Constipation and bloating are very common during pregnancy and in the post-partum period. Up to 40% of pregnant women are affected. Hormonal changes, in particular increased progesterone levels, result in the slower transit time of food in the gut.
Certain medications such as oral iron, anti-nausea medication and strong pain relief can worsen constipation.
Staying mobile, keeping up your fluids and optimising your diet will often alleviate most cases of constipation. A high fibre intake (e.g. whole grains, rice, bran, beans, lentils, nuts, dried fruit, fresh fruit and vegetables) is essential. These foods should be introduced gradually if they’re not normally a part of your diet as bloating and flatulence may occur.
There are a number of laxatives that are safe to use in pregnancy while others are best avoided if possible. Common laxative types are listed below starting with the safest options at the top:
1. Bulk forming laxatives. First line option and safe. These are effective but take a few days to work. Examples include:
- Psyllium (Metamusil® capsules or powder)
- Ispaghula (Fybogel® oral granules).
2. Osmotic laxatives. Second line. These should be used with caution in pregnancy but the following are considered safe.
| Active Ingredient | Onset of Action | Safety |
|---|---|---|
| Lactulose (Actilax®) | 24-72 hours | Preferred agent |
| Microlax® enema (saline laxative) | 2-30 mins | Safe in pregnancy |
| Movicol® (macrogol laxative) | 1-4 days | Limited data, occasional doses appear to be safe. |
| Glycerol suppositories | 5-30 mins | Safe in pregnancy |
| Sorbitol (Sorbilax ®) | 24-72 hours | Safe in pregnancy |
3. Stool softeners. Third line and used in combination with other therapy.
| Active Ingredient | Onset of Action | Safety |
|---|---|---|
| Docusate (Coloxy®l) | 1-3 days | Safe in pregnancy (not with Senna). |
| Liquid Parrafin (Agarol®) | 2-3 days | Occasional doses safe to use |
| Poloxamer (Coloxyl Drops®) | 2-3 days | Consider an alternative in pregnancy |
4. Stimulatant laxatives. These should be avoided except for occasional doses. They are not teratogenic but have other adverse effects. They are safe while breastfeeding. Examples include:
- Bisacodyl (Bisalax)
- Senna (Senekot, sennetabs)
- Sodium Picosulfate (Ducolax)
