Constipation in Pregnancy

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Constipation is a very common complaint in many women. Almost half of all pregnant women suffer from constipation at some time or other during their pregnancy.

 Constipation in pregnancy

Constipation usually starts in the first trimester of pregnancy, is relieved to some extent in the second trimester and occurs again in the third trimester.

For many women however, it tends to increase gradually until it peaks close to the time of childbirth.

Causes of Constipation

  • Hormonal cause: As soon as pregnancy occurs, the levels of the hormones progesterone and oestrogen rises sharply in the body.

    Progesterone helps to maintain the pregnancy by relaxing the muscles of the uterus so that they can enlarge and grow. But progesterone also causes relaxation of all the smooth muscles of the body, including the muscles of the large and small intestines.

    As the muscles become sluggish, movement of food along the intestines slows down. This allows the water in the food to be absorbed almost totally from the intestines, so that the end products that reach the rectum are less bulky, hard and difficult to expel.

    Since the stool that collects in the rectum is less bulky, it does not fully fill up the rectum.

    The incompletely filled rectum fails to send signals to the brain at the right time. And the brain fails to send signals to the muscles around the rectum to contract and expel the stool. As a result, you may develop constipation and find that you get a bowel movement only after 2 - 3 days.

    Since the stools also contain less water and are hard, you will need to push harder for the stools to come out. This may lead to painful fissures in the anal canal.

     Constipation in pregnancy

  • Pressure by the uterus: As the uterus grows bigger and bigger during pregnancy, it presses on the rectum situated right behind it. This prevents the rectum from filling up properly and causes constipation.

  • Lack of fluids: In early pregnancy, nausea and vomiting of morning sickness can contribute to less intake of fluids. Vomiting also causes loss of fluids. This causes dehydration, hard stools and constipation.

  • Lack of exercise: Most women tend to be less active during their pregnancies. They take less exercise, more rest, eat more ('enough for two') and lead a sedentary life.

    Of course, for many pregnant women exhaustion and fatigue in pregnancy is a very real cause for inactivity. But this lack of exercise contributes to less movement of the intestines and consequently to constipation.

  • Metals like Iron and Zinc usually given as supplements in pregnancy can also contribute to constipation. Most women take a better diet in pregnancy - the nutrients in the diet needs plenty of fluid to be properly absorbed. If there is a lack of fluids, it can result in constipation.

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    How to Prevent Constipation in Pregnancy

    The main factors for controlling constipation are the three F's - Fluid, Fibre and Fitness.

     Prevent Constipation in pregnancy

  • Fibre: Increase the amount of fibre in the food you eat daily. Fibre swells up in contact with the fluids in the intestine increasing the bulk of the stool and preventing constipation. It also helps in retaining moisture within the intestine and making your stools soft.

    Start the day with a bowl of high-fibre cereal or oats. Increase your intake of fresh fruits and raw vegetables. Give priority to whole fruits and fruit smoothies rather than juices and extracts. Eat plenty of vegetables as salads with every meal. You should eat between 28 and 34 grams of fiber each day.

  • Fluids : Increase your water intake to at least 8-10 glasses every day. Fresh fruits also contain plenty of fluids. Yogurts help in digestion and smooth passage of food through the intestines. Drink 10 to 12 cups of fluids each day.

    If you are unable to drink plain water, try adding clear soups, teas, and naturally sweetened fruit or vegetable juices to their diet.

  • Fitness: Exercise regularly. It stimulates the intestines and prevents sluggish movements to a great extent. Thirty minutes of a mild exercise like walking thrice a week will help you prevent constipation.

  • Probiotics: Probiotics can help improve the intestinal flora with healthy bacteria which help in digestion of food. Proper digestion can prevent constipation to some extent. Foods high in probiotics include yogurt, sauerkraut, and kimchi.

  • Medical advice: Ask your doctor for help if your constipation does not decrease or it is making you feel uncomfortable. Ideally, drugs that increase the movements of the intestines are not given during pregnancy as they can also cause the muscles of the uterus to contract. It is generally safe to use gentle laxatives, but it is best to avoid stimulant laxatives because they can induce uterine contractions.

  • Psyllium husk:Your doctor may prescribe Psyllium husk (Isabgol) which is the best natural laxative available and can be safely used in pregnancy. It is a herbal fibre ( the husk of the psyllium seed) that swells up in contact with water.

    Psyllium husk is inert in the human body, that is, it is not absorbed by the body and does not change its form in any way. It passes out as it is through the intestines and is excreted in the stool. What it does do is swell up in the intestines, increasing the bulk of the stool. Being mucoid (mucous-like) in nature it also coats the stool, making it easy to pass out.

    When to see the doctor: Consult your doctor if you have:

  • Constipation that lasts for longer than 1 - 2 weeks
  • Bleeding from the rectum
  • Pain while passing stool.
  • No relief after using a laxative

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