My Pregnancy

Constipation in pregnancy

Constipation in pregnancy

Lifestyle modification: Constipation in pregnancy can often be remedied by lifestyle modification.

– Adding fiber to the diet with foods or over-the-counter (OTC) fiber supplements ( 2-6 Tb Sp, unprocessed Bran with glass of water with each meal). Foods rich in fiber are whole grain breads and cereals, bran, fruit, and green, leafy vegetables.

– Increasing fluids, 6 to 8 full glasses (8 ounces each) of liquids each day.

– Regular exercise, if permitted by your obstetrician.

Foods that worsen constipation: Foods such as caffeine, pastries, bananas, puddings, sugar, candy, cake, chocolate, cheese, white rice, red meat, white bread, fast foods, processed food, frozen dinners, chips, dry products, alcohol and some supplements may make the constipation worse. 

Laxatives:

Bulk-formers fiber laxatives: (OTC/ Non prescription)

Bulk-forming laxatives are not digested or absorbed and are safest for long-term use. They act by absorbing liquid in the intestines and swell to form a soft, bulky stool. The bowel is then stimulated by the presence of the bulky mass. 

There are 2 types of bulk forming fiber laxatives. Soluble and insoluble

– Soluble are Sterculia, Polycarbophil. It can ferment and cause bloating, flatulence and cramps.

– Insoluble is Psyllium seeds (ispaghule), 

– Methyl cellulose contains both soluble and insoluble fiber. 

Examples of bulk-forming laxatives include

– Psyllium seeds (ispaghula husk) : Fybogel, Benefiber, 1 tsp up to 3 times daily

 Citrucel ( Methylcellulose), 1 tsp up to 3 times daily

– Normacol (Sterculia)

Osmotic laxatives:

They encourage bowel movements by drawing water into the bowel from surrounding body tissues. This provides a soft stool mass and increased bowel movement.

There are three types of hyperosmotic laxatives taken by mouth—the saline osmotic laxatives, saccharides osmotic laxatives (Lactulose & Sorbitol), and the polymer types:

Lactulose osmotic laxative:  (by Prescription only) Duphalac

Lactulose relieves constipation by drawing water into the bowel to make poo softer. The most common side effects are diarrhoea, bloating and wind. These are usually mild and shortlived. Lactulose takes at least 48 hours to work. If you find the taste of lactulose too sweet, you can dilute it with fruit juice or water.

Sorbitol osmotic laxative:  (OTC/ Non prescription) 

Caution during pregnancy

Macrogol, Polyglycol, polyethylene glycol or PEG:  (OTC/ Non prescription)

Its a preferred laxative in pregnancy. A large molecule that causes water to be retained in the stool; this will soften the stool and increase the number of bowel movements. It is used to treat constipation and to help clear build- up poo in your bowel (faecal impaction). It can take 1 to 2 days to work. Most common side effects are stomach pain, diarrhea, wind and sore bottom ( anus). These are usually mild and short lived. 

Saline laxatives:  (OTC/ Non prescription) FDA Category C during pregnancy. Safe but not advisable for daily use.

Lubricant laxatives/ mineral oils: 

It acts by  coating the bowel and the stool mass with a waterproof film. This keeps moisture in the stool. The stool remains soft and its passage is made easier.

Mineral oil: (OTC/ Non prescription) Contraindicated in pregnancy due to decreased maternal absorption of fat-soluble vitamins and risk of neonatal hypothrombinemia and hemorrhage. 

Irritant/Stimulant/contact laxatives:

Trigger rhythmic contractions of intestinal muscles to eliminate stool. These are popular type of laxative for self-treatment. However, they also are more likely to cause side effects. 

Castor oil: (OTC/ Non prescription) Contraindicated in pregnancy. It can initiate premature uterine contractions.

Bisacodyl: (OTC/ Non prescription) FDA Category C during pregnancy.  Should not be taken within 1 h of calcium-containing compounds as can cause early medication release and gastric irritation. 

Senna: (OTC/ Non prescription) FDA Category C during pregnancy. Caution in pregnancy, also secreted in breast milk. Acceptable only for short term use.

Stool softeners/ Emollients laxatives:

Add moisture to stool to allow strain-free bowel movements.

Docusate/ Cloace (OTC/ Non prescription): FDA Category C during pregnancy. Limited efficacy data in pregnancy.