Constipation

Bloating and constipation are very common during pregnancy. Even from very early in pregnancy when the progesterone levels rise above premenstrual levels after conception the bowel can be slowed. In early pregnancy poor appetite due to nausea and vomiting can further reduce the bowel function. Increased transit time through the bowel can make the bowel motions firm and difficult to pass. This increases the chance of developing haemorrhoids.

As the pregnancy grows it displaces the bowel upwards and outwards. The pregnancy will be developing in the pelvis until after 14 weeks when it becomes palpable in the abdominal cavity. Prior to that bowel is displaced from the pelvis upwards into the abdominal cavity and this can lead to bloating and tighter clothes. If the bowel function is slowed there may be as much as 3 litres of content in the bowel by the end of the day which contributes to the bloating. As the pregnancy continues, the bowel is further displaced upwards and outwards. This can make the bowel irritable and it is possible to have constipation interspersed with episodes of loose bowel motions throughout the pregnancy.

It is important to be well hydrated throughout pregnancy to avoid constipation. If there is nausea and vomiting, this may require having small sips of fluid frequently. Although frequent small snacks may help with nausea and vomiting this may not help the bowel function. Dietary fibre is required for sufficient bulk for efficient transit of the bowel motions. Fibre capsules may be taken but it is essential to have plenty of fluids with them. If there is a lot of fibre but insufficient fluid in the bowel motion then the fibre causes the bowel motion to become very firm and painful to pass. If fluid and fibre are not sufficient to result in a soft but formed motion every day then stool softeners are recommended.

The common stool softeners are Movicol which is a powder that can be mixed up in water and Lactulose which is a syrup. Both of these preparations have molecules that hold water in the bowel motion and stop the motion from becoming overly firm. Softer motions will improve bowel motion generally. Softeners can be taken up to 3 times per day. Initially the dose is 1 per day. If there is no motion passed that day, then then the dose can be increased to 2 or 3 times the following day. If the motions become too soft then the softener can be withheld for a day. Softeners do not irritate the bowel like other preparations that encourage bowel motions, so it is possible to use softeners for longer term during pregnancy.

Constipation Postpartum

Constipation can worsen in the postpartum period. During labour or Caesarean delivery, the bowels come to a complete stop and it takes several days to restart their function. In that time it is very important to keep up the fluid and fibre and softeners may be required as well.

With breastfeeding, fluid from the circulation goes to the breasts for milk production and volume. It is very easy to become dehydrated and this leads to firm bowel motions causing constipation. Haemorrhoid symptoms of bleeding and pain can be increased. Firm bowel motions can lead to anal margin tearing which may become a chronic anal fissure.

As well as lots of fluid and fibre it may be necessary to continue softeners such as Movicol or Lactulose. These can be taken up to 3 times per day to maintain a daily soft, but formed, motion.