Pregnancy is a perfect storm for slow bowels. Increasing hormones during pregnancy serve to slow bowel transit times substantially. The blood volume is expanding by up to 50% so the bowels are trying to get every last drop of water out of your food and stool as possible. Morning sickness can make it hard to get enough water in the diet. When a diet is changed to simpler refined food such as crackers and soda it doesn’t help. Prenatal vitamins often contain iron, which hardens the stool. Zofran®, a common antiemetic, also can worsen things. Moms often have disrupted their morning coffee routine as well.
So, what can be done about it?
The strategy is to reprogram routine, increase water consumption, decrease exposure to meds with constipation as side effect.
If tolerable, ideally a mom would have a cup of coffee in the morning upon waking up and would push water until the urine is clear until mid afternoon. Avoid high fat foods (which tend to slow the bowels) and add more fruits and vegetables to the diet.
Not practical? Often the above isn’t practical because of work schedule and tolerance of certain foods. I recommend over the counter stool softeners (Surfak® and Colace® are common ones). Starting once a day and going up to three times a day (breakfast, lunch and dinner) is a good strategy. These medications work by retaining moisture in the stool and must be chased with water.
If stool softeners don’t work initially and you feel backed up, sometimes unclogging the drain helps get things going and then you can get back on stool softeners as maintenance. This can be done with oral liquid osmotic laxatives such as milk of magnesia and MiraLAX®. These are non absorbed and safe. I recommend one serving every two hours until lift off. An alternative regimen if you cannot tolerate oral liquid is a Dulcolax® suppository or Fleet® type enema. Cramps are normal after any of these regimens and will settle down as the bowels settle down. Cramps are ok as long as there is no bleeding.
Kyle P. McMorries, MD, FACOG