INFORMATION:
Constipation affects up to 38% of pregnancies. Women may develop this for first time in pregnancy or have worsening symptoms if they have previously suffered from constipation.
Patients should be reassured that these symptoms are transient and normal during pregnancy. Most will see improvement by increasing dietary fibre should as bran and fluid intake. Moderate exercise may also be helpful.
STEP 1 – Increase dietary fibre, fluid intake and moderate exercise.
STEP 2 – If no improvement offer laxatives. Adding or switching the below combination is appropriate in pregnancy.
LAXATIVES:
OSMOTIC LAXATIVE:
Eg. LACTULOSE 10-15mls 1-2 times per day.
Common side effects are flatulence and abdominal bloating.
BULK-FORMING LAXATIVE:
Eg. ISPAGHULA, 1 sachet 1-2 times per day.
Women should be advised these can take a few days before benefit is seen.
SUPPOSITORIES:
Eg. GLYCERINE SUPPOSITORIES, 1 as required 1-2 times per day.
STEP 3:
When regular bowel movements return without difficulty, laxative may be withdrawn gradually. If a combination is used, one laxative should be stopped at a time. Patients should be aware weaning off laxatives may take several months. Relapses often occur and require prompt increase/reintroduction of laxative.
Verghese TS et al. Constipation in pregnancy. The Obstetrician & Gynaecologist 2015; 17:111-5.
