Condition Management
Constipation is common in pregnancy affecting approximately 40% of women. It is thought to be caused by progesterone-induced intestinal smooth muscle relaxation.
It is important to complete an individual risk assessment for your patient and to apply the principles of prescribing during pregnancy when looking at the available information and making treatment decisions. Check to see if a risk assessment has already been completed.
Guidelines
NICE CKS Constipation refers to UKTIS Treatment of constipation in pregnancy for advice on medicines to treat constipation.
You should check if there is local guidance for you to use in your area.
Stepwise recommendations
The CKS recommends a stepwise approach starting with non-pharmacological measures if appropriate or possible, through the range of pharmacological options:
Non-pharmacological management
- Exercise, dietary measures and increased fluid intake.
Pharmacological management
If lifestyle measures are ineffective, or symptoms do not respond adequately, offer short-term treatment with oral laxatives.
Adjust the dose, choice, and combination, depending on symptoms, the desired speed of symptom relief, the response to treatment, and the woman’s personal preference.
First line
Bulk-forming laxatives e.g. ispaghula husk, sterculia or wheat bran.
Second line
Osmotic laxatives lactulose and macrogol – the manufacturers state that use in pregnancy may be considered if necessary.
Other options
If stools are soft but difficult to pass, or there is a sensation of incomplete emptying, consider a short course of a stimulant such as senna.
If the response to treatment is still inadequate, consider a glycerol suppository.
Pregnancy outcome information
The UK Teratology Information Service (UKTIS) provides an overview of the treatment of constipation in pregnancy which provides information on the individual treatments.
Patient information
Each of the UKTIS summaries has corresponding Best Use of Medicine in Pregnancy (BUMPS) patient information.
NHS Medicines A-Z provides a summary statement on the use in pregnancy of specific medicines include isphagula husk, lactulose, macrogol and senna.