Constipation during pregnancy: How to get relief

Why do I have constipation during pregnancy?

Constipation is a common problem during pregnancy: Up to half of pregnant women get constipated at some point.

One reason for constipation during pregnancy is an increase in the hormone progesterone, which relaxes muscles throughout the body, including the digestive tract. This means that food moves through the intestines more slowly.

Additionally, there are distinct changes in your blood vessels and total body fluid while pregnant. Your blood vessels dilate so they can hold approximately 50 percent more fluid by the time you deliver. As your pregnancy progresses, your “hydration goal-line" if you will, is constantly changing as your body holds on to more and more fluid. This can lead to symptoms of dehydration, including constipation and headaches. Other factors can include eating a low-fiber diet (which many women switch to due to nausea or pregnancy bloating), and reduced physical activity because of pregnancy fatigue and discomfort.

And the problem may be compounded later in pregnancy by the pressure of your growing uterus on your colon and rectum. Iron supplements, especially in high doses, can make constipation worse.

Will the constipation extend beyond the first trimester?

It can. That’s because some of the top factors for constipation such as increased progesterone and lowered physical activity can continue after your first trimester. Also, your intestines will absorb less water overall, which causes stools to dry out more.

Later in your pregnancy, these issues are exacerbated by an enlarging uterus, which may slow the movement of feces through your system.

Should I worry about constipation while pregnant?

Not usually, but occasionally constipation during pregnancy can be a symptom of another problem. For example, health conditions that can cause constipation include:

• Endocrine issues like hypothyroidism or diabetes
• Irritable bowel syndrome
• Intestinal obstruction
• Neurologic disorders like multiple sclerosis
• Colorectal cancer

If you have severe constipation that's accompanied by abdominal pain, alternates with diarrhea, or you pass mucus or blood, call your doctor or midwife immediately.

Constipation can cause other problems, too. One of the most common is hemorrhoids, which are swollen veins in the rectum and anus.  These are common in pregnancy due to the natural pressure put on your abdomen. Hemorrhoids are aggravated by straining during a bowel movement or passing a hard stool.

Hemorrhoids can be extremely uncomfortable, though they rarely cause serious problems. In most cases, they go away fairly soon after your baby is born. However, if the pain is severe, or if you have rectal bleeding, call your provider.

Straining with bowel movements can also affect your pelvic floor muscles, which help control your bladder. This can lead to a condition called stress urinary incontinence, when your urine leaks during activities – and that includes laughing, sneezing, or coughing. This condition is already often related to pregnancy and childbirth because of the added pressure on your body from carrying a pregnancy and the process of vaginal deliveries, but your risk of developing it could increase due to constipation.

Pregnancy constipation relief: Ways to feel better

Here are some tips for preventing and easing constipation when you're pregnant:

• Drink plenty of water. Try to have 10 to 12 cups of water or other beverages daily. (Or sip throughout the day until your urine is clear or pale yellow in color – a sign of adequate hydration.) Drinking a glass of fruit juice every day, especially prune juice, can also be helpful. Some people find that drinking a warm liquid right after waking up helps get things moving. Keep in mind that humid weather, sweating, and exercise may increase how much fluid you need.
• Eat high-fiber foods, including whole grain cereals and breads, brown rice, beans, and fresh fruits and vegetables every day. It can help to add a couple of tablespoons of unprocessed wheat bran (available at health food stores) to your cereal in the morning, though it may take a few days before you notice a difference. Options like these help to add bulk to your stools so they go through your system easier.

• Exercise regularly. Walking, swimming, riding a stationary bike, and yoga can all ease constipation and leave you feeling more fit and healthy.
• Listen to your body. Your bowels are most likely to be active after meals, so make time to use the bathroom after you eat if you need to. Don't put off going to the bathroom when you feel the urge.
• Try another prenatal vitamin. If your prenatal multivitamin contains a large dose of iron (and you're not anemic), ask your healthcare provider about switching to a supplement with less iron. You can also take your iron supplements in smaller doses throughout the day (such as in liquid or gummy form) which can reduce their effect on your bowels.
• Try a stool softener, such as colace (docusate sodium). It is not a laxative and won’t “make you go” but it will make your bowel movements a lot easier to manage.
• Ask your doctor about taking magnesium. They may recommend you take 200 to 400 milligrams once or twice a day to help keep things regular.

If the measures above don't help (or it's hard for you to follow them), talk to your provider about taking an over-the-counter fiber supplement. Just make sure you also increase your water intake to compensate for the extra fiber. These supplements are usually appropriate most women, but sometimes they can cause uterine contractions so it's important you follow your doctor's guidance. Also, if you're taking too much, you may actually experience diarrhea. 

In general, constipation and other bathroom issues may extend into the postpartum period, but rest assured that you’ll get back on track. Often, you’ll have a bowel movement within three or four days after delivery, although it may take a few months to get on a regular schedule. If you’re still struggling by then, talk with your doctor.

Learn more:

• Gas and bloating during pregnancy
• Heartburn during pregnancy
• Your pregnancy diet: The basics of eating well