What to Know

• Constipation during pregnancy and postpartum
• Lifestyle modifications to help manage constipation

Although constipation is defined as having fewer than three bowel movements in a week, feeling ‘backed up’ can happen any time your normal routine is disrupted. Sometimes stools can feel hard, dry, small, painful or difficult to pass You may even feel the discomfort of having an incomplete bowel movement.

Unfortunately, your likelihood of experiencing constipation is increased during pregnancy and post-partum. In fact, an estimated 11-38% of pregnant women experience constipation. Raging hormones, decreased physical activity, and increased vitamin supplementation (the main culprits are calcium and iron) can all contribute to constipation while you are growing your sweet babe. Not to mention that in pregnancy, your growing uterus can slow down bowel transit time and increased water absorption in the intestines which can cause stool to dry out.

Remember that everyone is different and there is no normal. Some people regularly move their bowels three times a day while other people only three times a week. Any deviation from your norm can be unpleasant and cause discomfort.

So how can you find relief? A number of daily lifestyle choices affect bowel regularity. By minimizing the possible culprits and increasing healthy behaviors, you can prevent and manage constipation.

Possible culprits of constipation include:

• Certain medications like painkillers, sedatives or medication to lower blood pressure
• Certain supplements like iron or calcium, common in prenatal and postnatal vitamins
• Ignoring or delaying the urge to have a bowel movement
• Getting little to no physical activity
• Drinking inadequate fluids – dehydration, a result of inadequate fluid intake, can lead to stool that is hard, dry and difficult to pass
• Eating a diet low in fiber – soluble fiber (found in oats, peas, beans, apples, citrus fruits, carrots, barley and psyllium) adds bulk to your stool while insoluble fiber (found in whole wheat, wheat bran, nuts, beans, and vegetables like cauliflower, green beans and potatoes) promotes the movement of stool through your digestive tract. Together, both types of fiber help keep you regular. For more information on which foods are high in which kinds of fiber, check out Getting enough fiber? Myself? My baby? My child?

Healthy behaviors to increase include:

• Increasing your fiber and fluid intake along with physical activity. These are your first lines of defense!
• Eating more probiotics – probiotics also known as “friendly bacteria” or “good bacteria”, are live microorganisms that are similar to the beneficial microorganisms found in the human gut. Probiotics are available to consumers as dietary supplements and are also found in foods like yogurt, sauerkraut, miso, kimchi. Some probiotic formulations show promise in research to improve gastrointestinal issues like constipation and diarrhea.
• Try abdominal massage –this can help stimulate muscle contractions that move food through the digestive tract. Avoid hard pressure or deep massage on your belly while pregnant and recovering from childbirth. However this option may work for women trying to conceive or who are healed postpartum (with her healthcare provider’s approval). In fact, the “I love you” massage used to alleviate gas and constipation in babies works great for adults too.
• Try a fiber supplement, stool softener or lubricant-laxative – always consult with your healthcare provider before taking anything new. Some laxatives are considered safe to use in pregnancy (fiber supplements like psyllium, lubricants like mineral oil, and stool softeners like ducosate sodium) while others are not recommended (osmotic or stimulant laxatives and lubiprostone or linaclotide medications). Just because a laxative claims to be ‘natural’ does not mean it is necessarily safe. Laxatives are commonly associated with side effects including gas, bloating and cramping.

While you may think that constipation is just an unpleasant short-term problem, it’s important to address the situation as uncomfortable complications from constipation and strained bowel movements, like hemorrhoids and anal fissure (tears in the anus from passing hard stool), can result. Though more serious long-term complications of constipation like fecal impaction (when stool gets stuck in your intestines) and rectal prolapse (when the intestine protrudes from the anus) are rare.

What to Do

Incorporate fiber-rich foods at every meal

Eat an overall diet rich in soluble and insoluble fiber like fruits, vegetables, whole grains, nuts, seeds and beans

For breakfast, try a bowl of whole grain, high fiber cereal (with at least 5g of fiber and less than 4g of sugar) with fresh blueberries and ground flax seeds. For lunch, chow down on carrots and hummus, a whole grain sandwich and leafy green salad or lentil soup. At dinner time, include a generous portion of vegetables, whole grains or beans.

Talk with the Happy Family coaches for ways to get the recommended 14 grams of fiber per every 1,000 calories you eat.

In total, most women need about 25-30 grams of fiber daily. As your calorie needs increase while pregnant and breastfeeding, so will your fiber needs. By your third trimester, you may need as much as 35 grams per day.

Slowly add fiber to your diet to work up to this goal, as a sudden increase in the amount of fiber you eat can cause bloating and gas.

Limit low-fiber or “binding” foods

If you are eating a lot of processed and refined grains which have very little fiber, such as white rice, plain white pasta, crackers, white bread, refined hot cereals (like Cream of Wheat) certain cold cereals (with less than 5g of fiber per serving), and pancakes and waffles made from white flour then it is likely you are not getting enough fiber and eating enough of the good stuff. (think whole grains) You may want to take a look at our “What is a Whole Grain” article.

Know your own food triggers

Remember that everyone is different. Pay attention to your own food triggers or reactions and limit those foods.

Get plenty of physical activity

The American College of Obstetricians and Gynecologists recommends, per approval from your healthcare provider, that pregnant and postpartum women get at least 30 minutes or more of moderate exercise most days of the week. Remember that even a short walk counts!

Drink water!

Drink at least 8-13 cups of fluids daily, choosing mostly water.

Start your morning with warm, homemade ginger tea. Simply boil ginger in water and enjoy! (This is also a great thing to try if you are suffering from morning sickness!). Caffeine in coffee and tea are also stimulating (especially when served hot), but make sure you’re not overdoing it with caffeine if you’re pregnant or breastfeeding.

Reap the benefits of probiotics from fermented foods that are safe to consume during pregnancy and breastfeeding

Try yogurt, sauerkraut, miso and kimchi

Because the safety of kombucha during pregnancy and breastfeeding is unclear (it contains both caffeine and alcohol) it’s best to avoid this beverage until you are no longer pregnant or breastfeeding.

If it feels good, enjoy some light abdominal massage, but avoid hard pressure on your belly while pregnant and recovering from childbirth.

Check out Baby massage: benefits and techniques for an example video.

Don’t ignore the urge to go!

Take your time in the bathroom. Allow yourself enough time to have a bowel movement without feeling rushed. While this practice may seem difficult with a newborn, remember that it’s OK to have your baby in the bathroom with you – you won’t be the first or the last mom to do this! Bring a baby pillow or bouncer into the bathroom to keep your baby comfortable and occupied while you take your time doing your business.

Speak with your healthcare provider if you need relief

If you suspect that your pre or postnatal vitamin or medication is causing constipation, your healthcare provider may be able to recommend an alternative with less calcium or iron.

If you have tried increasing fiber, fluids and physical activity without relief, you may be a candidate for laxatives or medication.

If you are experiencing constipation with accompanying symptoms like dry, hard or difficult to pass stool or abdominal pain for more than three months, you may be suffering from chronic constipation.