Postpartum Constipation

Category: Birth & Beyond

Experiencing postpartum constipation? Here’s everything you need to know about this uncomfortable condition, and the ways you can help to relieve it.

WORDS CHRISTEL GERALYN GOMES

Constipation can be a real pain (no pun intended) and even more so if you’ve had it during pregnancy and are now hoping that since you’ve delivered, your long spell of pregnancy-related physical discomfort is at its end. Unfortunately, that’s not always the case. Here’s everything you need to know about postpartum constipation, and the ways you can help to relieve it.

First, it’s more common than you would think. “At least 20 per cent of mums experience some degree of constipation after giving birth,” says Dr Kelly Loi, obstetrician and gynaecologist at the Health & Fertility Centre for Women, at Paragon Medical.

But the good news is that it won’t last very long. You can expect for the problem to improve by itself fairly quickly. Sometimes it lasts a few days… maybe two weeks. Your bowels should definitely be moving normally after the six-week postpartum period. If it doesn’t automatically clear up, be sure to alert your doctor.

What Causes Postpartum Constipation?
Our doctors tell us that postpartum constipation is caused by a few different things:

1. A lack of internal regularity
According to Dr Watt Wing Fong, specialist in obstetrics and gynaecology & consultant, Raffles Women’s Centre, “pregnancy hormones can cause a relaxation of the smooth muscles in your intestines which reduce bowel activity”. During pregnancy, your body has higher levels of progesterone in it – which is why you might have had constipation during pregnancy as well. It takes a while for your hormonal levels to go back to normal and so it’s fairly usual if you have a few days of constipation despite having delivered.
 
2. Pregnancy drugs or prenatal vitamins
There are a variety of pregnancy-related drugs and supplements that may cause constipation. “If you had drugs for pain relief during labour, such as pethidine or codeine, it may have slowed down your bowels,” says Dr Loi. Dr Watt concurs, saying various painkillers can reduce intestinal motility, such as tramadol or ultracet. “Vitamin or mineral supplements such as calcium and iron can also cause constipation,” she adds.

3. A tender perineum or haemorrhoids
You may also be avoiding pushing as hard as you normally would if you have an episiotomy wound after a vaginal birth. “Pain at that site or fear of the wound tearing may cause the woman to avoid straining,” says Dr Watt. You may have a similar problem if you’re having haemorrhoids after all that pushing during delivery. “Pain from haemorrhoids also cause the woman the woman to hold back. Sometimes there may be an injury to the anal sphincter with vaginal birth, and this may contribute to the constipation,” the doctor adds.

4. Keeping your bowels in
If you’re keeping your bowels in for longer than you should, water gets absorbed from the stool, making your stool much harder and causing constipation. It may also be partly psychological if you are “feeling apprehensive about going to the loo, especially if you have stitches and bruising”, says Dr Loi.

Do your best not to delay going to the bathroom once you get the urge. Mothers tend to put it off especially if they are in the midst of breastfeeding. “This will also contribute to hard stool,” says Dr Watt.

5. Confinement practices
This should come as no surprise – confinement practices may do more harm than good. “Some confinement food is quite ‘heaty’ and often women are advised against drinking water by their parents or confinement nanny. Such practices should be discouraged,” Dr Watt advises.

Dietary Solutions
The main thing you can do is to increase your intake of fibre. “Try to eat high-fibre foods, such as wholegrain rice. Also, try eating figs and prunes which are natural mild laxatives,” advises Dr Loi.

Dr Watt agrees. “Eat more fruits and vegetables. Dried fruits like raisins help. Take complex carbs such as brown rice, cereal, and wholemeal bread. Yogurt may also help as it is rich in good bacteria which improves intestinal health.” Of course, both experts stress that you should never forget the importance of water – no less than eight glasses a day! “Drinking fluids will make your poo softer and easier to pass. If you are breastfeeding you will need to rehydrate even more, so you’ll need to drink lots,” says Dr Loi. On the flipside, if your body thinks it doesn’t have enough water, it will absorb more water in the intestines, causing your stool to harden.

Helpful Tips
There are a couple other things you can do if you want to minimise your risk of getting constipated after childbirth – the first thing you can do is to get out of bed as early as you can after delivery. “Take short walks around the ward, or around your home. Sitting or lying down for long periods makes constipation more likely to happen,” Dr Loi asserts.
    
Keep this up in the days and weeks after delivery, even if you would rather not. “Going for walks instead of lying in bed most of the time also helps the bowel to get moving,” agrees Dr Watt.
    
That aside, ask your doctor how to choose supplements or painkillers which are less likely to cause constipation.

When to Visit Your Doctor
Dr Loi’s advice is that, “if you have severe constipation that is accompanied by abdominal pain, alternating with diarrhea, or you pass mucus or blood, you should let your doctor know”.
    
“Also, straining when passing a hard stool can lead to or worsen hemorrhoids”, she adds. Hemorrhoids are swollen veins in the rectal area. They can be extremely uncomfortable but they rarely cause serious problems and mostly disappear soon after the baby is born. “However, if the pain is severe or you have rectal bleeding, you should let your doctor evaluate you,” she finishes.
    
Dr Watt agrees, saying, “If it is causing significant distress or pain, an enema may need to be given. Occasionally it may be necessary to do a manual evacuation.”

Medical Solutions
Medical solutions are only necessary after dietary modifications fail. You can purchase stool softeners, fibre supplements, drugs that help stimulate bowel activity or probiotics over the counter at a pharmacy. “But take care not to overdo it,” cautions Dr Watt. Alternatively, see your doctor so he or she can prescribe something to suit you. There are different kinds of laxatives that are grouped according to function. You may opt for “bulk-forming laxatives (such as bran and methylcellulose) that increase the weight and water content of the stool to facilitate bowel movement; osmotic laxatives (such as lactulose) that add water to the colon; or stimulant laxatives (such as bisacodyl and senna), which act by irritating the intestinal wall”, says Dr Loi.

    “To start with, your doctor will probably suggest that you try a liquid laxative that you can swallow. If this doesn’t work after three or four days, they may suggest you try a laxative in the form of a suppository, which you can insert into your bottom,” she finishes.

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