I’m Pregnant, and I Can’t Poop

Sound familiar? Constipation and digestive issues are part of the not-so-fun symptoms of pregnancy. OBGYN Dr. Gleaton explains why this occurs, why you shouldn’t be embarrassed, and how you can manage it.

By Dr. Kenosha Gleaton

Morning sickness, nausea, swelling, the list goes on for uncomfortable pregnancy symptoms. But one that may also be at the top of the list is constipation. Constipation during pregnancy is extremely common. In fact, up to half of women will experience constipation at some point during pregnancy. Pregnancy constipation (and traditional constipation) are both defined as having fewer than three bowel movements per week and are associated with small, hard, dry, stool. These bowel movements are often painful and difficult to pass.

Various factors may contribute to constipation during pregnancy including:

1. Hormonal changes, including increased progesterone, which decreases bowel motility and causes food to hang around longer
2. Enlarged uterus,which affects the successful transit of stool
3. Inadequate fiber intake
4. Inadequate fluid intake 
5. Certain medications, including iron supplementation

Signs of pregnancy constipation

Constipation signs and symptoms can vary from mild to severe and can include abdominal bloating, cramping, hard firm stools that are difficult to pass, straining with bowel movements, and bleeding with bowel movements.

Lifestyle changes that may help manage pregnancy constipation

While constipation during pregnancy can’t always be avoided, there are some useful remedies. These include:

• Increased hydration
• Increased exercise and physical activity
• Vegetable and fiber-rich diet with at least 25 grams of fiber per day (we recommend considering supplementation with soluble fiber capsules for extra digestive support)

What supplements help manage constipation?

Even after increasing dietary fiber intake, exercise, and hydration, some patients will require additional treatments for constipation relief. We recommend adding fiber supplements as a first option, followed by stool softeners, and then laxatives as a last alternative. Bulk-forming laxatives absorb water and expand, which in turn increases moisture in the stool and makes it easier to pass. Although most laxatives have minimal absorption into the bloodstream and will not harm the fetus, bulk-forming laxatives are thought to be the safest and are recommended as the first line.

What are some of the common digestive issues associated with pregnancy?

Although we often think, “Bigger is Better,” this certainly does not apply to the growing abdomen of most pregnant women! While the belly does get bigger, for most, the gastrointestinal (GI) function is certainly not better! From morning sickness, nausea, and vomiting starting in early pregnancy to indigestion, heartburn, constipation, and hemorrhoids in subsequent stages, there are a ton of hiccups to address with our GI system during pregnancy.

Do digestive issues typically associated with pregnancy vary by trimester, or change throughout the course of pregnancy?

Although every woman and every pregnancy is different, there are common trends relating to GI disease occurrence and severity. While nausea and vomiting (also known as hyperemesis gravidarum) typically dominate the first trimester for every pregnant woman, heartburn (aka gastroesophageal reflux disease or GERD), indigestion, constipation, and hemorrhoids usually occur later in the second and third trimesters.

While nausea and vomiting typically dominate the first trimester of pregnancy, heartburn, indigestion, constipation, and hemorrhoids usually occur later in the second and third trimesters.

Simple changes to improve quality of (pregnancy) life

Pregnancy can lead to a wide manifestation of GI issues. And while most of these conditions are not life-threatening, they can cause significant distress and impair women's quality of life. Nausea and vomiting, especially in the first trimester, can sometimes be easily relieved with herbal tea for pregnancy. 

Constipation, one of the most frequent conditions and pregnancy symptoms, can be successfully managed by prompt recognition and lifestyle changes, including increased hydration, fiber, and exercise.

And despite the best intentions, estrogen-induced pregnancy cravings can sabotage a woman’s diet and worsen nausea, GERD, and constipation. To help you stay on track, check out the book, What to Eat When You’re Pregnant.