About Postpartum Constipation

Overview

Postpartum constipation happens when new mothers have trouble with bowel movements after giving birth. Stools may come less often, feel incomplete, or require a lot of effort or even help to pass. It’s common but not often talked about. The causes of postpartum constipation can vary and may include:

• Hormonal changes
• Eating less during labor
• Not drinking enough water during labor
• Painkillers or opiates used during labor
• Pain from a perineal tear or cesarean section
• Hemorrhoids
• Injury to the pelvic floor muscles

Postpartum constipation symptoms include trouble passing stool, needing to strain a lot or use help to go, and feeling pain or seeing bleeding from the rectum during or after bowel movements. Treating it quickly is important to keep new moms comfortable and avoid further issues.

Causes and Risk Factors

Postpartum constipation can have several root causes, including:

• Hormonal changes: After childbirth, there is a decrease in the hormone progesterone, which can slow down bowel movements and lead to constipation.
• Reduced muscle tone: The stretching and relaxation of the pelvic floor muscles during pregnancy and childbirth can result in weakened muscle tone, making it harder to pass stool.
• Dehydration: Many new mothers may not consume enough fluids, leading to dehydration. This can contribute to harder stools and difficulty passing them.

The non-modifiable risk factors for postpartum constipation include:

• Previous history of constipation: If a woman has experienced constipation before pregnancy, she may be more prone to postpartum constipation.
• Multiple pregnancies: Women who have had multiple pregnancies are at a higher risk of developing postpartum constipation.

The modifiable risk factors for postpartum constipation include:

• Lack of physical activity: Inactivity or a sedentary lifestyle can contribute to slower bowel movements and constipation. Regular exercise can help promote healthy digestion.
• Poor diet: A diet low in fiber and high in processed foods can lead to constipation. Including fiber-rich foods like fruits, vegetables, and whole grains in the diet can help prevent constipation.
• Medications: Certain pain medications or supplements taken after childbirth may cause constipation as a side effect. It is important to discuss any medications with your healthcare professional.

Remember, these are general factors that may contribute to postpartum constipation. It is always best to consult with your healthcare professional for personalized advice and management strategies.

Symptoms

The most common early symptoms of postpartum constipation include:

• Infrequent bowel movements: Having fewer bowel movements than usual is a common sign of constipation. It may take several days before you have your first postpartum bowel movement.

Other common symptoms that may occur with later stages, progression, or higher severity of postpartum constipation include:

• Abdominal pain and bloating: Constipation can cause discomfort in the abdomen, leading to pain and bloating.
• Hard and lumpy stools: When constipated, stools can become hard and difficult to pass. This can further contribute to discomfort and straining during bowel movements.
• Hemorrhoids: Hemorrhoids are swollen blood vessels in the rectum that can cause pain, itching, and bleeding. They are common during pregnancy and can be exacerbated by constipation.
• Fecal incontinence: Strenuous pushing during delivery can weaken the pelvic floor muscles, leading to symptoms of anal incontinence, including difficulty controlling gas and stool.

Remember, it is important to consult with your healthcare professional for an accurate diagnosis and appropriate management of postpartum constipation. They can provide personalized recommendations based on your individual situation.

Diagnosis

To diagnose postpartum constipation, doctors may perform the following examinations, tests, and procedures:

• Physical exam: A general examination of the body to check for signs of disease or abnormalities. This may include checking for bowel sounds and a swollen, painful abdomen.
• Digital rectal exam (DRE): An examination of the rectum and sometimes the vagina in women. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for any lumps or abnormalities.
• Fecal occult blood test: A test to check for blood in the stool that can only be seen under a microscope. Small samples of stool are placed on special cards and sent to a laboratory for testing.

Additional examinations, tests, and procedures to determine the stage or severity of postpartum constipation may include:

• Blood tests: These tests can help identify any underlying medical conditions that may be contributing to constipation.
• Ultrasounds: These imaging tests can provide a visual examination of the abdomen and pelvic area to look for any abnormalities or blockages.
• X-rays: X-rays can help visualize the intestines and identify any obstructions or abnormalities.

It is important to consult with your healthcare professional about which examinations, tests, and procedures are appropriate for your individual situation.

Treatment Options

The goals of treatment for postpartum constipation are to relieve symptoms and promote regular bowel movements. Here are the various treatment options and how they work to achieve these goals:

• Medication types:
• Stool softeners: These medications, such as docusate sodium, help soften the stool, making it easier to pass.
• Over-the-counter laxatives and softeners: These include psyllium and methylcellulose, bisacodyl, senna, or castor oil. They help stimulate bowel movements or soften the stool.
• Therapies:
• Pelvic floor muscle training (PFMT): This therapy involves exercises to strengthen the pelvic floor muscles, which can help improve bowel function.
• Health behavior changes:
• Hydration: Drinking plenty of water and other liquids helps prevent dehydration and keeps the stool soft.
• Increasing fiber intake: Consuming fiber-rich foods like whole grains, bran, lentils, and beans adds bulk to the stool and promotes regular bowel movements.
• Natural laxatives: Eating foods like prunes that have natural laxative properties can help alleviate constipation.
• Exercise: Engaging in gentle exercise, such as squats, can stimulate bowel movements.

It is important to consult with your healthcare professional before starting any medication or making significant changes to your diet or exercise routine. They can provide personalized advice based on your individual situation.

Medication dosing may be affected by many factors. Check with your healthcare professional about dosing for your individual situation. Other side effects can occur. Check with your healthcare professional or read the information provided with your medication for additional side effect information.