Constipation in pregnancy (2023)

Constipation is very common in pregnancy (NICE 2022). It can start as early as the first trimester but you’re more likely to get constipated in your second and third trimesters (Bianco 2022, Kuronen et al 2022, NHS 2021a). You can help ease and prevent constipation by making simple lifestyle changes, such as eating foods that are high in fibre, drinking plenty of water and exercising regularly (NHS 2021a).

Read on to learn about the common causes of constipation in pregnancy and the self-care and treatment options available.

When does constipation start in pregnancy?

Constipation in pregnancy can start as early as the first trimester, once hormone levels of progesterone begin to rise to support your growing pregnancy (Jessie et al 2022). However, you’re more likely to be affected by constipation in your second and third trimesters as your pregnancy progresses (Bianco 2022, Kuronen et al 2022, NHS 2021a).

Why am I so constipated?

If you're experiencing constipation during pregnancy, it could be due to several factors, including:

• You’re not eating enough fibre such as fruit and vegetables, pulses, wholegrain cereals and wholemeal breads (NHS 2021a).
• You’re not drinking enough fluids.
• You’re not exercising or are less active (NHS 2020a).
• Your body is making more of the hormone progesterone, which slows the movement of food through your digestive system (Bianco 2022, HSE 2019).
• You’re taking iron pills or prenatal vitamin supplements, containing iron. Constipation is a common side effect of iron supplements (GUTS UK 2021, HSE 2019).
• Your growing baby and womb are putting extra pressure on your rectum (this is the final stretch of your intestine where poo is stored until you're ready to go), which can slow down your bowels (Bianco 2022, HSE 2019).
• You’re feeling worried, anxious or stressed during pregnancy. Feeling down, upset or stressed can slow down the bowel. If you’re experiencing feelings of depression during pregnancy, speak to your doctor or midwife who can provide you with help and support (GUTS UK 2021, NHS 2020b).

How can I relieve or prevent constipation in pregnancy?

The good news is there's several ways to prevent or ease constipation in pregnancy.

Eat a healthy diet full of high fibre foods

Eating a healthy diet with plenty of fresh fruit and vegetables every day can ease constipation (NHS 2020c, NICE 2022). Some fruits, such as apples, apricots, grapes, pears, prunes and strawberries have high levels of sorbitol, which is a natural laxative (NICE 2022).

Choose high-fibre foods such as wholegrain cereals or wholemeal bread, instead of refined and processed foods (NHS 2022a).

If you’re not used to eating high-fibre foods, try them bit by bit to prevent wind and bloating (NICE 2022). Stick with it, even if you don’t get results straight away.

Fibre helps some people within days, but it can take up to four weeks before you feel the positive effects (NICE 2022).

Keep hydrated

Make sure you drink plenty of fluids to help ease and prevent constipation (BDA 2017, NICE 2022).

You need to be drinking at least nine glasses of fluid every day, which is at least 1.9 litres (3.3 pints). Remember, a medium size glass is 200ml (BDA 2017, NICE 2022).

A couple of glasses of fruit juice a day are fine as part of this, and apricot and prune juice are good choices because they’re high in sorbitol (BDA 2017, NICE 2022).

Notice when and how you go to the toilet

Paying attention to your toilet habits can also help prevent constipation. Some things you can try each day include:

• Try to go to the toilet as part of your morning routine. Having a warm drink at breakfast can help. If you don’t go in the morning, about half an hour after you’ve had a meal is another time when you’re likely to need a poo.
• Listen to your body. Always go to the toilet when you feel the urge. Ignoring the urge to go can contribute to constipation.
• Give yourself plenty of time to sit on the toilet, and try not to hurry yourself along by straining.
• A sense of privacy can help, though if you have a toddler, this may be easier said than done.
• To make it easier to poo, try putting your feet on a low stool when doing a poo, as a squatting position is better than a sitting position. The image below shows you how to sit (GUTS UK nd, NICE 2022).

Give yourself a perineal massage

If you’re really struggling to do a poo, there’s a reflex point you can stimulate that may make having a poo easier (Abbott et al 2015). Massage the area between your vagina and back passage (perineum) while trying to have a poo.

Practice daily pelvic floor exercises

Having a strong pelvic floor is likely to help (Guts UK nd) ease and prevent constipation, so try to do your pelvic floor exercises daily.

If your pelvic floor is weak when you strain to do a poo, your bowel may bulge down, making pooing more difficult (Guts UK 2021).

Keep active

Gentle exercise such as walking, swimming, cycling on a stationary bike, yoga and Pilates may help, (NHS 2020b, NICE 2022) as well as making you feel fitter and healthier.

Work out what helps you most

Everybody’s digestive system is different, so experiment. You may find that certain things work well to help you poo more easily. You may, for example, find that eating dairy produce or drinking grape juice helps more than eating lots of high-fibre foods.

Consider your iron supplement

If you’re taking a vitamin supplement containing iron, ask your midwife or doctor if you can manage without it, or switch to a different type (HSE 2019). Unless you've been diagnosed with anaemia, you shouldn’t need iron supplements (NHS 2021a).

If you are taking iron supplements for anaemia, and you’re experiencing constipation, talk to your midwife or doctor. They may suggest you take the iron supplements every other day instead of every day (NICE 2021).

What medications can I take to ease constipation in pregnancy?

It’s always better to ease constipation without taking a medicine. But if changes to your diet and lifestyle aren’t helping, speak to your midwife or doctor before taking over-the-counter laxatives.

Your doctor or midwife may prescribe a laxative that’s safe to use in pregnancy (NHS 2019, NICE 2022). They may suggest you try the following for a short time:

• Fybogel (also known as ispaghula husk) is a bulk-forming laxative, which works by increasing the weight of poo, in turn stimulating your bowel. This is a high-fibre drink that you take morning and evening after you've eaten. It takes two or three days to work. If you take this laxative, it’s essential to drink plenty of fluids (NHS 2022b, NICE 2022).
• Lactulose is an osmotic laxative, which draws water from the rest of your body into your bowel to soften your poo. It takes about two to three days to work (NHS 2022b).
• Glycerol (also called glycerin) suppositories, a type of medicine you place in your bottom. They are generally used for more severe constipation, to lubricate and stimulate your bowel. They take about 15 to 20 minutes to work (UKTIS 2018).

Is constipation in pregnancy ever serious?

You’ll probably find constipation more of an inconvenience than a major problem. But if it persists, mention it to your doctor or midwife. Sometimes, constipation can lead to other problems, including the following:

• Piles (also called haemorrhoids) are enlarged or swollen veins in or around the rectum and opening of your bottom. Piles can be sore, itchy and uncomfortable. You may also experience bleeding when you poo (NHS 2022c).
• An anal fissure (also known as an anal tear) is a small tear or open sore in the skin around the anus. A fissure is usually caused by constipation, after a large or hard poo tears the lining of the anal canal. They can feel especially painful when you have a poo, followed by a burning pain up to a few hours after. You may notice bleeding when you wipe your bottom or in your poo (NHS 2021b).

The symptoms of piles and anal fissures can be relieved with creams and ointments. Ask your pharmacist, midwife or doctor for a treatment that is safe to use in pregnancy (NHS 2018b, NHS 2021b).

Piles will usually shrink and get better after giving birth (NHS Inform 2021, NHS 2020c). If piles are bothering you for longer than that, see your doctor. There’s no need to put up with them, or feel embarrassed about getting help.

Most anal fissures heal themselves within a few weeks, but continued problems with constipation can affect healing time and make it more likely to recur (NHS 2021b).

It can feel awkward talking about your bowel habits, but remember that a health professional is there to help and support you. If you have bleeding or pain around your bottom, always speak to your doctor or midwife.

More on constipation in pregnancy and after birth:

• Natural remedies for constipation
• Constipation after having a baby
• Rectal bleeding in pregnancy