From the Guidelines
For breastfeeding mothers, the safest and most effective laxative/stool softener is polyethylene glycol–based laxatives, such as Miralax, due to its minimal absorption into the bloodstream and safety profile, as recommended by the latest clinical practice update on pregnancy-related gastrointestinal and liver disease 1. When considering laxatives or stool softeners for breastfeeding mothers, it is essential to prioritize options that are minimally absorbed into the bloodstream to ensure safety for both the mother and the baby.
- Key considerations include:
- Minimal absorption into the bloodstream
- Safety profile during breastfeeding
- Efficacy in relieving constipation According to the latest clinical practice update on pregnancy-related gastrointestinal and liver disease, polyethylene glycol–based laxatives, such as Miralax, are considered safe to administer during pregnancy and breastfeeding 1.
- The recommended dosage for Miralax is 17g (one capful) dissolved in 8 ounces of water once daily. Before using any medication, breastfeeding mothers should try increasing water intake to at least 8-10 glasses daily, consuming more fiber-rich foods like fruits, vegetables, and whole grains, and engaging in light exercise, as these natural approaches can often resolve constipation without medication, as suggested by the clinical practice update 1. If constipation persists beyond a week, is accompanied by severe pain, bleeding, or other concerning symptoms, it is crucial to consult a healthcare provider for further evaluation and guidance.
- Stimulant laxatives like senna or bisacodyl should be avoided during breastfeeding unless specifically recommended by a doctor, as they may cause cramping for both the mother and potentially the baby.
From the FDA Drug Label
If pregnant or breast-feeding, ask a health professional before use. The FDA drug label does not answer the question.
From the Research
Laxatives and Stool Softeners for Breastfeeding Mothers
- The study 2 suggests that natural fibers, docusate sodium, mineral oils, macrogol, sugars, and sugar alcohols seem to be safe for use during lactation.
- Macrogol and lactulose are recommended as first-line therapy for treating chronic constipation during pregnancy and lactation, with macrogol showing faster onset of bowel action and fewer flatulences 2.
- The American College of Gastroenterology's Committee on FDA related matters and the Motherisk Programme provide alternative solutions for decision-making on laxative use during pregnancy and lactation 2.
- Psyllium is found to be superior to docusate sodium for treating chronic constipation, increasing stool water content and having greater overall laxative efficacy 3.
Safety and Efficacy of Specific Laxatives
- Docusate sodium is not found to be effective for constipation in older people, with psyllium and sennosides showing more effectiveness compared to docusate 4.
- Macrogol, lactulose, bisacodyl, and sodium picosulfate are recommended for use during lactation, depending on the nature of the condition 2.
- There is a lack of data to support the use of docusate for constipation, and its efficacy is not established 4.
Nutritional Considerations for Breastfeeding Mothers
- Breastfeeding mothers are often vulnerable to nutritional deficiencies, including vitamins and minerals such as folic acid, vitamin B12, and iron 5.
- Nutritional supplementation during lactation may be necessary, depending on the mother's eating habits and nutritional status 5.
- Human milk provides optimal nutrition and other benefits for infants, and breastfeeding beyond 12 months may have additional health benefits for mothers and infants 6.