What are the treatment options for constipation in pregnant women?

Treatment Options for Constipation in Pregnant Women

Dietary fiber, polyethylene glycol (PEG), and lactulose are the first-line treatments for constipation in pregnant women, with PEG showing faster relief compared to lactulose. 1, 2

Understanding Constipation in Pregnancy

Constipation affects approximately 20-40% of pregnant women due to several factors:

• Increased progesterone levels slowing GI motility
• Physical compression from the growing uterus
• Iron supplementation (common in prenatal vitamins)
• Reduced physical activity
• Inadequate fluid intake
• Hormonal changes 1, 2

Treatment Algorithm

First-Line Approaches (Non-Pharmacological)

• Dietary modifications:
  • Increase fiber intake to approximately 30g/day (fruits, vegetables, whole grains, legumes)
  • Ensure adequate fluid intake, particularly water 1
  • Avoid excessive straining during bowel movements
  • Use relaxation techniques when defecating

First-Line Pharmacological Options

1. Bulk-forming agents:

   • Psyllium husk (6.8-10.8g daily with 8-10 oz fluid)
   • Safe in pregnancy due to minimal systemic absorption 1, 2
   • Take immediately before meals rather than between meals
   • May cause bloating as a side effect

2. Osmotic laxatives:

   • Polyethylene glycol (PEG) (17g daily mixed with 4-8 oz of liquid)

     • Faster onset of action compared to lactulose 3
     • Less bloating than lactulose
     • FDA pregnancy category C 4

   • Lactulose (15 mL twice daily)

     • Effective but may cause more bloating than PEG 1, 3

Second-Line Options (for refractory cases)

• Stimulant laxatives (use with caution in second and third trimesters only):
  • Bisacodyl or sodium picosulfate
  • Should be used only short-term or occasionally to avoid dehydration or electrolyte imbalances 5, 6

Important Considerations and Cautions

• Avoid stimulant laxatives in first trimester due to limited safety data 1, 6

• Limit duration of osmotic laxatives to avoid electrolyte imbalances 5

• Monitor for adverse effects:

  • PEG may cause nausea, stomach fullness, cramping, diarrhea, or gas 4
  • Excessive use of PEG may lead to fluid loss and electrolyte imbalances 4
  • Bulk-forming agents may cause bloating and abdominal discomfort 2

• Contraindications:

  • Do not use PEG if allergic to polyethylene glycol 4
  • Avoid all laxatives if symptoms of bowel obstruction are present (nausea, vomiting, abdominal pain) 4

Duration of Treatment

• PEG is most effective when used for 1-2 weeks 4
• Discontinue once regular bowel movements are established
• For persistent constipation beyond 2 weeks, consult a healthcare provider 4

Follow-up Recommendations

After successful treatment, focus on lifestyle modifications to maintain regular bowel habits:

• Maintain adequate dietary fiber intake
• Ensure sufficient fluid intake
• Engage in regular physical activity as appropriate during pregnancy 4

Remember that constipation in pregnancy is common and typically resolves with appropriate management. The treatment approach should prioritize safety for both mother and fetus while effectively relieving symptoms.