Constipation is another common symptom that may occur when women are pregnant and can be very uncomfortable for patients that experience it. During pregnancy, there are a lot of changes to a woman’s body and one of them include changes in hormones. An increase in the progesterone hormone in pregnancy is one of the main causes of constipation. This hormone slows down the movement of food that passes through the intestine which leads to constipation. So what are some helpful tips to relieve the symptoms related to constipation? Here are some answers to the most commonly asked questions relating to managing symptoms of constipation during pregnancy.
What are some lifestyle modifications that may help with constipation?
The first thing I would recommend to patients before they try relieving their constipation with medications is to increase their fluid intake. Drinking plenty of water can help soften the stool to make it easier to have a bowel movement. Moreover, increasing your fiber intake in your diet may also help increase your bowel movement. Lastly, regular exercise can help with constipation by stimulating the muscles in your body, leading to more regular bowel movements. So what if you’ve tried all of these lifestyle modifications with no such luck? There are different over the counter products that you can purchase without a prescription from the doctor.
What is the over the counter drug of choice to help relieve my constipation symptoms during pregnancy?
The first line agent that is recommended for the management of constipation symptoms in pregnancy is a specific type of fiber product called psyllium (Metamucil is the brand name). This is a bulking product that absorbs water and forms bulky stools to stimulate a bowel movement. The dose for Metamucil is 1 teaspoonful of the powder dissolved in water or juice and can be used up to 3 times a day. It is important to work up to this frequency slowly to avoid excess gas as a side effect. Make sure to take this powder with plenty of water to maximize efficacy.
I used Metamucil in the past with no such luck! What are other safe over the counter medications I can take for my constipation?
The second line agent that is preferred for the management of constipation is called docusate. Docusate is a stool softener that helps soften the stool to make it easier for patients to have a bowel movement. This medication has minimal absorption to the baby and clinical studies have shown no evidence of harm. The usual dose for this medication is 50 to 200 mg once daily or divided into 2 to 4 doses. Again, make sure to take this medication with plenty of water to maximize efficacy. In addition to the docusate, another agent that can be used in pregnancy is Miralax powder. Miralax is considered a 3rd line agent after patients have used Metamucil or a stool softener with no relief. This medication is considered 3rd line because even though there is minimal absorption to the baby, there is limited clinical data that supports its use in pregnancy. This medication should only be used for a maximum duration of 2 weeks because it may cause dehydration and electrolyte imbalance in patients. The dosing for this medication is usually 1 capful (17 grams) of the powder dissolved in 8 ounces of water or juice and can be used once daily.
Can I use a stimulant laxative such as bisacodyl or senna during pregnancy to help with my constipation?
Stimulant laxatives such as bisacodyl or senna work by increasing the rate of stool movement in the colon to increase bowel movement. Based on past clinical studies, there is limited data on the use of these agents during pregnancy. I would recommend using the top 3 medications mentioned above before using a stimulant laxative due its limited data. If it is absolutely necessary, it is recommended to limit the duration of use to 2 weeks.
Is castor oil or mineral oil safe to use during pregnancy?
PLEASE AVOID THESE AGENTS AT ALL COST DURING PREGNANCY! Although castor oil and mineral oil are effective in contracting the muscles to stimulate a bowel movement, it can lead to serious side effects in pregnant women. Castor oil has been shown to cause an increase in uterine contraction and rupture. Moreover, mineral oil can cause a decrease in absorption of vitamins during pregnancy and can lead to an increase in bleeding risk. Therefore, my recommendation as a clinical pharmacist is to steer clear from both of these agents at all cost!
I hope you found these tips useful for the next time you suffer from symptoms related to constipation during pregnancy. If you plan on taking any of these medications, feel free to ask your pharmacist where to find these medications in the over the counter section. Although the doctor may write prescriptions for some of these medications, it is usually not covered by your insurance because it can be purchased over the counter. An exception to this statement is if your doctor writes a prescription for Miralax. This medication is covered by many insurances (but not all) so feel free to ask your doctor for a prescription. It is best practice to call the number in the back of your medication insurance card to see if Miralax is covered. If you have any questions on this blog, leave me a message and I will gladly answer them. My next blog will provide helpful tips on how to manage your acid reflux during pregnancy. Please feel free to subscribe to my blog if you wish to get notification on the most current pharmacy tips from your friendly pharmacist. 🙂