Constipation during Pregnancy

Constipation during pregnancy is a transient condition. That is the good news. The bad news is that you are stuck with it for several months. So you need solutions.

The fact that you are carrying a baby limits the list of natural constipation remedies you have at your disposal. But it does not eliminate them all. There is hope.

Constipation during pregnancy

The goal of this article is first to explain what triggers constipation during pregnancy. In the second part of the article, we will go through a list of tips and tricks to stay constipation-free as long as possible.

What causes constipation during pregnancy?

I am a man, and I will never be able to fully understand what happens within a woman’s body during pregnancy. Granted, I closely followed my wife’s pregnancies, and I have seen many pregnant women in my naturopathic clinic. Still, the hormonal rollercoaster is something I will never experience.

Changes in your hormonal levels is what causes constipation during pregnancy. Your levels of progesterone go up. Progesterone supports gestation and the development of the embryo.

But progesterone also relaxes and slows down your digestive tract so that more nutrients can be absorbed in order to nourish your baby. You will remember from the introductory article on constipation that slowing down the progress of fecal matter in the colon causes over-dehydration of stools and constipation.

Between 13%(1) and 43.5%(2) of women get constipation during pregnancy according to medical studies. In other words, a very large proportion.

After the birth of your baby, your hormone levels will slowly go back to normal. So your constipation should go away. For now though, keep reading to see what you can do to cope with the situation.

Aggravating factors

In addition to the hormonal changes, several factors can aggravate your constipation during pregnancy.

1. Iron supplements

As explained in details in the iron article, iron supplements can cause constipation. You will find suggestions at the end of the article to reduce the risk of constipation if you take those supplements. I will summarize them here (more details in the iron article):

  1. Try different forms of iron supplements. Ferrous sulfate is the cheapest and most commonly prescribed form, but the most problematic too. Try another form, ferrous gluconate or ferrous fumarate, which may reduce the risk of constipation during pregnancy.
  2. Increase your heme-iron intake from dietary sources. See the table provided in the iron article.
  3. Take substances that increase iron absorption, leading to a lower need for supplements. Vitamin C and animal proteins will have this effect.
  4. Avoid substances that decrease iron absorption. See the full list given in the iron article.

2. Inactivity

A growing belly and the joy of cocooning at home may have inadvertently impacted your sports routine. And yes, some sports are not adapted to pregnancy.

But there is a link between constipation and inactivity(3). Certain physical movements, especially those related to the lower trunk and legs, can improve the activity of the colon. Slowing down your physical activity may have been one of the aggravating factors.

3. Nutritional changes

A larger appetite along with new food cravings may mean your nutritional routine went through a change. Moreover, certain foods that did not trigger constipation before may have become a trigger due to your increased sensitivity and hormonal changes.

I encourage you to review the foods that cause constipation article. In my experience, the two main culprits are grains and dairy products.

What to do ?

Physical activity

Adjust your sports routine to take your pregnancy situation into account. But by all mean, do those exercises that get your lower trunk and legs moving, especially after lunch or dinner:

  • Walking is one of the best exercises ;
  • Swimming is great, and well adapted to pregnancy.

If you suffer from constipation during pregnancy, you will have to establish a routine where you practice those exercises several times a week, say swimming once or twice a week, and walking one hour the days you don’t swim.

Nutrition for Constipation during Pregnancy

The first step is to try to stop your consumption of grain based products. I know this is constraining, and that there is a long list of products to avoid: bread, pasta, crackers, pizza dough, cakes, etc. Give it a few days and see if it makes any difference.

The second step is to stop your consumption of dairy products, milk in particular, and see if it makes a difference. Cheese, butter and other refined milk products are usually less problematic. And believe me, there are much better sources of bio-available calcium in fruits, vegetables, meats and fishes than in milk (the key word here is “bio-available”, not total calcium). Give it a few days and see if it makes a difference.

Overall, my nutritional recommendations are close to the paleo camp, with a few variations specifically to address constipation. I will present this program in details in a future article. I do not believe this program leads to nutritional deficiencies for pregnant women for reasons that are too long to explain here. Please see the paleo diet websites for more information on this topic.

I am not a big fan of adding fibers everywhere. I get much better results by encouraging the consumption of fruits and vegetables. They of course contain fibers, but those are much better digested than wheat bran added everywhere. Steamed vegetables are always better digested than raw ones.

So in summary, eat a lot of vegetables of all types and colors, fresh fruits, pastured meats, fish and good fats (olive oil, butter, coconut oil). Skip the grains and dairies and see what it does to your constipation.

Supplements for Constipation during Pregnancy

As explained in the magnesium article, the general population today is seriously magnesium deficient. A lack of magnesium affects the activity of all muscles in the body, the colonic muscles included.

Scientific studies have demonstrated the advantage of taking magnesium supplements during pregnancy(4)(5)(6). Consider taking 200mg to 300mg of magnesium a day. Seek the agreement of your obstetrician before you do so.

If you have taken antibiotics in the past 12 months, or if you have not eaten in a very balanced way, if you had digestive troubles before getting pregnant, consider taking a quality probiotic.

Probiotics have been shown to help get rid of problems with difficult evacuations and hard stools(7), but you must give it time. Take the probiotics for a period of 2 to 3 months to enable the different bacterial strains to take hold.

Water for Constipation during Pregnancy

You have heard the advice “drink plenty of water” multiple times. I like to put it in a slightly different way: help your body manage fluids better.

One plant that I particularly like in those cases of constipation where the person has trouble keeping enough fluids in her body (which usually translates into a dry skin for instance) is marshmallow (Althaea officinalis).

Marshmallow is a very gentle, nourishing plant that will not interfere with your pregnancy. Marshmallow loves water and helps you keep more water in your digestive tract. Moreover, it is very soothing to the digestive mucous membranes, which might be irritated by chronic digestive upsets.

The way to use marshmallow is very simple :

  • Buy powdered marshmallow roots. Starwest botanical, from which I have bought on a regular basis, sells this product by the pound;
  • Put a teaspoon of marshmallow root powder at the bottom of a large glass;
  • Fill the glass with cold water;
  • Stir and let the glass rest for one hour. The root powder will deposit at the bottom of the glass. The water will become mucilaginous;
  • Drink that nourishing gelatinous water throughout the day.

Additional tools for Constipation during Pregnancy

Try those tips one at a time, don’t try to do them all at once, otherwise you never know what is working and what is not.

  • As explained in the olive oil article, take one tablespoon of olive oil first thing in the morning. This will make your gallbladder release a good amount of bile (which is our natural laxative).
    If the taste makes you nauseated, add a squirt of lemon juice. Then proceed with your breakfast. As explained in my other articles, I am not a big fan of flax oil or worse mineral oil (a derivative of petroleum).
  • Prune juice can be of great help. It creates a laxative effect via the sugar content of the prune juice (sorbitol), and it is safe for your situation. Drink a third of a cup of prune juice. Wait 2 hours. If nothing happens, drink another third of a cup, then wait another 2 hours. Repeat until you feel the urge. Take it slowly.

Laxatives

Do not take over-the-counter or any other stimulant laxatives when you are pregnant. Check with your doctor to see if there is a laxative that is adapted to your situation.

Medicinal plants for Constipation during Pregnancy

Due to the risk of lawsuits, nobody will dare recommending any medicinal plant to a pregnant woman. Which is a shame, because midwifes have used medicinal plants safely for centuries

Susun Weed for instance, well known for her herbal writing and clinical experience with women, talks about two plants specifically:

  • Dandelion to tonify the liver and gallbladder (bile is our natural laxative). Susun recommends that you try a dose of 10-20 drops of dandelion tincture (roots, leaves or both) in a small glass of water just before meals;
  • Ginger to not only fight morning sickness but also to encourage the secretion of digestive juices, which in turn moistens the stools. Ginger can be used fresh or dried as a tea. The fresh root can be purchased in many supermarkets, then grated to prepare a tea.

In any case, I recommend that you do check with your doctor to make sure he does not have any concerns with those plants. You may be taking drugs for instance, and plants like dandelion, by acting on the liver, also act on the metabolism of drugs.

The dreaded hemorrhoids

Constipation plus the added weight of the baby on the veins of your lower body may lead to hemorrhoids. Here again, because you are pregnant, the choice of medicinal plants and other natural therapies is limited.

Witch hazel

Externally, I recommend the application of Witch Hazel. Witch Hazel can be easily found in any pharmacy. It is an astringent plant that shrinks inflamed and puffed-up tissues. It also tones up weakened veins. This will be used as external application.

Leave the bottle in the fridge in order to create a cooling effect. Remove the bottle from the fridge, moisten a cotton pad with it and immediately apply it on your hemorrhoids. Leave the cotton pads there for a few minutes, then remove it. Apply several times during the day.

If you also suffer from varicose veins along your legs and you have tired legs at the end of the day, rest your legs in an elevated position (on your bed on a couple of pillows for instance). This will help get the blood back to the heart.

In addition, have your husband, mother or anybody else massage witch hazel on your legs, always massaging from the ankles to the pelvis (again, to facilitate blood return to the heart).

Sitz baths

The second thing I highly recommend are alternating hot/cold sitz baths. Here is the method :

  • Prepare 2 buckets, one with hot water, one with water as cold as you can have it;
  • Start by sitting into the hot bucket (not so hot as to burn yourself of course) and stay there a minute;
  • Then sit in the cold water bucket (hold your breath, it will feel really cold and shrinking to your hemorrhoids);
  • Alternate the hot/cold baths for 5 minutes;
  • Always finish with sitting in the cold bucket.

Do this twice a day if you can.

Conclusion

Pregnancy is usually a happy and exciting moment. But it is not without challenges. Constipation during pregnancy is a common condition, unfortunately without many practical advices from websites out there. I do hope you have found this article helpful and practical.

And even though 9 months sounds like an eternity to you at the moment, you will eventually get out of it and recover your pre-pregnancy transit!


References for "Constipation during Pregnancy"

(1) Saha S, Manlolo J, McGowan CE, Reinert S, Degli Esposti S. “Gastroenterology consultations in pregnancy”. J Womens Health (Larchmt). 2011 Mar;20(3):359-63.

(2) Perlen S, Woolhouse H, Gartland D, Brown SJ. “Maternal depression and physical health problems in early pregnancy: Findings of an Australian nulliparous pregnancy cohort study”. Midwifery. 2012 Feb 21.

(3) Simrén M. "Physical activity and the gastrointestinal tract". Eur J Gastroenterol Hepatol. 2002 Oct;14(10):1053-6. (note: this article is not directly related to constipation after surgery, but addresses the link between lack of movement and constipation).

(4) Hovdenak N, Haram K. “Influence of mineral and vitamin supplements on pregnancy outcome". Eur J Obstet Gynecol Reprod Biol. 2012 Jul 5.

(5) Supakatisant C, Phupong V. “Oral magnesium for relief in pregnancy-induced leg cramps: a randomised controlled trial”. Matern Child Nutr. 2012 Aug 22.

(6) Yamasaki M. “Recent Progress in Magnesium Research. Magnesium and pregnancy”. Clin Calcium. 2012 Aug;22(8):1205-10.

(7) Del Piano M, Carmagnola S, Anderloni A, Andorno S, Ballarè M, Balzarini M, Montino F, Orsello M, Pagliarulo M, Sartori M, Tari R, Sforza F, Capurso L. “The use of probiotics in healthy volunteers with evacuation disorders and hard stools: a double-blind, randomized, placebo-controlled study”. J Clin Gastroenterol. 2010 Sep;44 Suppl 1:S30-4.


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