Imagine being pregnant and unable to have a bowel movement for over a month. This happened to Ivana Gogh* from Pittsburgh. Needless to say, she was very uncomfortable. Her stomach hurt a lot and she felt bloated. Her belly was distended, and it wasn’t from the pregnancy—because at 8 weeks she was too early to be showing as much as she was. Gogh was extremely fatigued and barely had enough energy to take care of herself, much less her toddler. Many days it was a struggle to even shower. Unfortunately, Gogh’s predicament—while extreme in its length—is common for pregnant women.
More than 50 percent of all pregnant women suffer some degree of constipation, says Dr. Ken Troffater, director of Maternal-Fetal Medicine at the University of South Carolina. “It is probably only second to headaches among common pregnancy complaints. Think of it as ‘nature’s way’ of getting the mother to absorb the most food and fluid from her diet she possibly can to help maintain the pregnancy.”
The Three Ws: What, When, and Why
The standard definition of constipation is having a bowel movement less than three times per week, but in Dr. Trofatter’s experience, even this can’t be defined as constipation unless it’s accompanied by hard, dry stool that requires straining to eliminate. This discomfort can start early in the first trimester, but usually becomes more of a problem from 20 weeks on, Dr. Troffater says. He says that some people are unusually prone to constipation because of poor fluid or fiber intake in their diets, so it can be a chronic problem throughout the pregnancy.
What causes this lovely side effect of pregnancy, anyway? A primary cause is the hormone progesterone, which is made in large amounts by the placenta by the end of the first trimester. “One of the major effects of progesterone is to cause relaxation of ‘smooth muscles,'” Dr. Trofatter says. “Progesterone decreases the strength and frequency of bowel contractions. The slower the motility of the bowel, the greater the opportunity for absorption of fluids and foods. Unfortunately, by the end, if the remaining waste becomes very dehydrated, the stool becomes compact and hard, making it more uncomfortable to pass, sometimes getting to the point where a woman will not have a bowel movement for five or more days. This is constipation and it can be very uncomfortable.” He says other causes are iron and calcium supplements, poor fluid and fiber intake, and too little exercise during pregnancy.
There is also an anatomical effect, says Dr. Madhuri Bewtra, an OB-GYN in Bergen County, New Jersey. The uterus enlarges, the fetal head is in the pelvis, and the pelvic floor relaxes as the pregnancy progresses, causing the lower intestine and rectum to become compressed.
Prevention and Treatment
Gogh started experiencing constipation when she was about 8 weeks along. After a week, she swallowed her embarrassment and contacted her OB-GYN. The nurse recommended a regimen of increased water (at least six to eight glasses per day), more fruits and fiber-rich foods in her diet, apricot nectar, a fiber supplement, and then if none of these things worked within a few days, a stool softener.
Gogh was told that her prenatal vitamin could be contributing to the problem since it had a lot of iron in it, so she was given the OK to stop taking it for the first trimester and substitute a children’s vitamin. Once she entered the second trimester, the nurse told her to return to the prenatal vitamin as she would need the increased iron. Indeed, this advice is echoed by Dr. Trofatter, who says 15 grams or more per day of fiber is recommended. He adds that exercise is also good, unless on bed rest, as it helps improve bowel motility.
Dr. Bewtra suggests practicing Kegel exercises to strengthen the pelvic floor. “Regular bowel movements are important,” she says. “Women should not hold in their stool when they have the urge to go. Routine is helpful. Women should try to defecate at the same time every day after a meal.”
Bulk laxatives can help treat constipation, but avoid irritant laxatives, mineral oils, and irritating enemas since these might cause the uterus to contract prematurely, Dr. Trofatter says.
Gogh tried the nurse’s suggestions for a few days, but was unsuccessful. At this point, she called the OB-GYN’s office again. This time, one of the doctors said it was now an issue for her primary-care physician (PCP). Gogh’s PCP was unfamiliar with treating a pregnant woman for constipation. One of the things he suggested—magnesium citrate—was nixed by the OB-GYN’s office.
As an alternative, Gogh took milk of magnesia twice a day and two fiber pills twice a day. It was supposed to work within a few days, but when it hadn’t, Gogh called her PCP again. He told her to contact her OB-GYN, who said if she didn’t have a bowel movement by the next day, he would recommend an enema. “Fortunately, I must have been scared into having one, because I did by the next day!” Gogh says.
7 Symptoms to Watch For
Constipation can be the result of an underlying medical condition that is more serious. If patients are not only constipated, but have the following symptoms, discuss your situation with a physician rather than attempt to just treat the constipation. These may be indicators of more serious medical conditions, says Dr. Ken Trofatter:
- Persistent abdominal pain
- Severe abdominal distension
- Constipation that alternates with diarrhea
- Bloody stools
- Dark and tarry stools
- Unexplained weight loss
- Long, thin, pencil-like stools
Gogh was later prescribed a prenatal vitamin that had a stool softener in it. It is through prescription only and not covered by her insurance. She also continued to take her fiber pills and was back to being regular.Indeed, Dr. Trofatter says there’s cause for concern when the stool is so hard and distends the bowel, causing pain and bleeding. “This can be a serious problem if a woman has large hemorrhoids,” Dr. Trofatter says. “Also, when the bowel gets over-distended or impacted in its lowest portion, it can release chemicals that try to force the bowel to contract.” This, in turn, can precipitate premature labor.
But ignore all those old wives’ tales about toxins building up and being dangerous for the mother and baby. “Constipation by itself is a relatively benign condition, even if it does make you miserable,” Dr. Trofatter says.
*Named changed to protect privacy.