Constipation during pregnancy

Are you pregnant and cringing at the thought of visiting a toilet for a long call because you have hard stool? Passing such stool can be a trying and painful experience. You sit there and push with all your mind and might but alas! Nothing comes out and when it does, it is slow, scant and painful! That is the nature of constipation, a condition where there is an abnormal decrease in frequency of long calls, difficulty in emptying the bowels due to hard stool or a change in bowel habits from the normal. Many pregnant women experience constipation, sometimes quite intense.

What causes constipation in pregnancy?
In general, constipation can be caused by worry, anxiety, poor nutrition, poor bowel habits, anal-rectal problems or a low-fibre diet.

• In pregnant women, constipation is thought to be the result of hormones (oestrogen and progesterone) that relax the intestinal muscles, and the pressure of the expanding uterus on the intestines. Oestrogen and progesterone are hormonal products that are produced in large amounts by the placenta and have many effects in addition to muscle relaxation. They are the main chemical products that support pregnancy and breast development.
• Relaxation of the intestinal muscles causes food and waste to move slower through the system. The longer the stool stays in the large intestine the harder and drier it gets.
• Pressure of the growing uterus on the rectum (lower part of the large intestine leading to the anal canal) can also cause constipation. Other causes of constipation are poor diet, and a diet rich in animal fats (meat and dairy products), or refined carbohydrates that are low in fibre such as white sugar.
• Irritable bowel syndrome (IBS), a condition where spasms develop in the large intestines that delay the speed with which the contents of the intestines move through the digestive tract.
• Constipation can also be caused by poor bowel habits, like when one ignores the urge to empty the bowels when the need arises. This may be because one is avoiding using a public toilet or because one is too busy doing other things. After a while the urge to open bowel stops, but this results in constipation.
• Constipation can also be caused by fissures and haemorrhoids. Fissures are small ulcerative cracks on the anal skin and haemorrhoids are varicose-like anal swellings that are extremely painful especially when infected. When one opens bowels and the stool passes through these lesions (injuries), it hurts a lot. Fissures and haemorrhoids produce spasms of the ring-shaped muscle which closes the anus, causing a delay in bowel opening.
• Insufficient intake of fluids and lack of exercise is another cause of constipation. Regular exercise prevents the digestive system from being sluggish.

How to avoid constipation

• Constipation can be avoided by eating a diet rich in fibre. This increases stool bulk in the intestines and has the effect of causing more bowel movement resulting in expulsion of the stool before it becomes hard. Fibre also absorbs water and will help ensure that the stool remains soft. Examples of foods rich in fibre are fruits like pawpaw and water melon, green leafy vegetables (like sukuma wiki and spinach), whole meal bread, and breakfast cereals.
• One can also avoid constipation by taking plenty of water and fluids; stool becomes soft with increased water content in its composition. So, it is good to drink as much water as you can – one -should drink a minimum of 2 litres of fluids per day.
• The urge to go to the toilet should not be ignored to avoid stools becoming hard and difficult to pass.
• Exercising gently stimulates the bowel, which leads to improved digestion and helps prevent the digestive system from becoming sluggish. It is important to walk or to carry out active domestic tasks for about 20 to 30 minutes daily, at least three times a week.                                                 Note that exercises also enhance general well-being and fitness in preparation for delivery.

Treating constipation

• For most women a good diet rich in fibre can lessen the chances of constipation.
• Drinking plenty of fluids and exercising will help increase fluid content in the faeces.
• Constipation can also be treated by having sufficient undisturbed toilet visits (at least twice a day) and not ignoring the urge to open bowels.
•  It is important to note that treatment with drugs is not recommended in pregnancy because it can cause recto-uterine reflex which can lead to premature births. In this situation excessive rectal movement can lead to reflex uterine contraction and labour. Drugs treatment should therefore be the last resort and should be undertaken only under a doctor’s supervision. A doctor is the best qualified person to determine when a laxative (medicine that loosens the bowel contents) or purgative (a drug that stimulates the emptying of bowel contents) is needed and which type is best for use and when.

Will constipation affect the unborn child?
Constipation on its own has more side effects on the mother than the child but it can affect the unborn child if the mother avoids eating, which can lead to malnutrition and growth retardation of the child in the womb.
It can also turn out to be serious if it interferes with delivery. A full rectum can prevent the baby’s head from passing through the birth canal just as a full bladder. In such cases, an enema is administered to aid bowel movement before delivery. Enema is an injection of fluid into the lower part of the large intestine leading to the anus. Enema however is not always effective.

Can constipation persist after birth?
Depending on the complications it has caused like painful haemorrhoids, fissures and anal-rectal wounds, constipation can persist after birth. After delivery it can be treated with medicines such as laxatives (drug that loosens the bowel contents) or purgatives (drug that stimulates the emptying of bowel contents). As there is no longer a risk of premature fetal expulsion, the drugs can now be used safely. While treatment continues, a diet rich in fibre and good toilet habits is also encouraged for prevention and long-term care.”

END: PG 03 /14