Written by Jessica McKinney, PT, MS and Samantha Pulliam, MD and sponsored by
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Things moving a little slower than normal? You may be among the 25 to 40% of women who experience postpartum constipation, typically marked by excessive straining, abdominal pain, bloating, hard, difficult-to-pass stools, or a sense of incomplete emptying.
What causes these digestive problems? Constipation in the early postpartum period may be related to the pregnancy hormone progesterone, which relaxes and slows the motion of digestion, making things a bit more sluggish. You may eat less or at irregular times compared to normal during labor, delivery, and the first weeks postpartum, which can take its toll on the digestive tract. There is also some evidence that decreased abdominal muscle function, which can happen as a result of these muscles stretching or thinning during pregnancy and delivery, can add to constipation symptoms. Other factors, such as lower than normal physical activity or continued iron supplementation can also contribute to constipation.
In addition to this, there is a real fear factor. That’s right! If you have hemorrhoids or had an episiotomy or perineal tearing during delivery, fear of pain with a bowel movement can absolutely slow things down or bring them to a stop. The demands of new motherhood are immense, and it’s easy to ignore your body’s signals while learning and responding to the signals from your new baby – but when you have to go, it’s important not to wait. Waiting can make it harder to go later.
Often, constipation can be managed well with diet and exercise. It’s important to drink lots of water and eat fiber-rich foods, such as fruits, vegetables, and whole grains. You may also want to discuss options for fiber supplements or stool softeners with your health care provider. If you are taking iron supplements, there may be alternatives that are gentler on your gut. Physical activity and an eventual gradual return to exercise is also important to regulate bowel function. Talk to your health care provider if you have any concerns about when to start (or resume) your exercise routine.
About the authors:
Ms. McKinney is a physical therapist and has specialized in pelvic and women’s health throughout her career. Her background includes women’s health education, advocacy, and business and program development in the US as well as in low-resource global health settings. She currently serves as Vice President of Medical Affairs and Clinical Advocacy at Renovia Inc.
Dr. Pulliam a fellowship-trained and board certified urogynecologist, a subspecialty of medicine focused exclusively on female pelvic health. She has been in clinical and leadership positions at Massachusetts General Hospital and the University of North Carolina (Chapel Hill), as well as within the American Urogynecologic Society, and she currently serves as the Chief Medical Officer at Renovia Inc.
Sources
- Eb T, Musekiwa A, Ac R. Interventions for preventing postpartum constipation ( Review ). 2015;(9). doi:10.1002/14651858.CD011625.pub2.www.cochranelibrary.com.
- Shin GH, Toto EL, Schey R. Pregnancy and Postpartum Bowel Changes : Constipation and Fecal Incontinence. Am J Gastroenterol. 2015;110(4):521-529. doi:10.1038/ajg.2015.76.
- Rao SSC, Patcharatrakul T. Diagnosis and treatment of dyssynergic defecation. J Neurogastroenterol Motil. 2016;22(3):423-435. doi:10.5056/jnm16060.
- Massery M. Multisystem consequences of impaired breathing mechanics and/or postural control. Cardiovasc Pulm Phys Ther Evid Pract. 2006:695-717.
