Constipation in Pregnancy – some hard facts

Today we are going to be talking about Constipation in Pregnancy and to throw some nutritional light on this subject we have collaborated with our guest author, Nutritionist, Juhi Mimani.

She is beauty and brains personified, a celebrity nutritionist, she is the Founder of J M Nutrition after having completed her Graduation from Uk and then moving on to acquire a Diploma in Nutrition and Health Education and a Diploma in Dietetics, Health and Nutrition.

But before that lets address some basic facts regarding ill effects of constipation during pregnancy.

Can diet compound the problem of Constipation in pregnancy?

Lets understand how diet can help with this problem, lets try and understand the problem a little deeper. 
Constipation in pregnancy is the most common digestive problem in the world. Pregnancy is probably the most common event to happen in a woman’s life  ………………. When these two come together, it is a perfect recipe for disaster. Constipation affects about 38% of women in the 1st and 2nd trimester, 21% in the 3rd trimester and 17% post-delivery. It may happen for the first time in pregnancy or it might be an aggravation of a previously existing problem. Thus women who are already suffering from nausea, vomiting, bloating, weakness, headache, indigestion, aversion to food, …..whew…..dizziness, breast tenderness, and anxiety  to name a few of the problems, are further burdened by constipation, it seems like the final nail in the coffin.

10 reasons why constipation happens in pregnancy:

  1. In the first 9 weeks of pregnancy, before the placenta forms and takes, progesterone is secreted by the mothers body to support, nourish and maintain the pregnancy. The rising progesterone levels and sometimes the progesterone supplements that we give in pregnancy unfortunately reduce the intestinal smooth muscle motility thus making bowel movements slow.
  2. Progesterone also reduces the secretion of Motilin, a peptide hormone that promotes bowel motility
  3. Relaxin, a hormone that prevents uterine contractions also lands up relaxing the bowel muscles. Thus we see that a lot of good is happening in the body to protect the pregnancy but sometimes it lands up also causing some trouble like constipation.
  4. There is increased water absorption from the bowels and kidneys thus leading to reduced water content and hardening of stools.
  5. Nausea and vomiting leads to reduced water and fibre intake which adds to the problem
  6. If maternal activity is reduced, it can increase constipation. Moreover pregnant patients are generally inactive esp. in the first 3 months and this aggravates if they are put on bed rest
  7. Iron supplements are notorious for causing constipation
  8. thyroid disorders or irritable bowel syndrome can sometimes complicate matters in pregnancy by causing constipation
  9. In the 3rd trimester, the enlarging uterus may compress the bowels and slow onward movement.
  10. In the post-partum or after delivery stage haemorrhoids or piles, anal fissures or pain at episiotomy wound may be the reason for constipation. 

Besides the obvious discomfort which constipation causes, there are the 5 other problems associated with it in pregnancy

  1. Constipation leading to gas leading to more nausea and aversion to food
  2. Stomach pain 
  3. Anal fissure due to hard stools
  4. Excessive straining can lead to some nerve damage and weakening of pelvic muscles
  5. Excessive straining can also sometimes lead to bleeding into the pregnancy.

Lastly what are the 10 things you can do to relieve constipation;

  1. Start exercising but of course with the consent of your doctor
  2. Drink plenty of water
  3. Include a lot of fibre, figs and prunes in your diet. Ofcourse this will be dealt with in more details by Juhi Mimani, our guest of honour
  4. Take small frequent meals in your diet. That helps the stomach digest them more easily.
  5. Probiotics can normalize your gut flora and relieve constipation
  6. If you are on progesterone medication, ask your doctor if it can be reduced or stopped
  7. Speak to your doctor and stop iron medicines or change the brand or get iron injections administered if you are iron deficient.
  8. Limit the amount of caffeine you take
  9. There are some very safe medications which can be used. In pregnancy we obviously want to use as little medicines as possible but if we do have to, it would be a blessing if the medicines did their job without even getting absorbed into the system thus ensuring they won’t have any effects on the baby. Bulk forming agents like Isabgul husk, osmotic laxatives like lactulose and Macrogols do just that. Oral medicines that one normally uses for constipation in the non-pregnant state should not be used in pregnancy as it can be harmful to both the mother and the baby. Your doctor knows best….speak to him or her for advise at this step. 
  10. Lastly speak to your nutritionist. Technically this should come before you take medicines from your doctor for constipation. Diet has a huge role to play in relieving constipation and we are doing to do just that today. 

Lets find out what Nutritionist Juhi Mimani has to say on the topic of diet in relation to constipation in pregnancy:

Patients come to nutritionist Juhi Mimani, because they have heard from countless other people about how fantastic she is with her work. Here’s is her expert advise on this topic:

Constipation in pregnancy is an issue that can very easily be treated by a well planned diet. 

First lets talk about some of the primary foods that are in most cases the cause of constipation. The very first and probably the biggest culprit of constipation and various other problems during pregnancy is “processed and packaged foods.” Whilst all of us like to have packaged foods because of taste or convenience, what we need to realise is that the high contents of sugar, salt, sodium, preservatives etc in these foods completely rid us of any and all nutrients that our body consumes. This leads to major indigestion & gastric distress, increase in blood pressure and a compromise of our overall health. Few examples of these are chips, breakfast cereals (cornflakes etc.), biscuits, processed breads, aerated beverages, jams, sugary products etc.

Another type of foods to avoid is any refined food produce like Refined flour or maida, sugar, basmati rice etc. These refined food products despite being used in everyday cooking at home have been stripped off their fibres and most other nutrients in the processing stage. As a matter of fact, even something as simple as fresh squeezed fruit juices have lost all fibre content and as such contribute to poor digestion and constipation.

Let us now discuss the foods which are very rich in fiber and will help us in treating or limiting constipation.  

  1. Dried fruits like dates, prunes, figs. Incidentally, dates and prunes can be made into a paste and can be a great substitute for sugar in your everyday diet. These dried fruits are naturally rich in fiber and iron as well. While iron supplements can cause constipation, the fiber content here helps to ease the ill effects of the same while providing the body with natural iron.  
  2. Seeds like Chia seeds & fenugreek are a natural laxative and help in regulating the bowel movements. We can easily put fenugreek in parathas, rotis, curd or even salads. A great way to add chia seeds in your meals is by adding them to porridge, oatmeal, coconut water or butter milk. A yummy and fancy way to consume this is to make a breakfast bowl with cold oatmeal, fresh fruits, chia seeds and honey!!! Just remember not to add this to anything hot!!
  3. Whole eggs – Contrary to popular belief, a whole egg omelette is much better than an egg white omelette to ease constipation. This is basically because of the good fats like Omega 3 & Omega6 which is only there in the yolk of the egg and is much needed during pregnancy. A tip to make the perfect breakfast to help you here would be whole eggs omelette made with lots of green vegetables for a delicious and wholesome meal!!
  4. Fruits & Vegetables can add extra roughage to the diet. Some of the recommended fruits and vegetables would be Pears, Cheekoo, Mangoes, bananas, spinach, broccoli, onions, lettuce, beetroot etc. Remember roughage is your ally in this fight against constipation.
  5. Pulses and lentils like green moong dal, rajma, chola etc. Khichdi is a super food which can be made out of different types of dal.
  6. Let us not forget the age old traditional foods like ghee and Indian spices like turmeric.
  7. Other recommended foods to add to your diet would be unstrained soups, dahliya & barley. They are rich in multiple nutrients and are great for you!!

A lot of people either have pre existing allergic conditions or develop allergies to foods during pregnancy which can also be a cause of indigestion and constipation. The most common allergies or intolerance are towards Gluten and/or lactose. For those of you who have a gluten allergy, the best substitute grains are Ragi, Buckwheat, jowar and bajra. These are often considered more nutritious as they are high in iron & fibre both. People with lactose intolerance should switch to soyamilk or oatmilk which are lactose free and full of proteins.

Sometimes even though we know what foods can help us to avoid certain issues, we are often confused as to how we can inculcate the same into our daily meals. So here is a basic step by step approach to help us to avoid constipation. 

First start your day with 10 raisins OR 2 dates. This needs to be the first thing that you eat in the morning. 

Secondly add 2 tsp of chia seeds in either a glass of buttermilk or coconut water.

Also add 3 fruits in your daily diet. Recommended ones are pears, bananas, oranges, mangoes

Follow these recommendations for about 3-4 days and check if this eases your constipation. In case these recommendations dont help at all then we need to add on 2 more steps which are 

Drink a cup of warm milk with turmeric before sleeping / for people who are lactose intolerant can have a cup of soyamilk instead. 

And having a small portion of salad with all your main meals. 

These 5 steps will definitely ease out constipation issues in most cases. In case even after following these 5 steps for a few days does nothing to cure constipation, then you should speak to your doctor and get medication for the same. I would also like to reiterate a couple of points that Dr. Rajeev has already made which are regular exercise and proper water intake. Both of these are of utmost importance. 

Overall during the pregnancy period in particular, we should always focus on having whole foods as they contain all natural nutrients which are unadulterated and perfectly synced to the needs of our body. 

I sometimes feel that people underestimate the value and power of diet and diet management. I advise each and every single pregnant patient of mine to undergo a diet consult irrespective of whether they have a problem or not. A lot many of them have the same standard answer that ; oh but doctor, my diet is anyways very light and healthy, I don’t think I need a diet consult’………. fine that’s still fair but when that same reply also comes despite them having constipation, excess weight gain or gestational diabetes, then as their doctor I am definitely concerned.

Also read: Nausea and vomiting in pregnancy

This brings me to the end of yet another discussion. This discussion is also available as a podcast – check out here.

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Do email me on if you have any queries or if you want me to create a podcast on any topic of your choice. 

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