If you're someone who has always been a 'regular' kind of gal, then the digestive changes of pregnancy may come as a surprise to you!
But you're not alone, as nearly half of all pregnant women experience constipation at some point in their pregnancy.
For some, it's more obvious in the 1st and 2nd trimesters, whilst for others the 3rd trimester seems to really bring things to a grinding halt!
If you're someone who was naturally prone to sluggish bowels/constipation before pregnancy, then unfortunately you're likely to experience a worsening of your symptoms.
As you can imagine (or perhaps you're currently experiencing) having sluggish bowels can make you feeling pretty crappy in the process (sorry, couldn’t resist that one).
It can also lead to haemorrhoids, anal fissures and other unpleasant lingering complications.
So why does it happen, and what can you do about it?
HORMONES
As with all things in pregnancy, it's the hormones at play. In particular, progesterone.
Firstly, progesterone inhibits the secretion of a gut hormone called motilin. Motilin is produced by the cells in the small intestine. Its name comes from its ability to stimulate the movement (motility) of the digestive organs, primarily through intestinal muscle contractions. These literally push and squeeze things along the digestive tract!
So without motilin doing its thing (due to the higher levels of progesterone on board) there's a mini vacay of the smooth muscles of our digestive tract. The result is an overall slowing in transit time and therefore less bowel action. But on the flip side, this slower transit time is thought to help increase nutrient absorption from our food.
Then there's the effects of the hormone relaxin. Most pregnant women have heard of this one. As the name implies, this hormone relaxes the body's muscles, joints and ligaments. This is particularly helpful in labour and birth, as our pelvic joints can get nice and mobile to allow baby down and out!
But whilst pregnant, relaxin effects the smooth muscle of the digestive tract: another vote for slowing things down!
The normal function of the large intestine is to absorb water from the digestive contents, which in turn creates stools (poo). But the longer the contents sit in the large intestine, the more water is reabsorbed from them. This creates dry, hard, small stools (AKA rabbit poos).
Plus, if you're dehydrated the body will take water from anywhere to help maintain fluid homeostasis.
Then there's aldosterone. This hormone is also stimulated during pregnancy due to the high levels of circulating oestrogen and progesterone.
Aldosterone stimulates sodium and water reabsorption from the colon (known as colonic water). Again, contributing to the dry, hard stools.
All of this 👆🏻 will be made much worse if your diet is low in fibre and you're prone to being dehydrated!
ANATOMY
As you can see below, the growing uterus shifts and puts extra internal pressure on our digestive organs!
So it's no surprise this contributes to the slow transit time. Remember the slower the pace, the more water is reabsorbed in the colon, the harder the stools.
CARB CRAVINGS
For many women dealing with an all-day-quease and/or morning sickness, food choices can change dramatically.
Sometimes refined carbs, salty carbs, fatty carbs (or all three) are the only foods desired or tolerated.
Bread, hot chips, muffins, crumpets, pastries etc are not your typical bowel movers. So when these are regularly consumed within the pregnancy diet, this can contribute to things binding up and slowing down.
(SOME) IRON SUPPLEMENTS
Many women enter pregnancy with low iron stores. This often results in the need for iron supplements at some point to help meet the needs of themselves and baby.
There are some cheap and nasty supplements on the market (Ferro-Grad I'm looking at you). The iron in this supplement is in the form of dried ferrous sulphate, also known as iron sulphate.
Each tablet has a dose of 325mg, which is massive and you'll soon see why. The issue with iron sulphate supplements is two-fold.
Ugh, all that grief for very little return. There are kinder and better absorbed iron supplements available. I've listed what to look for when choosing an iron supplement (if it's required) below.
WHAT HELPS?
1. WATER
This should be pretty obvious after reading how the hormones affect the water content in our bowels. Plus, our fluid needs increase during pregnancy as we literally make a human from scratch!
Extra fluids are needed for the baby's circulation, the amniotic fluid, plus a mother's overall blood volume increases by 40-50% in pregnancy! So aim for 2-3 litres throughout the day.
Try a warm glass of water, or a ginger tea, with a squeeze of lemon juice added first thing in the morning. Mix up your fluid intake by using warm or chilled herbal teas, soups, soda water or even bone broth.
Tea and coffee (caffeine in general) don't really count as they have a diuretic affect in the body - meaning they make us excrete water via our urine.
If you're vomiting from morning sickness you'll need these fluids replaced also! And consider replacing your electrolytes too (Labourade can help here).
2. FIBRE
Fibre is a close second to water, and it's also its bestie. It's the part of plant-based food that mostly passes through the gut without breaking down.
There are 2 types of fibre: soluble and insoluble.
Most plants contain both in different amounts so I suggest getting a good mix of the two daily.
Here's how fibres work:
SOLUBLE FIBRE dissolves and swells with water to create a gel like substance. It acts as a food (prebiotic) for our gut bacteria, helping them reproduce to keeps our gut healthy. It also helps bowel regularity. Examples include oats/oatmeal, chia seeds, psyllium husks, flax/linseed meal, inulin powder, apples, beans, carrots, sweet potatoes, figs, prunes, citrus fruits.
INSOLUBLE FIBRE does not dissolve in water. Instead it attracts water into your bowels making your stool softer and easier to pass. Examples include wholegrains (breads/pastas), lentils, strawberries, avocado, kale, cauliflower, nuts, potatoes, popcorn.
⚠️ WARNING: Taking on more fibre without drinking adequate water for it to work it's magic, may work against you and make constipation worse!
3. PROBIOTICS
These have been shown to assist both the digestive system and the immune system during pregnancy.
A multispecies combo of Bifidobacterium and Lactobacillus probiotic mixture was found to alleviate constipation and increase the number of bowel movements per week. So look for pregnancy specific, quality probiotic supplement. This one is at most good pharmacies.
You can also include some food based probiotics (ie. fermented foods) such as kombucha, kefir, miso, tempeh, kimchi or natural pot set yoghurt in your diet. These foods also contain the two beneficial bacteria above.
4. MAGNESIUM
One of my top 3 favourite minerals, magnesium can also help with constipation. There are various forms of supplemental magnesium; citrate, oxide, amino acid chelate, glycinate, phosphate, taurate, orotate... the list goes on.
For the job of helping constipation, look for a supplement of magnesium citrate or magnesium oxide. These types of magnesiums have an osmotic laxative effect. This means it helps relax your bowels and pulls water into the intestines. The water helps soften and bulk up your stool, which makes it easier to pass.
So if you're struggling with hard stools, try 150mg of either magnesium citrate or magnesium oxide before bed. Magnesium citrate is often better tolerated than magnesium oxide, which can cause cramps and explosive poos.
Some may feel the effects in the morning, whilst others it may take 1-2 days. Wait it out for any effect and if nothing you can try an increased dose up to 300-400mg.
5. DIGESTIVE BITTERS
Most naturopaths fly the digestive bitters flag, whether pregnant or not. Any substance that naturally stimulates the secretion of our digestive juices, helps keep things moving along.
A simple home remedy is 1 teaspoon-1 tablespoon of apple cider vinegar (AVC) in a small glass of water.
It has a distinct smell and taste and is probably not a good idea for those under the dreaded spell of morning sickness. Although some say it may help ease nausea - I'll let you be the judge here.
Herbal teas, such as Dandelion Root and Fennel are both gentle and safe and can support your digestion, whilst helping your fluid intake.
6. MOVEMENT
Staying active can definitely have a knock on effect on your bowels. It doesn’t have to be super strenuous, just consistent. Walking daily, prenatal yoga and/or swimming help keep things ticking along. Even if its a walk around the block to the park for 30 minutes with the dog or toddler in pram, it all adds up.
Aim for 30-60 minutes of activity every day. This doesn't have to be in one hit of an hour. Consider breaking it up into 2 or 3 sessions if need be.
Certain prenatal yoga postures that involve gentle twisting and squatting often aid our digestion. Ask your yoga teacher for some tips here!
Think of yourself as a 'first responder.' At the first urges of anything, visit the toilet. Avoid putting it off or delaying the call of nature as you need to seize every opportunity ASAP!
7. FOOT STOOL
Our western toilets don't position us optimally for emptying our bowels. As a result we often need to strain.
But, by having your feet resting on a small stool whilst on the loo, the alignment of the colon and pelvic floor muscles shifts to a more favourable position. The result is often easier bowel movements and less straining.
(The foot stool is a far more graceful twist on the squat toilets I endured for months travelling through India!)
8. FOODS
There is a variety of foods you can add into your day. Try a few, or try them all (not at the same time though!) to see what works for you.
- Prunes: as a whole fruit snack or cut up into porridge/smoothies/muesli. Aim for 4-5 prunes daily. Or try the unsweetened, natural bottled juice. Try 1/2-1 cup day before a meal. Dilute with water if you find the taste is too strong.
- Dried fruits: try dates, figs, apricots. Often helpful, but also super high in sugar, so don't go too crazy every day on these.
- Vegies: chock full of natural fibres, vitamins, minerals and way less sugar than fruits. Include with each meal and incorporate into snacks. Limit fresh fruit/vegie juices to 1 x day as the whole food provides rounded benefits. Many consider cooked vegies (rather than raw) easier to digest.
- Chia seeds: make a chia pudding (tonnes of recipes online), or add 1 tablespoon into porridges, smoothies, muesli blends, or sprinkle through salads or add into soups.
- Healthy unrefined carbs: brown rice, oats, quinoa, buckwheat, spelt
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Psyllium husks: the classic, bulk-forming fibre made from the seed husks of the plant, Plantago ovata. It's a form of water soluble plant fibre with prebiotic affects. With the aid of water it forms a viscous gel which helps bulk up the stool, making them more mobile through the gut and easier to pass.
Start with 1 teaspoon in water and/or prune juice in the morning - drink immediately. It will start to solidify within 1 minute so don't hang about. It's texture may be a challenge for some, so if you're really struggling consider Metamucil (a commercial product) or simply use as gentle fibres below.
- Gentle fibres: These include ground flaxseeds or flaxseed oil, LSA powder (ie. ground linseeds, sunflower seeds, almonds), oat bran; add these into muesli, porridge, smoothies, baked goods such as date slice, banana bread, seeded muffins etc.
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Coconut oil: Along with its abundance of medium-chain fatty acids (MCFAs) it also has lubricating and stool softening effects within the gut.
Some add 1 teaspoon - 1 tablespoon into smoothies. Or take it straight off the spoon. Look for certified organic, virgin varieties. Some suggest cod liver oil has similar effects.
Including healthy fats in the diet stimulates the gall bladder to release bile into the digestive tract. This helps us digest the fats and also stimulates our overall digestive processes.
*Although a renown old-school laxative, do not use castor oil during pregnancy due to to its potential to bring on contractions!
9. CHECK YOUR SUPPLEMENTS
Iron: As mentioned, avoid taking an iron supplement where the iron is in a 'ferrous' or 'ferric salt' form. Instead look for iron in the form of iron biglycinate. This may also be written as Iron (II) glycinate.
Another great source of iron is liver. If you can't face bringing it into your diet consider a supplement. Look for desiccated organic, grass-fed and grass-finished beef liver capsules.
Calcium: Supplements that have calcium alone, and not alongside magnesium may contribute to constipation. Look for one with both minerals together. A good ratio is 2:1, so 2 parts calcium to 1 part magnesium.
10. TISSUE SALTS, CELLOIDS & HOMEOPATHICS
Tissue salts (also known as cell salts) are homeopathically prepared, easily absorbed micro minerals that help correct cellular imbalances in the body. A popular and accessible brand is Schuessler Tissue Salts. I like them because they are easy to take, safe in pregnancy, cost effective and rapidly absorbed.
There are single and combination remedies, in both chewable tablets and/or sprays.
Single remedies to consider for constipation: MAG PHOS, NAT MUR, NAT SULPH, NAT PHOS.
Combination remedies to consider for constipation: COMB C, COMB E, COMB S, NAT PHOS or COMB C can also help with heartburn.
Celloids are another form of using minerals, except that the dosage is different and the minerals are differently prepared. This method was devised Dr Maurice Blackmore, an Australian Naturopathic Physician. Although the dosage of the minerals is higher than that of the tissue salts, they are still pharmacologically small doses.
They also come as single remedies and as combination. They are considered a 'professional range' so need to be prescribed or advised via a naturopath. Often health food store or pharmacies have naturopaths in store to help here.
Homeopathics: there are various remedies to help constipation in pregnancy. Try to match your symptoms for the right remedy or seek advise from a homeopath. I've found good results with clients using Bryonia, Lycopodium, Nat Mur and Nux Vom.
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So there you have it. Hopefully 1 or 2, or perhaps all 10 will provide you some relief and ongoing momentum.
Yet if all of these fail and you're feeling pretty miserable, please seek advise from your care provider. There are stool softener medications (laxatives) and even pregnancy enemas if you're feeling desperate.
Keep the above tips in mind also for your postpartum. As sometimes it can take a while for optimal digestive and bowel function to return.
Kristin x