‘Why am I so constipated in pregnancy?’ And going for your first poo after birth…

I have given an overview of the different hormones at play during your pregnancy before in this post. One of the hormonal key players for many of the weird and wonderful joys of pregnancy is progesterone. Progesterone relaxes smooth muscle in the body. It acts in this way to prevent the uterus contracting, and therefore labour starting, before the baby is ready to be born. But this also has a knock on effect on other smooth muscle in the body, and predominantly the digestive system as the oesophagus, stomach and intestine are made up of smooth muscle. Peristalsis (wave like muscular contractions) is the movement through which food is moved through the digestive tract, and the high level of progesterone slows this process down in pregnancy. Cue: acid reflux and heartburn, burping, bloating, gas and constipation. All of the fun.

Tips to avoid constipation:

  • Drinking plenty of water. Hot drinks such as herbal teas, particularly peppermint and fennel can help. Avoid caffeine.
  • Eating foods high in fibre (wholegrains, fresh fruit and vegetables, pulses)
  • Gentle exercise (swimming, walking, yoga)

You may be taking iron supplements in pregnancy if you have become anaemic (low iron levels). These can contribute to constipation, especially if you are taking a high dose of iron. It may be necessary to take a medicine to soften your stool, so speak to your GP if you are suffering from constipation despite following the above tips.

Pooing after the birth

You may not have even given this a thought prior to the birth. Why would you? All your preparation has been geared towards a little human arriving earthside. And then that happens, and life goes on, meaning you have to poo again… but no one told you about the post-birth constipation! In whatever way your baby has been born (vaginal or C-section), you are likely to have some constipation following the birth.

There are a few reasons for this:

  • You are still recovering from the effects of progesterone in the pregnancy
  • You are likely to have emptied your bowels during labour
  • After the birth your body goes through ‘diuresis’, which is an increased production of urine. This is because you had increased fluid (blood volume) in pregnancy, which is no longer needed. This sudden loss of fluid can leave you a bit dehydrated
  • You may have received certain drugs, such as pethidine or morphine, which can cause constipation
  • You may be less mobile if you have had a C-section which can slow down digestion
  • If you have had a c-section your bowel may have been disturbed in the process

It is common to feel nervous and fearful of going to the toilet after birth. You will likely have some bruising and may have had stitches following a vaginal birth, or have a C-section wound. All of these can make you feel anxious and fearful of doing a poo as you are understandably scared that ‘pushing’ to open your bowels will a) hurt and b) cause stitches to undo. First of all, you will not open any stitches by going to the toilet. Sutures are strong and designed to hold tissue together until it has healed. The area may feel sore and swollen, and you can take pain relief such as paracetamol and ibuprofen. Second, you should not be straining to open your bowels as this can lead to or worsen existing haemorrhoids (also known as ‘piles’, a swelling containing enlarged blood vessels inside or around the anus). Saying this, haemorrhoids are common in pregnancy due to the increased pressure on your pelvic blood vessels and because of our good friend progesterone relaxing your bloods vessels (they are made of smooth muscle too). Try going to the toilet with your feet raised slightly off the floor, using a stool or a stack of books, mimicking a squat position. This helps the muscle that holds our poo in when we are standing to fully release and makes it easier to empty the rectum.

So there we have it, hopefully! If in doubt: FLUIDS, FIBRE, (gentle) MOVEMENT!

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