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Fruit of the Womb
Fruit of the Womb

Constipation in Pregnancy - 2

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Since constipation can be a chronic and ongoing concern in pregnancy, it is worth revisiting at least once with a few additional comments. Actually, the writer referred to in the previous post had some more specific follow-up questions and my responses touched on issues that were omitted from that post...

What is the definition of constipation during pregnancy? In other words, when is a woman considered constipated?
The ‘standard’ definition of constipation is having a bowel movement less than 3 times per week, however, in my experience, even that cannot be defined as ‘constipation’ unless it is accompanied by hard, dry stool that requires straining to eliminate. Patients with constipation will frequently complain that their bowel, particularly, the rectum, feels “full” and doesn’t feel completely empty even after they have strained to pass a small amount of stool. They will also often complain of feeling “bloated” and have abdominal discomfort and cramping as the result of retained gas and stool. So, ‘constipation’ is not a disease as much as it is a complex of these symptoms.

Incidentally, although we did not discuss this in my previous responses, constipation, even if it is not a disease, it can be the result of certain common medications, especially narcotics, or a more serious underlying medical condition such as irritable bowel syndrome, bowel cancer, diabetes, multiple sclerosis, hypothyroidism, or certain autoimmune or neurological disorders, to mention just a few. If you are not only constipated, but have persistent abdominal pain, severe abdominal distention, constipation that alternates with diarrhea, bloody stools, dark and tarry stools, unexplained weight loss, long thin ‘pencil-like’ stools, fever, or other systemic symptoms, you should be discussing these findings with a physician rather than attempting to just treat your constipation, because these may be indicators of much more serious medical conditions.

What happens if a pregnant woman has been constipated for a while, and stool softeners or laxatives aren't working?
Under these circumstances, milk of magnesia, mineral oil, or an enema with a solution that does not cause a lot of irritation may be necessary. It is unusual that fiber, fluid, and exercise won’t work. Indeed, consultation with a gastroenterologist may be necessary at that point to rule out a true bowel motility problem that might be associated with a neurologic abnormality or another of the more serious medical conditions mentioned above.

I have had some patients with premature labor who have been so impacted with hard, dry stool in their rectums that we had to manually break this up and extract the stool before their contractions would stop. I can recall one case that was so severe that we had to perform the procedure under anesthesia because the woman was in such bad pain. I have had other patients in active labor at term where the fetal head would not descend into the pelvis until we had digitally ‘disimpacted’ them.

Can constipation affect the pregnancy at all other than what you mentioned in your last response?
“Constipation” by itself is a relatively benign condition, even if it does make you miserable. There are ‘old wives tales’ that when you are constipated, toxins will build up and be dangerous for you and a baby, but I doubt there is any truth to that. If constipation is associated with preterm contractions, THAT IS a serious condition, and the straining that a woman has to do to eliminate her stool can accelerate that process as it is exactly the type of ‘bearing down’ we ask a woman to do when she is ready to deliver a baby. Such straining might also weaken the woman’s pelvic floor, increasing her risk for long-term problems related to “pelvic floor relaxation and dysfunction” such as urinary incontinence, uterine prolapse, rectal prolapse, and pain with intercourse. Another, and perhaps greater concern I would have with regard to ‘pregnancy risk’ is that one of the more serious medical conditions mentioned above might be overlooked if the patient’s complaints were simply written off as ‘pregnancy-related.’
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