Constipation

What It Is & Why It Happens

Constipation is defined as having fewer than three bowel movements per week, difficulty passing stool, or passing hard, dry stools. It is an extremely common pregnancy complaint, affecting up to 40% of expectant individuals.

The primary cause is progesterone, the hormone responsible for maintaining a healthy pregnancy. Progesterone relaxes smooth muscle tissue throughout the body, including the digestive tract. This relaxation slows down the contractions (peristalsis) of the intestines, causing food to pass through the digestive system much slower. As a result, the colon absorbs more water from the stool, making it dry, hard, and difficult to pass.

In later pregnancy, physical pressure from the heavy uterus on the rectum further slows bowel movements. Additionally, iron supplements commonly found in prenatal vitamins exacerbate constipation.

Typical Timeline

Constipation can occur throughout the entire pregnancy:

• First Trimester (Weeks 4-12): Triggered early on by surging progesterone levels and initial dietary changes.
• Second Trimester (Weeks 13-27): May stabilize, but often persists if supplemental iron is introduced to treat anemia.
• Third Trimester (Weeks 28-40): Peak intensity due to physical compression of the bowel by the expanding uterus and reduced mobility.

Safe Comfort Measures

Try these clinical, evidence-based lifestyle changes to relieve constipation:

• Increase Dietary Fiber: Eat 25 to 30 grams of fiber daily. Good sources include fresh fruits (especially prunes, pears, and apples), vegetables, whole grains, and legumes.
• Hydrate Adequately: Drink at least 10 to 12 cups (80-96 oz) of water daily. Fiber requires water to pass smoothly through the digestive tract.
• Gentle Exercise: Walk for 20 to 30 minutes daily to stimulate intestinal activity.
• Consult Your OB-GYN: If lifestyle shifts are insufficient, discuss safe bulk-forming fiber supplements (such as psyllium) or stool softeners (such as docusate sodium).

When to Call the Doctor (Red Flags)

While common, severe constipation can lead to complications like fecal impaction or hemorrhoids, or indicate other abdominal concerns.

Contact your healthcare provider if you experience:

• Severe abdominal pain or cramping.
• Alternating constipation and diarrhea.
• Passing blood or mucus in your stool.
• Constipation accompanied by severe nausea and vomiting.
• Constipation that persists for more than a week despite lifestyle adjustments and stool softeners.