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Constipation in Pregnant Women

Introduction

Constipation is the difficultly or infrequent passage of stool, harden stool or incomplete

evacuation of stool. Additionally, according to the Pharmacotherapy Handbook 7th

Edition. It

defines constipation of having fewer than three stools per week for women. That is accompanied

by straining when defecating.

Pregnant women are frequent constipation due to the following: dietary alterations, changes in

water absorption, mechanical factors, hormonal changes (increase in progesterone), decrease

exercise levels, and an increase in pressure in the abdominal region. In the Western World

constipation is said to affect approximately 25% to 40% of women.

An increase in gastrointestinal transit time it a major factor that results in pregnant women beingconstipated. This normally occurs within the second and third trimester. The prolongation of

gastrointestinal transit time is as a result of hypo-motility, which is mainly caused by an increase

in progesterone levels.

In most pregnant women that are constipated there is usually an underlying disease or condition

that needs to be addressed in order for the woman to be relieved of constipation. In such an

instance a thorough investigation should ensue to determine the following: frequency of stool

passage, prolonged straining, urge to defecate, laxative use, intake of other medications, and

other noticeable symptoms.

Effects of Constipation on Pregnancy

If constipation is not addressed this could to the accumulation of toxin within the intestine which

can cause serious consequences to the embryonic development of the fetus and could possible

cause fetal malformation.

Also, constipation can cause premature labour. This is due to the increase pressure being place

on the abdomen which may initiate child birth.

Finally, due to constipation the accumulation of feces in the cause the individual to to have a

bloated abdomen, this will negatively impact the development of the fetus due to decrease inspace for fetal development to take place.

Non Pharmacological Approach for treating Constipation in Pregnant Women

Fibre Rich Food

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It is advised that a pregnant individual increases the intake of fibre this is due to fact that fibre

will cause the intestines to work harder in that it will cause the absorption of liquids, resulting in

the stool become soft. Foods that contain lots of fibre includes: fruits, vegetables, whole wheat

breads, prune and prune related substances.

Increase Water intake

Little to no liquid in the diet can negatively impact the digestion process and consequently result

in the stool becoming hard and difficult to pass. Due to this it is advised that the individual

increases their water intake to ten to twelve glasses of water per day.

Exercise

Exercise is known to stimulate the action of the bowel which leads to an improved digestion.

Therefore during pregnancy it is advised that the women engage in physical activity such as

walking or swimming for about twenty (20) to thirty (30) minutes for three times per week.

Pharmacological Approach

Bulk Forming Laxative

Examples includes Methylcellulose, Polycarbophil and Psyllium (Sillium)

M.O.A.

These agents cause the retention of fluid and increase faecal weight which results in stimulation

of peristalsis.

Dose

Psyllium3.5 g one to three times daily by mouth

Methylcelluose and Polycarbophil4-6g/day.

It should be noted that this concentration should be mixed in at least 150 ml of water. An the

individual consumes one tablespoonful three times per day

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Stool Softener

Which is also known as emollient laxatives can be used by pregnant women. These

agents are Docusate Sodium, Calcium and Potassium.

M.O.A.

These agents decrease surface tension and increase the penetration of intestinal fluid

resulting in an increase in faecal weight.

Dose

Both Docusate Sodium and Calcium ranges from 50-360 mg/day

Docusate Potassium 100-300 mg/day

It should be noted that Docusate Sodium can put the patient at risk of experiencing preeclampsia.

Therefore it is advised that the patient limits their intake with this agent.

Stimulant Laxative

Examples are: Bisacodyl, Cascara and Senna

M.O.A.

Stimulate the nerve endings in the colonic mucosa resulting in an increase in intestinal motility.

Dose

Bisacodyl- three (15mg) once daily preferably at nights

Drug Work Up

Bisacodyl

Brand Name:Duclolax

Common Name: Bisacodyl

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Class:Stimulant Laxative

Use:To relieve constipation

M.O.A.:Stimulate the nerve endings in the colonic mucosa resulting in an increase in intestinal

motility.

Dose515mg once daily.

Adverse EffectAbdominal Discomfort, Cramps.

OverdoseDiarrhoea with excessive loss of water and electrolytes

PrecautionsShould not be given with intestinal obstruction or acute abdominal conditions

(IBD). Safe to be use within the third trimester.

Pharmacokinetics

Bisacodyl is mainly excreted via faeces.

Absorption takes place within the G.I.T.

Small amount is excreted via urine.

References

Johnson, R. (2011, March 18). Common pregnancy problems - Pregnancy and baby guide - NHS

Choices:. Retrieved April 14, 2012, from www.nhs.uk:

http://www.nhs.uk/conditions/pregnancy-and-baby/pages/common-pregnancy-

problems.aspx

Roger , W., & Cunningham, G. F. (2007, March).Pregnancy and Constipation. Retrieved April

14, 2012, from http://www.americanpregnancy.org:

http://www.americanpregnancy.org/pregnancyhealth/constipation.html

Roy, P. K. (2011, March 29). Gastrointestinal Disease and Pregnancy . Retrieved April 14,

2012, from medscape.com: http://emedicine.medscape.com/article/186225-overview#a30

Well, B. G. (2009). Pharmacotherapy Handbook. In B. G. Well,Pharmacotherapy Handbook

(pp. 250-254). New York: McGraw Hill Medical.

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