Constipation, it’s not nice to talk about but it’s an incredibly common problem during pregnancy and is experienced by approximately half of all expectant mothers. In fact, it is potentially one of the most common symptoms pregnant women encounter.
In women pregnant with twins, triplets and other multiples, constipation problems are more likely to occur, and often involve more severe symptoms.
What is constipation?
“Constipation” can mean different things to different people. Here’s some examples of what people experience:
- infrequent bowel motions (less than once every one to two days)
- a reduced urge to visit the toilet
- hard stool
- difficulty in having a satisfactory evacuation
Other pregnant women may describe abdominal pain or cramps, or worsening bloating, on top of the distention in their abdomen they already have from pregnancy! Occasionally, constipation could be so severe that people can feel quite unwell with it, or even suffer from nausea.
Even in non-pregnant people, constipation is common. It can affect about a third of the entire population at some stage in their life. Most of these are mild cases, but anyone who suffers from constipation normally is more likely to develop it during pregnancy, and of course for carrying multiple children, the risk is amplified even further.
During pregnancy, constipation is often related to changes in the body, in particular with hormones.
The increased levels of progesterone leads to constipation and also in the latter stages of pregnancy, a hormone called relaxin (which is secreted to relax joints in preparation for labour) also has this effect on the bowel. The baby itself, as it grows, can exert some pressure on the large intestine/colon as well, worsening the constipation.
Along with this, many pregnant women are recommended iron supplementation to treat iron deficiency, in particular those who become very anaemic. The most common way of taking iron is via tablets, but unfortunately constipation is often a side effect, sometimes to the point that women even stop taking the supplement.
There’s an increasing trend for the alternative which is an intravenous infusion of iron. This has many advantages as it’s quick and easy, rapidly restoring iron levels in pregnant women. However, currently it is not recommended during the first trimester and this option is best discussed with your obstetrician or midwife. Intravenous iron has the advantage of avoiding constipation as a side effect, although there are very rare adverse effects that can accompany an iron transfusion.
How to manage constipation when pregnant with twins or triplets
The most effective way of managing constipation when pregnant with twins or triplets is to prevent it. Prevention is always better than cure! Starting with a high-fibre diet, rich in whole grain foods is helpful, and many pregnant women also benefit from taking a fibre supplement such as psyllium husk, guar gum or sterculia.
Common over-the-counter supplements include Metamucil, Benefiber, Normafibe and Normacol. These all have no effect on your baby and in many cases can prevent severe constipation.
If a fibre supplement is not enough, or your stool is still hard more than one day a week, it may be reasonable to add in a stool softener on a daily basis. Again, these have no effect on your developing baby, as laxatives are not absorbed into your bloodstream. Common effective laxatives include OsmoLax, Movicol and Coloxyl and Dulcolax (Bisacodyl). Talk to your pharmacist as to what dose to start with. A combination of a fibre supplement and stool softener is highly effective.
Some women, particularly those who find it more and more difficult to adequately empty their bowels, may also benefit from a warm “Sitz” (salt) bath. Run a bath at about 40 degrees an add a small amount of table salt. This can be very relaxing and has been shown to relax the anal sphincter and improve defaecation. For those experiencing ongoing problems, assessment by a specialist pelvic floor physiotherapist can also be extremely helpful.
Constipation when pregnant with twins or triplets can lead to haemorrhoids
It is not uncommon for pregnant women, in particular those carrying multiple babies, to develop problematic haemorrhoids towards the end of gestation. The best way to prevent this problem is to manage constipation at the very beginning. If you are troubled by significant haemorrhoids, topical creams, such as Rectinol and Anusol can be quite soothing, along with Sitz baths. Most of the time haemorrhoids tend to settle down after delivery. However in some cases a consultation with a colorectal surgeon after delivery can allow an assessment of your haemorrhoids and a treatment plan to be created.
If you experience constipation, remember, you’re not alone. It’s highly recommended to seek help if you’ve tried the suggestions mentioned and still need relief.
Dr Chris Gillespie
Colorectal Surgeon – BHB MBChB FRACS CSSANZ