Pregnancy is full of all sorts of challenges — some less pleasant than others, like morning sickness. On top of all that, many women suffer from constipation — which research finds may affect more than a third of pregnancies.
Hormonal changes during pregnancy can affect smooth muscle in the gastrointestinal tract and slow movement, or impact so-called motility, in the bowels. “So acid reflux is a lot more common, because the stomach empties much slower,” explains Dr. Jacob Larkin, a maternal-fetal medicine specialist at UPMC Magee-Womens Hospital in Pittsburgh. Constipation is much more common during pregnancy, as well, he says.
To protect against anemia, or not having enough healthy red blood cells — a concern when the body makes considerably more blood cells during pregnancy — an iron supplement is routinely recommended during pregnancy. But, as a side effect, that too can sometimes contribute to difficulty emptying the bowels. “The frequency of anemia during pregnancy is much higher, and so you’re much more likely to need iron supplements during pregnancy; and as a consequence that can contribute to constipation also,” says Larkin, who is also an assistant professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh. Although, experts emphasize that’s certainly not the case for all women taking iron.
Besides physiological changes and supplement side effects, understandable behavioral changes during pregnancy can lead to avoiding certain foods and not getting enough fluids, which may also cause constipation. “Unfortunately many women feel nauseated and even have vomiting during pregnancy, which decreases the desire to follow a general diet that has fiber,” says Dr. Anna Windsor, an OB-GYN who practices at Aurora Health Care in Milwaukee. “Nausea also decreases the desire to even drink water for a lot of women. So that lack of water intake can be a factor as well.”
Besides being annoying, severe constipation can be painful and excessive straining can even lead to hemorrhoids. The good news, clinicians say, is that there are some simple steps you can take to prevent and relieve this common problem during pregnancy:
— Stay hydrated.
— Balance your plate — and, of course, don’t forget the fiber.
— Stay active.
— Adjust your iron supplementation.
— Watch the antacids.
— Try stool softeners.
A first line of defense and way to relieve constipation may also be the most straightforward: “Probably the simplest thing is to just drink a lot of water,” Larkin says. Although no one wants to be running to the bathroom, dehydration is more common during pregnancy when you need more fluids. “Women should be drinking more water during pregnancy anyway — that’s probably the best thing they could do,” echoes Dr. Leo Brancazio, chair of the department of obstetrics and gynecology at West Virginia University School of Medicine.
While how much an individual needs to eat and drink varies, pee color can be an indicator when it comes to hydration. Generally speaking, pale straw colored urine indicates you’re well-hydrated, while if your pee is transparent, you’re drinking a lot of water and may even want to cut back, according to Cleveland Clinic. Dark yellow pee is a sign you need to get more water soon, and amber or honey-colored urine indicates you’re not drinking enough.
And while pee color provides clues to your hydration status, a lack of water affects your poop, too. Drink enough and it’s easier to pass; while dehydration can lead to water being pulled from the large intestine, or colon, to other parts of the body, and make stool, drier, harder and more difficult to pass.
Balance your plate — and, of course, don’t forget the fiber.
That includes eating lots of fruits and vegetables and whole grains — from apples to broccoli to quinoa — that are not only nutritious but high in fiber. “Women should avoid refined sugars, because that tends to make the matters worse,” Brancazio says.
Although it’s generally best to get fiber from foods, fiber supplements are typically considered safe as well, though you should check in advance with your health provider to determine if a supplement may interact with any medications you’re taking. “Fiber supplements can decrease the absorption of certain medications, such as aspirin, (the anti-seizure medicine) carbamazepine (Carbatrol, Epitol, others) and others,” notes Dr. Michael F. Picco of Mayo Clinic. “Fiber supplements can also reduce blood sugar levels, which may require an adjustment in your medications or insulin if you have diabetes.”
Besides plating a variety of healthy foods, you might also consider balancing consumption across your day. “Sometimes we try to encourage women to maybe eat smaller meals throughout the day instead of one large meal … and sometimes that will help as well,” Windsor says.
While it’s wise to avoid contact sports and other activities that could lead to abdominal trauma, like volleyball, judo or rock climbing — and worth talking to your doctor if you’re not sure about certain activities — there are many safe options to keep moving during pregnancy. And doing so can also, ahem, keep things moving. “Walking, swimming, stationary bike — those are all wonderful activities throughout pregnancy, and can help with the constipation,” Windsor says.
Adjust your iron supplementation.
For some women, taking an iron supplement can contribute to constipation. If that’s you, consider talking with your doctor about taking a different formulation of the iron supplement; or maybe, instead of taking an iron supplement every day, taking it every other day, Windsor says. “The doctor can help determine which iron formulation may or may not be more tolerable for the patient,” she says, “and based on her laboratory results, help her determine how much iron is an appropriate amount of iron to be taking in a supplement.”
Watch the antacids.
“A lot of women have heartburn in pregnancy, so they’ll take antacids that have calcium in them — things like Rolaids or Tums — and antacids with calcium can make constipation worse,” Brancazio says. Struggling with constipation, and really need heartburn relief, too? Brancazio suggests taking an over-the-counter medicine like Maalox or similar products that instead contain magnesium.
Try stool softeners.
If other changes aren’t enough, sometimes OTC stool softeners may be helpful and another safe way to ease constipation. Just be sure to let your doctor know about anything you’re taking — whether prescription, over-the-counter medication or supplement. Also, make sure to have a conversation before trying other means to ease constipation, like laxatives.
“Rarely, we have to use a laxative that causes the bowel to contract,” Brancazio says. While considered safe, clinicians typically recommend against using a laxative unless other approaches have been exhausted — and suggest only doing so under a doctor’s supervision. “It can cause dehydration, and there is concern that it also may cause the uterus to be irritable and possibly contract,” Brancazio says. “So yes, we try to avoid those.”
In many ways, experts say, the remedies for constipation during pregnancy are similar to those for constipation that occurs at any time. It’s just that during pregnancy it’s more common — and more likely to come back. That’s why — apart from pregnancy-related changes you can’t do anything about — it’s all the more important to address core causes of constipation, from hydration to diet, while reserving stool softeners, laxatives and the like as backups when other measures don’t work, clinicians say. “Increasing fluid intake, increasing fiber and increasing activity are the mainstays,” Windsor says, “for helping to avoid and treat constipation during pregnancy.”
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