The Bowel Blues – Why am I constipated?

  • Bowels commonly play havoc during pregnancy with constipation affecting up to 40% of women. Although an embarrassing topic to raise with your doctor, it is an important topic to address.

Why do I suffer from constipation in pregnancy?

There are a number of different factors in pregnancy that interfere with normal digestive processes and bowel motility and place you at risk of constipation. This can occur even if you have had no previous history of bowel problems. These factors include:

  •  Hormones – Increased levels of progesterone are said to relax the smooth muscle found inside your intestinal walls, resulting in bowel hypomotility or very ‘sluggish’ bowel movements. These hormonal changes are the greatest during your 1st and 2nd trimesters.
  •  Mechanical factors – As your baby grows bigger to its maximal size towards the end of your pregnancy, your uterus also enlarges and can compress on the neighbouring bowel. This will either stop or slow down the onward movement of your faeces which prevents your bowels from opening regularly.
  •  Dietary factors – Diet plays an important role in helping form the bowel motions, as well as ensuring regularity in movements. Fibre is an essential nutrient required daily to help increase stool bulk and frequency, and reduce the overall transit time or time that it takes for faeces to travel through the bowels.
  •  Iron supplements – These supplements may cause constipation, especially if not accompanied by a good diet and plenty of fluids. Certain brands such as ferrous sulphate or very high daily dose of iron will place you at higher risk.
  •  Medical conditions – If you have pre-existing medical conditions that have bowel disorders, in particular Inflammatory Bowel Disease or Coeliac disease, then the constipation is likely to worsen.

How does constipation affect my body?

Being constipated can make you feel very uncomfortable, with common symptoms including bloating, wind, abdominal discomfort or pain, and nausea.

The formal definition of constipation is to be suffering from at least one of the following symptoms:

  • Difficulty in passing stools
  • Hard stools
  • Infrequent bowel motions of less than 3 per week

Constipation can also place you at risk of developing other problems such as haemorrhoids. These are lumps or engorged veins that form around the anal area, usually due to straining during motions. If you suffer from severe and chronic constipation this places you at risk of uterovaginal prolapse, urinary incontinence due to damage to pudendal nerve where you lose the ability to control urination, and weakened pelvic floor muscles.

How can I avoid constipation?

The best way to avoid constipation is through a well balanced diet that is high in fibre, plenty of fluid and light physical exercise to help promote regular bowel movements.

  • The recommended daily intake for fibre during pregnancy is 28g per day, and can be met easily with high fibre food groups as discussed below.
  • Your diet should consist of small meals eaten frequently throughout the day to help ensure that the bowel stays stimulated and digestive system keeps working.
  • You must drink at least 6-8 glasses of water per day, as the fibre in your diet will absorb the fluid and extra is needed to help ensure soft stool consistency.
  • Light physical exercise of at least 30 minutes each day will also help promote regular bowel movements.

The reason fibre is such an important part of your diet is because it increases stool bulk and frequency, reduces the time it takes for bowel motions to form and be expelled from the body, and increases your stool weight. Foods high in fibre include:

  • Any fruits and vegetables with their skin left on
  • Wholemeal and wholegrain bread
  • High fibre breakfast cereals, for example muesli, Allbran, Healthwise, porridge
  • Dried beans such as baked beans, kidney beans, split peas, yellow lentils
  • Dried fruit and nuts
  • Prunes or prune juice
  • Pear juice

Medical treatment is only recommended when dietary attempts fail or your symptoms are severe enough and impact with your quality of life. These medications are safe to use during pregnancy and breastfeeding and side effects only relate to bloating and flatulence or excess gas, however must be used with caution and only after discussion with your doctor.

  • Bulking agents – This refers to products such as Psyllium Husk and Metamucil and are essentialing fibre agents that are first line treatment for constipation. They work by containing a high load of fibre and help by causing retention of fluid in the bowel and increasing the faecal mass. They are cheap and are widely available at any local supermarket or chemist.
  • Osmotic agents – This includes the substances Lactulose and Sorbitol. These are osmotic agents, which means that they help move and retain fluid in the bowel, and by altered the water constipation of faeces, result in softer and more frequent stools.

Constipation can be avoided with a great fibre packed diet and following the above advice. If the problems persist then it is very important to see your doctor to ensure that no nutrient deficiencies develop or your bowel blockage turns into something more serious.

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