With the body going through so many changes in pregnancy, feeling stuck can be common in more ways than one. Around 25% of pregnant women experience challenges with constipation at some point in pregnancy, and can also present as a post-natal worry. But what is the deal on why is becomes so hard to unload?
Bowel habits vary from one person to the next, but generally constipation refers to the delay of food residue, often combined with abdominal discomfort and/or painful defecation (the act of pooping). This can happen in pregnancy because of:
an inadequate intake of dietary fibre - whether it is due to challenges with nausea and vomiting in pregnancy, or simply previously insufficient amounts due to general habits (which can cause the same issue even outside pregnancy).
iron supplements, commonly prescribed to meet the increased requirements for pregnancy, which can also contribute to constipation.
the pressure of the growing uterus against the intestines.
Stress hormones, which can also slow down gut motility, can be more of a common in pregnancy for many reasons (oh my gosh, I'm growing a human; oh my gosh I have to give birth; oh my gosh I have to teach a human about life - to name just a few)
So why should we be proactive in unclogging the pipes?
Whilst there is little negative impact on the baby, it can be important to manage constipation to reduce discomfort, reduce unnecessary straining pressure on the pelvic floor and reduce the risk of abdominal separation, and to reduce the risk of haemorrhoids (an avoidable pain in the bum!)
Another big incentive: the first bathroom visit after bub is born.
Whether you have a vaginal or c-section delivery, the first bowel movement after birth can be one that makes you want to cross your legs, even after reminding yourself that you have just given birth to a full sized baby…
But there are definitely some lifestyle habits and techniques that help make more ease of the whole process, especially if you are in recovery from a c-section, episiotomy, prolapse or even feeling fatigued or weak after a challenging labour.
So what can be done to flush the system?
WHAT GOES IN
There are various types of fibre, including soluble fibre, insoluble fibre and prebiotic fibres (including resistant starch).
Soluble fibre is what dissolves in water to form a gluggy gel in the system by attracting fluid and softening the stool to make it easier for waste to move through the bowels. The added benefits of this type of fibre is that it slows gut transit time and helps us feel fuller for longer, helps steady blood glucose levels, and also lower levels of the ‘bad’ low density lipoprotein cholesterol (LDL-C), related to the risk of heart disease and some cancers.
Insoluble fibre, which includes parts of plants like cellulose, hemicellulose and lignin, does not dissolve in water but adds bulk to the stools and speeds up waste being processed out of the body.
Prebiotics include starches that are resistant to digestion in the human body, and provide food for the growth of some bacteria like probiotics (the good bacteria!)
The right combination and amount of these types of fibre have been the new pieces to the research puzzle for many aspects related to mums and baby's physical, immune health and even mental health during and after pregnancy – so much great information – stay tuned for more on this soon!
Essentially a variety of vegetables, fruit and wholegrains is what is needed for a good balance between all these types of fibres. Follow the link for a guide on quantities of serves for foods in pregnancy and during breastfeeding: Healthy Eating during your Pregnancy. If you are usually not in the habit having as many of these fibrous foods, aim to slowly increase over two to three weeks to reduce the common side effects like gas, discomfort and sudden added blockages.
Watch this space for exciting high fibre recipe ideas!
To help move along all this fibre, fluid is also essential. Whilst everyone's daily needs will differ (depending on physical activity, season etc) there is a general fluid guide for what to aim for from water and other fluids:
Pregnancy – 2.3 L/day (around 9 cups)
Breastfeeding – 2.6 L/day (around 9-10 cups; to meet the fluids lost to breastmilk)
Again, this is only a guide, and you can also check your hydration status by the colour of your morning urine, reflecting how well you hydrated the day before. No need to be too attentive to the 50 shades of yellow, but generally if you look back - darker yellow generally means you’re in need of more H20.
MOVING THE MOTIONS
Whilst exercise alone has little evidence for improving constipation, the combination of fibre, fluid and physical activity is known to improve gut motility. Bodily movement stimulates the nervous system, assisting the muscles and nerves in the gut to work better. The added benefits on mood, weight, and baby moving into position are also just some other incentives to keep moving regularly.
Believe it or not, the good ol’ squatty potty position is much more effective in easing out bowel movements than upright seated position we take on the he well-known ceramic throne. This is due to the angle created by the knees being higher than the pelvis which:
1) relaxes the Puborectalis muscle - one of the pelvic floor muscles that loops around the rectum (where poop leaves you), and
2) also creates a more effective angle for the passage out of the body.
So, here are a few little hints on positioning to empty without straining (I suggest being close to or on the toilet, just in case):
1) Get comfy:
Use a stool or some old yellow pages (does anyone even have these anymore?) to get your knees higher than hips and try to keep your legs apart.
lean slightly forward
rest your elbows on your knees .
2) Breathe slowly and gently as you allow all the muscles of the core and pelvic floor relax,
3) With each urge , it can help to exhale through your mouth slowly to empty your bowels, simulating or actually saying words like "ooo' (if you feel comfortable enough to say this in a public bathroom then go right ahead, otherwise just pretend)
Remember to keep breathing and take your time, avoiding straining if you are usually in the habit of this.
If these strategies are still not helping with unclogging the pipes, speak to your midwife or doctor about other potential underlying causes for constipation or to find the safest medical options for pregnancy and breastfeeding.
At the end of the day, this is definitely a case of better out than in. Happy pooping.