By Dr Manasri Naiker; Specialist Obstetrician and Gynaecologist
If you are pregnant, in your first or second trimester, you have a 39% chance of experiencing the discomfort of constipation. Bad news is that it’s also common shortly after delivery.
How do you define constipation?
If you are ‘going’ less than three times a week; if you are struggling to pass stools; and if they are hard and lumpy, you are constipated.
The main culprit for causing this problem is the raised levels of a hormone called progesterone. Progesterone relaxes your muscles, including your gut, which means that digested food gets moved along more slowly.
Another common contributing factor is the supplements used in pregnancy, which often include iron. Add to that the dietary changes and the decrease in physical activity, you can see why four out of ten pregnant women struggle with constipation. Further along in the pregnancy, the growing womb can also hinder the bowel movement.
After the baby has arrived there are aggravating factors like haemorrhoids, vaginal tears and episiotomies. The pain of trying to go can also lead to avoidance tactics, which ultimately lead to constipation.
Some symptoms of constipation also include abdominal and lower back pain, the feeling that you haven’t totally emptied your rectum, and bloating. Straining on the loo can worsen haemorrhoids and even damage the pelvic nerve, called the Pudendal nerve, which can in turn weaken your pelvic floor muscles.
With all these complicated factors, you may find yourself in a catch 22, not wanting to go, but not wanting to get constipated. It can be a terribly awkward topic to bring up with your doctor, but it is important to, and your doctor has certainly heard it a thousand times before.
So, what can we do about it?
Lifestyle changes can make a huge difference. Increasing the amount of fibre in your diet is number one. You should have 25-30 grams of fibre in your diet daily. For a reference point that is two to three servings of fruit or 200g of broccoli. Fibre softens your stool and helps it to move along through your gut. You can get it from vegetables, fruit, whole grains, lentils, peas, etc.
- Eating smaller but more frequent meals will decrease your digestive load, helping the system to keep up.
- Drinking more water is perhaps the simplest way to soften the stool and help it to traverse the gut. Most sources say the average sized woman should be drinking around 12 cups per day.
- Regular exercise is very important as it gets the muscles of the intestine moving. Most women decrease their physical activity during pregnancy, which is understandable considering the nausea, the fatigue, headaches, and the extra weight of a growing belly. Moderate exercise for 20-30 minutes, three times a week, will do a world of good. Consider a brisk walk or even prenatal yoga for instance.
If none of these options are helping, potentially talk to your doctor about changing your prenatal vitamin to one with less Iron, or a different form of iron.
Laxatives. Are they allowed?
The short answer is yes but be informed. There are different types of laxatives, and they can be divided into categories based on how they work. Please discuss this with your obstetrician before use.
- Wheat bran and psyllium husk fall under ‘bulk forming laxatives’. They increase the stool mass and therefore assist with movement. These are allowed during pregnancy but be patient, as they usually take a few days to work.
- Osmotic laxatives, such as Movicol, assist by increasing the amount of water in the stool, which aids movement. These are also safe to use during pregnancy and usually take around 12 hours to act.
- Senna falls under the ‘stimulant laxative banner’. They stimulate the muscles of the intestines to move. These tend to work much more rapidly, but can also cause uterine muscle irritability, so it is best to avoid these during pregnancy.
The ‘take home message’ is to eat enough veggies, stay hydrated and active!
Dr Manasri Naiker’s practice is based at Life Kingsbury Hospital, in Claremont. She has a passion for obstetrics and is proud of her high vaginal delivery rate. She enjoys helping younger patients with their reproductive needs or problems, but also has experience guiding mature women through menopause, which can hinder one’s quality of life. She is skilled in performing a wide range of gynaecological surgical procedures, which include minimally invasive surgery.