Constipation can be a real pain in the backside! One of the most common issues and frustrations during pregnancy can be constipation with varying reports suggesting anywhere between 9-40% of pregnant people experiencing constipation at some stage.
CAUSES
There are a number of contributing factors to constipation in all populations but during pregnancy there are a few more as well:
Progesterone
This is a hormone that is increased during pregnancy. It relaxes the smooth muscles in your body to help allow the uterus to expand. However this also affects the bowels, it makes the movement of the waste through the bowels slower which in turn allows more fluid to be absorbed out of the forming stool. This can result in a harder, dried out stool which is more difficult to pass out.
Diet
Like with all people if you do not get enough fibre in your diet this can lead to increased constipation. Combine this with insufficient fluid intake and then any fibre in the diet can become a constipating agent as opposed to a bulk creating agent.
Activity
It is not uncommon to experience fatigue and nausea especially in the first trimester. This can have a significant impact on your activity levels, unfortunately decreased activity levels can contribute to a slower gut transit and a higher likelihood of constipation
Supplements
Some of the prenatal supplements such as iron or calcium can also contribute to constipation
Fetus
The growing fetus and expanding uterus can put physical pressure on the gut and make it more challenging for the stool to pass through it
Pelvic Floor
Some people struggle with pelvic floor muscles that even when at rest are quite active. This results in sometimes having difficulty in relaxing these muscles in order to allow the poop to pass out.
Ignoring the call
Many people will put off going to the toilet to pass stool, however after about 15 minutes your internal anal sphincter will come back on and lift up the stool back into the intestine. This will then further dehydrate the stool and make it harder to pass later on.
TREATMENT
There are a number of ways to treat constipation, many of which are easily done with some basic lifestyle modifications:
Fluid
Keep HYDRATED! Sufferers of constipation have a dry stool that sticks like glue to the intestinal walls. As well as increased fibre, water or fluids go hand in hand to help reduce constipation. You can try prune juice if really constipated as it has a mild laxative effect.
Fibre
Increasing your fibre intake is crucial in fighting constipation. Fibre gives bulk and form to your stool as well as softening it. Fibre rich foods are fruits, vegetables, whole grains and pulses. Fibre recommendations vary from country to country but when pregnant and struggling with constipation try and aim for above 25g of fibre a day. If appropriate sometimes a fibre supplement can be taken but discuss with your healthcare provider first
Meals
As well as increasing fibre and fluid, try reducing the size of the meals and having them more frequently. So instead of 3 large meals try 6 smaller ones
Exercise
Taking regular activity has been shown to be beneficial for so many pregnancy related concerns and constipation is no exception
Supplements
Consider which supplements you are taking and discuss with your doctor about alternatives either different brands, dosages or alternative administration, for example iron IV infusions. And if not on a magnesium supplement discuss with your doctor about trialling some
Probiotics
Probiotics occur in many foods that have active cultures like yoghurt however some of these foods are not recommended if not prepared properly. Discuss with your doctor about supplements in capsule form too
Pelvic floor muscle exercises
While it is important to try and keep your pelvic floor strong through pregnancy and doing your kegel exercises help with this. If your pelvic floor tone is overactive doing too many kegels will not help and will likely worsen the constipation. You may benefit from doing some pelvic floor muscle relaxation work.
Tummy Massage
Some simple tummy massage techniques can help including clockwise circles and ‘I Love You’. The massage techniques follow the path of the intestines helping to move things along. See Digestion Massage Video
Laxatives
Not all stool softeners and laxatives are safe during pregnancy discuss before using with your doctor or pharmacist. And ideally will only be used for a short period of time not a long term management
Positioning
When you are going to have a bowel movement it is important to have your knees above your hips as this allows the puborectalis muscle to relax and let the intestine straighten out in order to let the stool pass out easier. Keep your feet on a stool or use a Potty Squatty. Remember to not strain but try and “breathe out the poop”. This can be a form of practice if you’re planning on a vaginal birth!
Timing
As soon as you feel the urge to pass a bowel movement you should go, before the internal anal sphincter turns back on.
As with many pregnancy symptoms, constipation is not necessarily of concern but can be very uncomfortable and frustrating. Some people feel embarrassed about discussing bowel issues but if you’re struggling do not feel concerned, have a chat with your healthcare provider they are there to help.
