What are the treatment options for postpartum constipation in a postpartum mother?

From the Guidelines

To treat constipation in a postpartum mom, increasing dietary fiber intake to approximately 30 g/d and consuming an adequate amount of fluids, particularly water, is recommended. This approach is based on the latest guidance from the American Gastroenterological Association, as outlined in their 2024 clinical practice update on pregnancy-related gastrointestinal and liver disease 1. The increased levels of progesterone during pregnancy can slow GI motility, contributing to constipation, and this effect may persist postpartum.

Some key considerations for managing constipation in postpartum women include:

• Increasing dietary fiber intake through foods like fruits, vegetables, whole grains, and legumes to promote regular bowel movements
• Consuming adequate amounts of fluids, particularly water, to help soften stools and ease bowel movements
• Using bulk-forming agents like psyllium husk or methylcellulose, which are safe during pregnancy and postpartum due to their lack of systemic absorption
• Considering osmotic laxatives such as polyethylene glycol or lactulose for more immediate relief, as they can be administered safely during pregnancy and are likely safe postpartum as well 1

It's also important to avoid straining during bowel movements by providing ample time, using relaxation techniques, and adjusting diet and hydration. Physical activity, even light walking, can stimulate bowel movements and is beneficial for overall health. If constipation persists or is severe, consulting a healthcare provider is necessary to rule out any underlying conditions that may require more targeted treatment.

From the FDA Drug Label

USE • relieves occasional constipation (irregularity) • generally produces a bowel movement in 1 to 3 days Uses for prevention of dry, hard stools for relief of occasional constipation This product generally produces a bowel movement within 12 to 72 hours.

To treat constipation in a postpartum mom, polyethylene glycol (PO) or docusate sodium (PO) can be used.

• Polyethylene glycol (PO) 2 can relieve occasional constipation and generally produces a bowel movement in 1 to 3 days.
• Docusate sodium (PO) 3 can prevent dry, hard stools and relieve occasional constipation, producing a bowel movement within 12 to 72 hours.

From the Research

Treatment Options for Postpartum Constipation

• Eating a high-fibre diet and increasing fluid intake is usually encouraged to assist defecation in the puerperium 4, 5
• Laxatives are commonly used in relieving constipation, but the effectiveness and safety of available interventions for preventing postpartum constipation needs to be ascertained 4, 5
• A laxative (senna) may increase the number of women having their first bowel movement within 24 hours after delivery, but the evidence is of low certainty 5
• Macrogol and lactulose are suggested as the first-line therapy in treating chronic constipation during pregnancy, with macrogol showing some advantages such as faster onset of bowel action and fewer flatulences 6
• Diphenolic laxatives such as bisacodyl and sodium picosulfate are recommended as a second-line treatment in the second and third trimester 6

Safety of Laxatives during Pregnancy and Lactation

• Natural fibres, docusate sodium, mineral oils, macrogol, sugars and sugar alcohols, and anthraquinones and diphenolic laxatives seem to be safe medicaments regarding teratogenicity and lactation 6
• The US Food and Drug Administration (FDA) risk categories for these substances taken during pregnancy and lactation are often the result of the lack of studies than of evidence-based information 6
• Macrogol, lactulose, bisacodyl, and sodium picosulfate are recommended during lactation, according to the nature of the conditions 6

Limitations of Current Evidence

• There is insufficient evidence to make general conclusions about the effectiveness and safety of laxatives for preventing postpartum constipation 4, 5
• The evidence in this review was assessed as low to very low-certainty evidence, with downgrading decisions based on limitations in study design, indirectness, and imprecision 5
• Further rigorous trials are needed to assess the effectiveness and safety of laxatives during the postpartum period for preventing constipation 4, 5