Constipation is one of the frequent ailments of pregnancy. Due to various factors, transit tends to slow down in pregnant women. The hygieno-dietetic measures generally make it possible to prevent constipation. In case of failure, the use of certain laxatives is possible.

Constipation is thought to affect between 11 and 38% of pregnant women (1). It affects expectant mothers who are usually subject to this transit problem as well as those who have never suffered from it before.

During pregnancy, different factors promote constipation:

• to promote the growth of the uterus, the strong secretion of progesterone causes relaxation of all tissues, including the smooth muscles of the large intestine. Less tonic, its motility is less efficient and intestinal transit is slowed down;
• with the decrease in physical activity over the weeks, the intestine is mechanically less stressed and less well oxygenated;
• over the weeks, the uterus compresses more and more the intestine, whose functioning already slowed down under the effect of hormones, becomes even more lazy;
• some iron supplements prescribed during pregnancy for the prevention or treatment of anemia may promote constipation, depending on the type of product.

Constipation is often more marked during the second part of pregnancy. It can last for two to three months after childbirth. The transit then returns normally to its previous state.

Various hygieno-dietetic measures help prevent constipation during pregnancy. They are the same for the pregnant woman, as the rest of the population Namely:

• eat a diet rich in fiber (fruits, especially cooked vegetables, whole or semi-complete cereals and bread, wheat, oat or rice bran, legumes, oilseeds), which facilitate intestinal transit. To avoid bloating, abdominal distension and gas, it is important to gradually increase your daily intake of fiber. We can, for example, start by replacing white bread and refined cereals (pasta, rice) with their semi-complete version. If the raw vegetables and fruits cause ballooning, prefer their cooked version;
• hydrate sufficiently, at a rate of 1,5 to 2 liters of water. Ideally, choose it rich in magnesium, a mineral that promotes transit. To hydrate, also think of herbal teas, broths, diluted fruit juice;
• prune is known to promote transit thanks to a substance called dihydroxyphenylisatin, which would stimulate peristalsis (muscle contractions of the digestive system). To be consumed at a rate of 2 to 3 per day in dried form or in the form of juice;
• favor dairy products with active bifidus, a probiotic that helps regulate intestinal transit;
• flax seeds, rich in mucilages (fibers not absorbed by the intestine) can be added at the rate of one spoon, crushed in yogurt.

Conversely, all foods and drinks that are difficult to digest or have a tendency to cause gas should be limited: fried foods, dishes in sauce, pastries, soft drinks, etc. Certain foods such as white rice, chocolate, bananas, cooked carrots are also known to slow transit (hence their recommended consumption in case of diarrhea).

On a daily basis, various actions help prevent or treat constipation:

• maintain regular physical activity suitable for pregnancy (walking, swimming, gentle gymnastics). By exerting a kind of massage of the intestines through a mechanical effect, moving in fact stimulates transit;
• when getting up, drink a large glass of cold water to wake up the transit;
• have a bowel movement as often as needed and avoid holding back;
• in the saddle, adopt the most efficient position for defecation: the knees raised above the hips, for example by placing a small step under the feet.

If constipation persists despite hygienic and dietary measures, do not hesitate to talk to your doctor, gynecologist or midwife. It is important to find a good transit for its comfort on a daily basis but also to prevent hemorrhoids favored by constipation due to the pushing effort, but also urinary infections.

In addition, in the event of bleeding during bowel movements, vomiting, abdominal pain and stopping digestive gas, a rapid consultation is required in order to rule out any risk of intestinal obstruction.

Finally, if constipation has appeared or worsened after starting to take iron supplements, talk to your doctor in order, possibly, to change the supplementation to a more easily assimilated form.

Some laxatives may be prescribed during pregnancy while others should be avoided. The Reference Center on Teratogenic Agents in Pregnant Women (2) thus recalls that the following two types of laxatives are to be favored during pregnancy:

• ballast laxatives: these are fibers, generally mucilages alone or in combination, derived from gum (guar), seeds (sterculia, ispaghul, psyllium) or bran. Not absorbed by the digestive tract, they increase the volume and hydration of the stool and thus promote transit;
• osmotic laxatives: based on polyethylene glycol (PEG) or sugars such as lactulose, lacticol or sorbitol, they act by increasing the volume of salts.

The occasional use of a lubricating laxative such as unassociated paraffin oil is possible but not recommended during pregnancy, as it may decrease the absorption of fat-soluble vitamins (A, D, E, K).

Stimulating laxatives based on anthracenes (extracts from various plants: aloe, anise, fucus, buckthorn, boldo, tamarind, cascara, senna), docusate sodium, bisacodyl or picosulfate sodium are not recommended during pregnancy with the exception of senna, whose data concerning pregnant or breastfeeding women are numerous and reassuring.

In homeopathy, different remedies are used against constipation during pregnancy, depending on the symptoms. To take Sepia officinalis 7CH et Nux vomica 5CH, 5 granules of each 3 times a day, and add according to the symptoms:

• in case of associated hemorrhoids: Collinsonia canadensis 5CH, 5 granules morning and evening;
• in case of safe stools, without wanting to go to the toilet: Hydrastis canadensis 5CH;
• in case of bloating, painful spasms, frequent gas: Raphanus niger 5CH et China rubra 5CH, 5 granules of each 2 times a day.

In acupuncture, there are different points to stimulate the transit from a distance. Consult a physician trained in acupuncture, or a midwife with an obstetric acupuncture IUD.

Finally, osteopathy can help restore the transit of the mother-to-be by working in particular on the mobility of the colon, its vascularization, the tone of the abdominal strap and the spine.