It is natural to experience digestive complaints during pregnancy, including Constipation. Pregnancy brings with it a lot of physical changes, many of which are normal ways that the body adjusts during the gestational period. Let’s take a look at managing Constipation the Naturopathic way during pregnancy to prevent unnecessary discomfort.
Constipation occurs in 11% to 38% of pregnant women(1) and is second only to nausea as the most common gastrointestinal complaint in pregnancy. (2) Generally described as infrequent bowel movements or difficult evacuation,(2) a number of women who suffer from constipation prior to conception will find their symptoms worsen during pregnancy. (3) The growing uterus and hormonal changes(2,4) during pregnancy often lead to Constipation appearing in the 2nd and 3rd trimester. (5) The dramatic hormonal shifts in oestrogen and progesterone impact gut function, gut contractility and transit time. (6) Changes to the maternal gut microbiome occur from these hormonal shifts by resulting in unique inflammatory and immune changes that alter the gut function and bacterial composition. (6) Much of this inflammatory and immune response is observed as a typical response to pregnancy, with the gut being vulnerable to these adaptive changes. Avoiding worsening of Constipation in pregnancy is important for a number of reasons but especially since disturbed defecation can result in the development of uterovaginal prolapse. (7)
While Constipation can occur for a number of reasons, observations of what can cause and contribute to it becoming more problematic include:(1,2)
- Low fluid intake, particularly in the third trimester
- Previous pregnancy or previous caesarean section
- Some medications and generic vitamin supplements such as iron, magnesium sulphate and calcium
- Hypothyroidism may also be a rare cause.
While many patients find relief from Constipation with recommended first-line therapy, including an increase in dietary fibre and fluids, as well as daily exercise, these are sometimes ineffective. (2) Constipation may be managed with home remedies or non-prescription preparations and nonpharmaceutical methods(1,7) including probiotics(8), gentle osmotic laxatives(2) and diet changes. (6)
In a small study, pregnant patients received a daily dose of a multi-strain probiotic for four weeks which was found to be effective in the treatment of constipation during pregnancy. (8) Here at the Clinic, we use particular strains with the research behind them to ensure effectiveness, safety and best quality. There are often added benefits such as strains used to reduce allergies in the first years of life, especially when there is family history.
Gentle laxative options
it is recommended that osmotic and stimulant laxatives be used only in the short term or occasionally to avoid dehydration or electrolyte imbalances in pregnant women. (2) Lactulose, an osmotic type of laxative, is considered by healthcare providers to be the first-line therapy in treating chronic Constipation during pregnancy. (9) The added benefit to this choice is the prebiotic qualities which also promote gut health. A great dietary source to help lubricate the bowels is flax oil. A human study showed that flax oil as a laxative is safe from the 2nd trimester onwards. (5) Lastly, senna, a stimulant laxative(5) can be used safely in pregnancy for the short term when other options are not effective.
There are a number of changes we can recommend to the individual, and pregnancy is a great time to get nutritional advice. Typically for good gut health and regular bowels, a healthy pregnancy diet includes:(2,6)
- Whole foods comprising of organic protein, unsaturated fatty acids, whole grains, high fibre and low in processed sugars
- Pre- and probiotic foods including fermented foods rich in probiotics and enzymes (such as yogurt, kefir, and miso)
- increasing dietary fibre with bulk-forming agents such as psyllium and bran aiding the passage of stool which require good water intake to be effective
Further diet and lifestyle tips
- Hydration! In pregnancy, there is increased water absorption from the intestines, which causes the stool to dry out. (2) Drinking at least 2-3 litres of good quality filtered water daily is vital
- Gentle exercise, since decreased maternal activity can further contribute to Constipation(2)
- Identification of food sensitivities (gluten, dairy, and nuts are common) and elimination of those foods from the diet reduces systemic inflammation and improves gut health. (6)This may be helpful if issues are not easily resolving.
- Squatting to pass bowel motions. Getting into a squat position by using a footstool to elevate the legs helps to improve the alignment of the recto-anal angle, permitting smooth bowel elimination. This prevents excessive straining. (10) In fact, from an anatomical perspective, the only natural defecation posture for a human being is squatting(10) and what better time to get in tune with your body language than in preparation for giving birth
- Relax and make it a priority to walk away from anything else when the urge comes on, or if there is a sense of feeling sluggish, make a point of giving yourself the time and space to pass your bowels. Remember, stress will contribute too, so slowing and deepening the breath will also help.
The changes like Constipation that may occur during pregnancy can sometimes be ignored when life gets busy, and while it may be a little awkward to discuss bowel motions when it comes to pregnancy, it always pays to seek advice. Women with simple Constipation can usually improve symptoms with diet and physical activity, while herbal medicines and medications are best avoided, but if necessary, should be taken under supervision using best available evidence. (3) A health check-up with one of our Naturopaths or Nutritionists will provide much more in-depth advice, including the right supplements and making sure nutrient absorption is optimal alongside discussing a range of questions you may have as an expectant mother – always ensuring the best health outcomes for mother and child.