Constipation during pregnancy: Causes, prevention and treatment

Normal bowel function varies from person to person but pronounced changes in its function, more particularly reduction in bowel movements, is what may be termed as constipation. Symptoms of constipation during pregnancy are no different than the ones experienced otherwise and generally include:

• Difficulty in passing stools
• Passing hard stools
• Feeling a need to push or strain in order to evacuate stools
• Having less than 3 bowel motions per week
• Fewer bowel movements than usual
• Abdominal pain
• A sensation of an incomplete bowel movement

The above symptoms are most commonly reported by women during the first and the second trimester but they may also be seen in later stages.

Causes of constipation during pregnancy are multifold but are usually related to dietary and hormonal factors. It could also be a manifestation of an underlying disorder. Let’s discuss each cause in some more detail.

Dietary causes of constipation during pregnancy

Quite inadvertently, diet has an effect on the pathogenesis of constipation even during pregnancy. Low intake of dietary fibres, limited intake of water and overindulgence in fast foods are the major causes of digestive issues during pregnancy.

It has been known that fibre is pivotal to the process of digestion. It helps in adding bulk to the faeces, which facilitates their easy elimination from the body. A lack of dietary fibres may thus cause disturbances in bowel movements causing constipation. Water, on the other hand, helps in the digestion of fibres and assists to make your stools softer, which allows them to pass easily without causing much discomfort.

Limited intake of water makes your stools harder and you experience immense pain and discomfort while passing them. This may also lead to an increase in pressure while passing out stools. Lastly, overeating and excessive indulgence in foods that are not conducive to your microbial flora, hinder the process of digestion leading to the symptoms of constipation.

Pregnancy-related causes of constipation during pregnancy

The aforementioned causes are the same for every individual regardless of pregnancy, but, certainly, there are some pregnancy-related causes as well. During pregnancy, your body goes through a plethora of hormonal changes to harbour the growing foetus.

• Due to an increase in the hormone relaxin during pregnancy, your intestinal muscles tend to relax. This causes the food and intestinal contents to stay for a longer time within your gut. As food moves slowly within your body and takes more time to digest, the forward passage of faeces also gets affected and the symptoms of constipation are experienced. But relaxin alone is not responsible for the manifestation of all these symptoms, there sure is the involvement of other female hormones like progesterone. Progesterone is also secreted in non-pregnant women, but, during pregnancy, there is an increase in the secretion of this hormone. As progesterone levels rise in the body, the motility of smooth muscles of the intestine is reduced. This is due to a reduction in the functioning of the hormone motilin, which stimulates intestinal motility. Other than this, there is also an increase in the reabsorption of water during pregnancy, which causes the stools to become harder than normal. You may then face greater difficulty in passing them out.
• Another cause of constipation during pregnancy, especially during the initial stages is the extra dose of iron, which is indicated for the proper development of foetal neural tube.
• Yet other causes are increased stress and anxiety during pregnancy, which could be due to a multitude of reasons concerning personal health or that of the baby. Lack of emotional support will further worsen this problem.
• Later in pregnancy, the cause of constipation can be ascertained to be an increase in the size of the uterus due to a growing foetus. As your uterus expands, it tends to put more pressure on the intestines further slowing the process of digestion and leading to the symptoms of constipation.

Disease-related causes of constipation during pregnancy

• Sometimes, it is likely that the individual already has some digestive issues and there is a heightened manifestation of the symptoms during pregnancy due to additional causes. Also, women who suffered from constipation prior to pregnancy will continue to have these symptoms.
• Based on these causes, constipation may either be due to hormonal changes during pregnancy or could be related to certain disease conditions like irritable bowel syndrome, diverticulitis or colon diseases. Use of certain medications and the presence of endocrine or metabolic disorders like hypothyroidism or hyperthyroidism also leads to constipation.
• Women suffering from diabetes mellitus, connective disorders and those who have had an injury to the intestinal tissues are more likely to suffer from constipation during pregnancy.
• Chronic constipation and obstruction in any part of the intestines can be ascertained as some other causes of constipation during pregnancy.
• Very rarely, constipation during pregnancy could be due to serious causes like colorectal cancer or other tumours, which were already present, but manifest during pregnancy.

Other causes of constipation during pregnancy

Women often tend to reduce physical activity during pregnancy and advance towards a more sedentary lifestyle. This is one of the major causes of reduction in bowel movement and constipation during pregnancy.

In some women, constipation may not an actual problem, but it may purely psychological. This can be confirmed in the absence of other probable causes.

There are a number of things you can do to prevent severe constipation during pregnancy, which are listed as follows:

• Consume a healthy diet
  During pregnancy, it is very important that you take care of your diet and remember to eat balanced meals, which will help to maintain your digestive health and ensure optimal levels of energy. (Read more: Balanced diet chart)

• Consume fibres
  Fibres are the best foods to avoid and treat constipation-related symptoms. Fibres cater to provide bulk to faeces, which makes them easier to pass. Some types of fibre also help to make your stools smoother. While it is important that you increase the intake of both soluble and insoluble types of fibres, it is suggested that you pay particular attention to the intake of soluble fibres like psyllium husk, since they have been found to be more effective against constipation as compared to insoluble sources like wheat bran. Studies have also suggested that soluble fibres function by altering the intestinal microbiota; thus, aiding in constipation relief. So, it is best to include them in your diet during pregnancy.

• Drink more water
  Water is crucial for the process of digestion and also assists in softening of stools. While you increase the intake of fibre in your diet, it is also important that you drink more water to aid in the digestion of fibres. This will help to prevent the symptoms of bloating and gas during pregnancy due to an increased intake of dietary fibres. Further, since more water is absorbed by the body during pregnancy, it is required to replenish your body stores for optimal digestion. This can be achieved by drinking at least 8 to glasses of water each day. (Read more: How much water to drink daily)

• Exercise often
  Physical activity and exercises improve the forward motion of faeces in digestive tract, which assists their elimination from the body. You must know that it is completely safe to exercise during pregnancy, in fact, researches have suggested better health outcomes for women who exercise than those who do not. Choose from your favourite exercises and perform at least 2 to 3 sessions of moderate physical activity every week. Simple exercises like jogging, swimming or yoga for a duration of 20 to 30 minutes can help. If you are new to exercising, you can simply begin by brisk walking for half an hour before starting with any other physical activity. In case of severe constipation, it is recommended to increase your physical activity even more. However, any form of physical activity during pregnancy must be performed under the guidance of a trained expert.

• Relaxation
  It is best that you keep stress at bay to avoid constipation during pregnancy. Exercising is indubitably the most effective method of reducing stress. Other than regular physical activity, you can practice yoga and meditation to manage your symptoms. Consult with your fitness expert about specific exercises that can be performed to obtain relief from your symptoms. You can also enrol with a pregnancy group for some advice and support.

Constipation during pregnancy can be diagnosed on the basis of individual symptoms and medical history, which will also help to determine the underlying cause. Knowledge of the cause is important to determine the course of treatment.

Since the diagnosis and treatment largely depend on the history and complaint, it is important that you specify your symptoms carefully including the type and intensity of pain, if experienced at all.

Sometimes, physical examination and stool tests are also performed to specify the diagnosis. In severe cases, endoscopy may be done.

The first line approach for the management of constipation during pregnancy involves dietary changes and an increase in physical activity. An increase in the intake of dietary fibre and water works well for the treatment of constipation, as it does for its prevention.

However, in some cases, this modality may not suffice, suggesting the need for pharmacological management. The following agents may then be used:

• Laxatives, which can either be bulk-forming laxatives or stimulant laxatives. Studies have found that stimulant laxatives are better than bulk-forming laxatives during pregnancy. Bulk-forming laxatives are associated with side effects like bloating, cramping and gas during pregnancy. Lubricant laxatives may also be used since they have lesser adverse effects.
• Stool softeners, which help to soften hard stools and allow their easy passage through the intestines. These agents will reduce pain and discomfort experienced while excreting.
• Supplementation of fibre in the diet, in addition to increasing dietary intake of water, which can be enabled by the addition of psyllium husk or isabgol. These are available as probiotics and natural supplements. As effective these remedies may be, it is important that you do not start using them without your doctor’s consult as this can have serious side effects.
• Newer drugs like Prucalopride are also available, but, they are not commonly prescribed in pregnancy unless their side effects have been shadowed by their need for management.
• Only in some cases with severe underlying causes will biofeedback therapy and surgical methods be used to assist the emptying of colon. Anyhow, these measures are quite effective.
• In case some drugs or supplements are responsible for the symptoms of constipation experienced during pregnancy, the dosage of these drugs will be modified or alternatives may be prescribed. The most common supplement causing constipation during pregnancy is iron. Your doctor will modify the dosage of iron depending on your symptoms and needs. Maybe he/she may recommend a different brand. You must, however, not stop taking supplements on your own as this can have damaging effects for the baby. The same goes for therapeutic drugs.
• When constipation during pregnancy is caused due to underlying disorders, these disorders managed.

While you are on these treatments, it is important that you take them in the prescribed dosage and time. It is imperative that you do not exceed the recommended dosage, in order to avoid serious side-effects. Any home remedies must be refrained from during pregnancy.

While the above-mentioned drugs have been deemed safe for use during pregnancy and cause no foetal defects, they can have other side effects. The most commonly observed side-effects include diarrhoea and abdominal discomfort. In some cases, dehydration may also be a pronounced symptom. Excessive use of laxatives can lead to an electrolyte imbalance in pregnant women.

If you observe any of these side-effects, it is important that you inform your doctor who may modify the dosage. As a preventive measure, it is also suggested to increase your water intake while on these medications. At best, it has been suggested to avoid the use of laxatives during pregnancy and stick to dietary measures.

In case these treatment approaches fail to work and no underlying causes can be determined, it is likely that the symptoms are psychological. In such cases, understanding individual symptoms and explaining them about the treatment course may help. Patient education of the risk factors along with reassurance, support and advice is likely to help in such situations. Some may also require counselling sessions for the same.

Constipation during pregnancy can have the following complications if not effectively managed:

• Piles or haemorrhoids
• Excessive pain and cramping
• Chronic constipation, which may continue even after pregnancy.