What are the treatment options for constipation during pregnancy?

From the Guidelines

Constipation during pregnancy should be managed with dietary fiber intake, lactulose, and polyethylene glycol–based laxatives as first-line treatment options. The treatment of constipation in pregnant individuals is crucial due to its high prevalence, affecting 20%–40% of pregnant persons 1. According to the AGA clinical practice update, increasing dietary fiber intake to the recommended daily amount of approximately 30 g/d can help promote regular bowel movements and prevent constipation 1.

Some key considerations for managing constipation in pregnancy include:

• Increasing dietary fiber intake through fruits, vegetables, whole grains, and legumes
• Consuming an adequate amount of fluids, particularly water, to help soften stools and ease bowel movements
• Using bulk-forming agents, such as psyllium husk or methylcellulose, which are safe to administer in pregnancy due to the lack of systemic absorption 1
• Administering osmotic laxatives, such as polyethylene glycol or lactulose, which can be safely used during pregnancy 1

It is essential to avoid stimulant laxatives during pregnancy, as safety data on these medications are conflicting 1. Additionally, encouraging pregnant women to avoid straining during bowel movements by providing ample time, using relaxation techniques, and adjusting diet and hydration can be helpful 1. By following these guidelines, healthcare providers can effectively manage constipation in pregnant individuals and improve their quality of life.

From the FDA Drug Label

Ask a doctor before use if you have ... are pregnant or breast feeding IF PREGNANT OR BREAST-FEEDING, ask a health professional before use. The treatment options for constipation during pregnancy include:

• Senna (PO): Ask a doctor before use 2
• Polyethylene glycol (PO): Ask a health professional before use 3

From the Research

Treatment Options for Constipation in Pregnancy

The treatment options for constipation in pregnancy include:

• Dietary changes, such as increasing fiber intake through diet or supplements 4, 5, 6
• Osmotic laxatives, such as polyethylene glycol 4000 and lactulose, which can help soften stool and increase bowel movements 7, 6, 8
• Stimulant laxatives, which can help increase bowel movements, but may be accompanied by side effects such as abdominal discomfort and diarrhea 8
• Bulk-forming laxatives, which can help increase the bulk of stool and promote bowel movements, but may not be as effective as stimulant laxatives 8
• Stool softeners, lubricant laxatives, and enemas or suppositories, which may also be used to treat constipation in pregnancy, but have limited evidence to support their effectiveness 6, 8

Safety and Efficacy of Treatment Options

The safety and efficacy of treatment options for constipation in pregnancy vary:

• Polyethylene glycol 4000 and lactulose have been shown to be safe and effective in treating constipation in pregnancy, with polyethylene glycol 4000 having a faster therapeutic effect 7
• Stimulant laxatives may be effective in improving constipation, but may be accompanied by side effects such as abdominal discomfort and diarrhea 8
• Fiber supplementation may increase the frequency of stools and improve stool consistency, but more evidence is needed to support its effectiveness 8
• The use of laxatives during pregnancy should be weighed against possible adverse effects, and the decision to use a particular laxative should be made on a case-by-case basis 4, 5, 6

Recommendations for Treatment

Based on the available evidence, the following recommendations can be made:

• Dietary changes, such as increasing fiber intake, should be the first line of treatment for constipation in pregnancy 4, 5, 6
• Osmotic laxatives, such as polyethylene glycol 4000 and lactulose, may be used as a second-line treatment for constipation in pregnancy 7, 6, 8
• Stimulant laxatives may be used as a third-line treatment for constipation in pregnancy, but should be used with caution due to the potential for side effects 8
• More research is needed to fully understand the safety and efficacy of treatment options for constipation in pregnancy, and to provide evidence-based recommendations for treatment 8