel sachets containing ispaghula husk are one example - adults should take 1 sachet in a glass of water twice daily. Again, they are best used if you've had constipation for less than 3 days and take 24 to 48 hours to take effect.

Glycerol or glycerin suppositories are particularly effective when other treatments have failed or when stools are difficult to pass. They work directly in the rectum; results are usually seen within an hour, or you can add them to other treatments.

You should avoid certain laxatives during pregnancy and in the post-partum stage after delivery. Stimulant laxatives such as senna and bisacodyl tablets (in brands Senokot or Dulcolax) work by forcing stools down and out. They work fairly quickly (within 8 to 12 hours). They should be avoided during pregnancy due to the possibility of causing abdominal cramps.

Stool softeners containing docusate sodium, such as Colace, should only be used during pregnancy if the benefits outweigh the risks. They are not recommended in breastfeeding as docusate sodium, and its metabolites are secreted into breast milk, which may present a risk. This should be done in consultation with your doctor.

It's important to check with your pharmacist or doctor before trying any supplements from health shops or products claiming to be natural remedies, as they may not have been rigorously tested and therefore deemed safe for pregnant women. Castor oil, for example, is to be avoided during pregnancy.