6 Things No One Tells You About Pregnancy Constipation

By Amy Marturana Winderl, C.P.T.

Right around the start of my second trimester, pregnancy constipation suddenly hit and was so extreme that I was actually concerned. One night, I legit googled "When is constipation dangerous?" I’m usually on a very regular schedule, but I realized it had been a week since my last bowel movement—and I had the bloat and discomfort to prove it. I barely even had an appetite because my body felt so full. (I guess now's a good time to disclose that there will be moments of TMI throughout this piece….)

I called up my friend who has two kids and asked her what I should do. First, she told me it was totally normal. Second, she said Metamucil, Miralax, and Colace (a stool softener) should become my new BFFs. So I messaged my ob-gyn to make sure those things were fair game and, with her blessing, embarked on a journey to get things moving. A journey that also included seeking out more fiber-rich foods, drinking more water, and getting myself up for a walk or Peloton class even when I really didn't feel like it.

Here's what I learned along the way—all of which prove that pregnancy constipation is very common, very annoying, and also very treatable (praise be).

You can partially thank hormones for pregnancy constipation. (The same thing that's partially to blame for other annoying side effects like acid reflux.) Hormones in pregnancy—specifically high levels of progesterone—have a relaxing effect on smooth muscles throughout the body, says Dana Elborno, MD, ob-gyn at Northwestern Medicine Central DuPage Hospital. This includes the intestines. "When these muscles are relaxed, the GI tract moves more slowly," she tells SELF.

Though some pregnant people may not notice the effects so dramatically, others will. "Some GI tracts are just more sensitive to any kind of changes and pregnancy is of course a major change in the body," Clara Paik, MD, ob-gyn, vice-chair of the department of obstetrics and gynecology, and chief of the division of gynecologic specialties at the University of California, Davis, tells SELF. A few other factors can make matters worse. Taking prenatal vitamins, for example, may cause constipation because they usually contain a higher amount of iron, Dr. Paik says.

It's also likely that your diet and exercise routines have both changed a lot since you got pregnant. "For a lot of people, it's true that they exercised regularly before pregnancy and had a healthy diet, and then suddenly with pregnancy, because of symptoms like fatigue and nausea, now they’re not exercising and their diet changed overnight," Dr. Elborno says. "It's a combination of the way hormones affect us and the pretty dramatic lifestyle changes that happen with pregnancy."

Personally, my bowel movements tend to change a ton when I stray from my routines—and the entire first trimester I exercised a fraction of the time I did previously and exclusively consumed mac and cheese, chicken tenders, pancakes, ice cream, and lemonade. (Basically alllll the comfort foods: white flour products, sugar, and cheese.) The last thing I wanted to eat were fibrous vegetables and whole grains. There were also about three weeks when I had a taste aversion to water (it suddenly had a thick texture and disgusted me). And, you guessed it, not drinking enough fluids can also contribute to constipation. All that finally caught up with me.

My bathroom issues seemed to hit me out of nowhere. I kind of just woke up one day and realized I didn't remember the last time I pooped. I felt very bloated and uncomfortably full, even first thing in the morning. There's so much going on when you’re pregnant that it's easy to ignore one symptom or feeling until suddenly it's bad enough that your body won't let you ignore it.

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Though constipation can set in at any point throughout pregnancy, it tends to get worse with time as your intestines become more squished by the growing fetus and your body continues to relax muscles in preparation for labor, Dr. Elborno says. What I’ve learned is that figuring out a strategy to mitigate constipation early is important, so that you can have a game plan for when it inevitably strikes again.

Unless you want hemorrhoids, it's not a good idea to just sit on the toilet and push hoping that you’ll eventually get relief.

Why? Well, without getting too technical, pushing harder to try and force a bowel movement can increase intrabdominal pressure, potentially leading to other GI issues, like hemorrhoids and anal fissures, Dr. Elborno says. Hemorrhoids are swollen veins in the anus that cause pain, swelling, and bleeding; fissures are essentially small tears in the lining of the anus. Ouch. Neither is a pleasant addition to pregnancy—or really any time in life.

Straining to poop also puts a lot of stress on muscles of the pelvic floor, Dr. Paik says. Straining will further weaken those muscles, which will already be put through the wringer during pregnancy and labor. "This can contribute to urinary incontinence and fecal incontinence," Dr. Paik says.

Instead, you want to make it easier for the poop to make its way out with just a normal amount of effort. "The ultimate goal is to try and make poop softer and easier to pass and a lot of times that's going to come from increasing hydration, having a more physically active lifestyle—movement will increase your intestinal motility—and having a good amount of fiber in your diet," Dr. Elborno says.

Of course, hydrating, exercising, and eating a well-balanced, fiber-rich diet are all easier said than done when you’re exhausted, nauseated, and just simply trying to make it through each day. Luckily, you can totally cheat on the fiber front.

"A lot of pregnancy is about survival," Dr. Elborno says. "I’ve had patients that are like, ‘All I can keep down are Warheads and Pop-Tarts,’ and at the end of the day, you have to get nutrition from somewhere." If you’re having a really tough time eating fiber-rich veggies and grains, it's okay to turn to something else like powdered fiber that you mix into water and quickly chug. That's what I did. The generic form of Metamucil, called psyllium husk, is a powder you spoon into water, mix, and then drink quickly before it gets gelatinous. It works by adding bulk to the stool, which helps prompt the intestines to contract and move stool through.

The one I bought was orange flavored, and it was very palatable, even when I was dealing with some nausea and terrible heartburn. But if the powder stuff in water makes you gag (your aversions could be totally different than mine!), Dr. Elborno suggests sneaking it into smoothies, or adding other fiber-rich ingredients like flax seeds. That way, you can get the benefits without having to stomach the taste or texture of something you’re not used to. (I haven't met a pregnant person yet who didn't enjoy a fruit smoothie, though I’m sure they exist and if that is you I am terribly sorry!) You can also blend fibrous veggies or powders into soups if it's easier for you to stomach something hot and brothy, Dr. Elborno adds.

Beyond fiber powder, I also have become quite partial to Miralax (the generic name is polyethylene glycol 3350) on occasion. It's what's known as an osmotic laxative, which means it works by drawing water into the stool to make it softer and easier to pass. A few days of twice-daily psyllium husk and once-daily polyethylene glycol finally gave me the relief I needed—and is now my go-to whenever I run into constipation again. Of course, always get the okay from your doctor but, generally, these things are all considered safe in pregnancy as long as you take them as directed.

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"You can use stool softeners—Miralax and Colace are absolutely pregnancy safe," Dr. Elborno says. "Because Miralax works by pulling water into the gut, it's not something that's affecting you systemically and that's one of the reasons it's safe," she says. "It is also something that has been used for a really long time. We have a lot more data on drugs that have been used in pregnancy for a long time as opposed to newer and more novel medications." She adds that while there are some newer prescription drugs for treating constipation, "we don't have experience using them in pregnancy so we fall back to the more traditional ones."

Colace, as Dr. Elborno mentioned, is another old faithful constipation medication that's safe to use in pregnancy. It's what's known as an emollient laxative, and works by drawing water and fat into the stool to make it easier to pass.

Seriously though, as someone who has never gone a week without pooping for as long as I can remember, I was kind of alarmed about this whole situation. I was more bloated and uncomfortable than I had ever been in my life.

Turns out, it's very uncommon for constipation to become an actual emergency. "If you’re super uncomfortable and having abdominal pain, you should probably go see someone," Dr. Elborno says. Other signs it's time to call your doctor include: nausea, vomiting, blood in your stool, and black or dark gray stool. "It is very rare but there are some people who need manual disimpaction," Dr. Elborno adds. Meaning, a doctor will need to remove the hardened, backed-up stool from the colon. Again, though, that's a rare occurrence. "In general, constipation is not so serious," she says.

But also, just because it's not so serious doesn't mean you have to just live with it. "A lot of people assume that if something is normal or expected for pregnancy, that they just have to kind of deal with it," Dr. Elborno says. "The reality is that there are a lot of supportive measures we can take to improve quality of life, decrease this symptom's effect on overall well-being, and try to make pregnancy more enjoyable."

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