Constipation in Pregnant Women
Content
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 being
constipated. 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 in
space for fetal development to take place.
Non Pharmacological Approach for treating Constipation in Pregnant Women
Fibre Rich Food
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
Psyllium – 3.5 g one to three times daily by mouth
Methylcelluose and Polycarbophil – 4-6g/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
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
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.
Dose – 5 – 15mg once daily.
Adverse Effect – Abdominal Discomfort, Cramps.
Overdose – Diarrhoea with excessive loss of water and electrolytes
Precautions – Should 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-pregnancyproblems.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.
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 being
constipated. 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 in
space for fetal development to take place.
Non Pharmacological Approach for treating Constipation in Pregnant Women
Fibre Rich Food
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
Psyllium – 3.5 g one to three times daily by mouth
Methylcelluose and Polycarbophil – 4-6g/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
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
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.
Dose – 5 – 15mg once daily.
Adverse Effect – Abdominal Discomfort, Cramps.
Overdose – Diarrhoea with excessive loss of water and electrolytes
Precautions – Should 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-pregnancyproblems.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.
