Irregular bowel movements that cause a bloated, gassy, clogged-up feeling are a common symptom in pregnancy.
Constipation is the term given to difficulty in passing stools, and in pregnancy, the increased progesterone levels cause the muscles in your bowels to relax. This affects their ability to work at a normal pace, making them sluggish and allowing food to hang around longer in the digestive tract. The benefit is this gives added time for nutrients to be absorbed into your bloodstream and reach your growing baby. It may get worse as pregnancy progresses and your uterus grows and takes up much of the space normally occupied by your bowel, giving it less room to work.
Iron tablets – often prescribed during pregnancy for low iron levels and anaemia – also commonly have a side-effect of constipation. If you experience this, speak to your GP or midwife and see if you can change to a different type.
Healthy eating habits and regular exercise encourage a speedy digestive system, which can help prevent constipation during pregnancy. Consuming lots of fibre-rich foods (fruits, vegetables, whole grains, nuts and pulses), drinking enough water and staying active can all combine to prevent constipation by counteracting the natural digestive slowdown of pregnancy.
For some women, constipation lasts throughout pregnancy as progesterone levels increase. However, if you watch what you eat and step up your exercise habits, things usually begin moving more smoothly. These changes to combat constipation can be implemented any point during your pregnancy.
You’ll probably find constipation more of an uncomfortable inconvenience than a major problem. Bowel gas and bloating can sometimes affect the view on an ultrasound scan, as a gassy bowel will obscure the pelvic organs in early pregnancy, especially if the uterus is tilted or retroverted.
Constipation can sometimes lead to other problems, such as:
Piles (haemorrhoids), which are enlarged or swollen veins in or around the rectum and back passage. They can be painful, itchy and uncomfortable. They can also bleed.
An anal fissure, which is a tear in the skin around the anus. A fissure can happen when passing a particularly hard or big poo. It can feel very painful when you have a poo and you may notice bleeding from the tear. They can also cause a burning pain that can last several hours after you’ve been to the loo.
Both piles and anal fissures can be treated with creams and ointments. Ask your pharmacist, midwife or GP for a cream that is safe to use in pregnancy. You should go back to your doctor if you experience persistent bleeding.
Here are some top tips to prevent constipation:
- Eat more fibre-rich food. A diet with plenty of whole grain cereals and breads, pulses (beans and chickpeas), nuts, fresh fruits and vegetables (raw or lightly cooked — preferably with skin left on), and dried fruits. Leafy green vegetables, prunes and kiwi fruit have a potent laxative effect. Try adding some bran to your diet, starting with a sprinkle and increasing as needed. Don’t have too much or it may have the opposite effect and carry away important nutrients before they can be absorbed. You will also experience bloating and wind, another common complaint of pregnancy as well as a temporary side effect of increasing the amount of fibre in your diet.
- Try to avoid refined carbohydrates (white bread, white rice, refined cereals and pasta) when you can; they tend to clog you up.
- Keep hydrated: Drinking plenty of clear fluids (8-10 glasses) every day keeps solids moving through your digestive tract and makes your stool soft and easier to pass. You can also drink warm drinks such as peppermint tea or hot water and lemon, to help stimulate peristalsis (the intestinal contractions that help you go). Prune juice contains sorbitol, which is a mild laxative and may help with more persistent constipation.
- Don’t eat big meals. Try eating six mini-meals a day rather than three large ones and you might also experience less gas and bloating.
- Don’t hold it in. Regularly holding it in can weaken the muscles that control your bowels and lead to constipation, so try to go whenever you have to.
- Consider your supplements and medications. Ironically, many of the supplements and medications that are essential in pregnancy (prenatal vitamins, calcium and iron supplements, as well as antacids) can exacerbate constipation. So check with your practitioner about alternatives (such as slow-release iron supplements) or adjustments in dosages until the situation improves.
- Add probiotics to your diet. The probiotic acidophilus, found in yogurts that contain active cultures, stimulate the intestinal bacteria to break down food better to keep the bowel moving. You can also ask your practitioner to recommend a good probiotic supplement in capsules, chewable tablets or powder form that can be added to smoothies.
- Try to do more exercise. This helps regular bowel movements. Even just a 10-minute walk can get things moving, but you could try swimming, yoga or Pilates.
- Pelvic floor exercises can help keep you regular when practiced regularly.
- Stay away from laxatives. Not all laxatives and stool softeners (especially herbal or homemade ones) are safe for use during pregnancy. Talk to your GP before taking any constipation medication or remedy. Your doctor or midwife may prescribe a laxative that’s safe to use in pregnancy. They may suggest you try the following, in this order:
- A laxative called Fybogel (also known as ispaghula husk). This is a high-fibre drink that you take morning and evening after you’ve eaten. It takes two or three days to work.
- A short course of Senna. This is a natural laxative made from the leaves and fruit of the senna plant. You take it as a tablet or liquid. It takes about eight hours to work. Senna can cause diarrhoea and tummy pain.