Constipation in pregnancy
TOG 2015
Key content
• Constipation affects up to 38% of pregnancies.
• Rising progesterone levels in pregnancy contribute to slow gut motility.
• The standard clinical measures of chronic constipation are the Rome III criteria, which
are based on frequency and difficulty in the passage of stool.
• Secondary constipation is due to primary disease of the colon (anal fissure, stricture
and neoplasia), metabolic disturbances (hypothyroidism and hypercalcaemia) and
neurological disorders.
• Severe constipation may result in faecal impaction, retention of urine, pain or
abdominal discomfort, rectal bleeding and/or rectal prolapse.
• A treatment algorithm using laxatives that are effective, safe and non-teratogenic will
be discussed.
Introduction
Constipation is a frequent and debilitating problem worldwide. It affects twice as many women
as men.
In 2010, 15.9 million prescriptions were dispensed in the community in England for laxatives, at
a cost of £70.6 million.
Treatment of chronic constipation can be difficult and in some cases women may require years
of treatment.
Detailed prognostic data are currently unavailable and long-term adverse effects are unknown.
Functional (primary) constipation is defined as infrequent bowel motion and/or difficulty in
passing stool, which is not attributable to an underlying pathology.
Secondary constipation results from either pharmacotherapy or a medical condition. Medical
conditions include primary disease of the gastrointestinal tract (such as, anal fissure, colorectal
strictures and neoplasia), metabolic disturbances (such as, hypothyroidism, hypercalcaemia)
and neurological disorders. Some individuals may suffer from irritable bowel syndrome
associated with constipation (IBS-C).
Constipation occurs in all age groups and can be particularly problematic in the elderly.
Pregnancy, immobility and change in diet can also worsen constipation.
Constipation is perhaps most conveniently thought of as a symptom.
, In contrast, functional and secondary constipation can be regarded as disorders.
The prevalence of constipation is estimated to affect 11–38% of pregnancies.
Information on bowel dysfunction during pregnancy is limited.
Pregnant women may develop this symptom for the first time in pregnancy or may experience
worsening of their symptoms if they had previously suffered from constipation.
The Rome III criteria are the most commonly used classification for chronic constipation (Table
1). Although it is not specifically designed for pregnancy, a more simplified criteria that may be
more appropriate could include:
low frequency of defaecation (less than thrice per week),
passage of hard stools and/or difficulties in regularly emptying the bowels.
Table 1. Rome III criteria for functional constipation
Diagnostic criteria*
1 Must include two or more of the following:
• Straining during at least 25% of defecations
• Lumpy or hard stools in at least 25% of defecations
• Sensation of incomplete evacuation for at least 25% of defecations
• Sensation of anorectal obstruction/blockage for at least 25% of defecations
• Manual manoeuvres to facilitate at least 25% of defecations (e.g., digital evacuation,
support of the pelvic floor) f. Fewer than three defecations per week
2. Loose stools are rarely present without the use of laxatives
3. Insufficient criteria for irritable bowel syndrome
*Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis.
Reproduced with permission from the Rome Foundation.
A study demonstrated that pregnant women are most prone to developing constipation in the
first two trimesters.
The prevalence of functional constipation in the first and second trimester varies between 35%
and 39%, is 21% in the third trimester and 17% peurperium.
TOG 2015
Key content
• Constipation affects up to 38% of pregnancies.
• Rising progesterone levels in pregnancy contribute to slow gut motility.
• The standard clinical measures of chronic constipation are the Rome III criteria, which
are based on frequency and difficulty in the passage of stool.
• Secondary constipation is due to primary disease of the colon (anal fissure, stricture
and neoplasia), metabolic disturbances (hypothyroidism and hypercalcaemia) and
neurological disorders.
• Severe constipation may result in faecal impaction, retention of urine, pain or
abdominal discomfort, rectal bleeding and/or rectal prolapse.
• A treatment algorithm using laxatives that are effective, safe and non-teratogenic will
be discussed.
Introduction
Constipation is a frequent and debilitating problem worldwide. It affects twice as many women
as men.
In 2010, 15.9 million prescriptions were dispensed in the community in England for laxatives, at
a cost of £70.6 million.
Treatment of chronic constipation can be difficult and in some cases women may require years
of treatment.
Detailed prognostic data are currently unavailable and long-term adverse effects are unknown.
Functional (primary) constipation is defined as infrequent bowel motion and/or difficulty in
passing stool, which is not attributable to an underlying pathology.
Secondary constipation results from either pharmacotherapy or a medical condition. Medical
conditions include primary disease of the gastrointestinal tract (such as, anal fissure, colorectal
strictures and neoplasia), metabolic disturbances (such as, hypothyroidism, hypercalcaemia)
and neurological disorders. Some individuals may suffer from irritable bowel syndrome
associated with constipation (IBS-C).
Constipation occurs in all age groups and can be particularly problematic in the elderly.
Pregnancy, immobility and change in diet can also worsen constipation.
Constipation is perhaps most conveniently thought of as a symptom.
, In contrast, functional and secondary constipation can be regarded as disorders.
The prevalence of constipation is estimated to affect 11–38% of pregnancies.
Information on bowel dysfunction during pregnancy is limited.
Pregnant women may develop this symptom for the first time in pregnancy or may experience
worsening of their symptoms if they had previously suffered from constipation.
The Rome III criteria are the most commonly used classification for chronic constipation (Table
1). Although it is not specifically designed for pregnancy, a more simplified criteria that may be
more appropriate could include:
low frequency of defaecation (less than thrice per week),
passage of hard stools and/or difficulties in regularly emptying the bowels.
Table 1. Rome III criteria for functional constipation
Diagnostic criteria*
1 Must include two or more of the following:
• Straining during at least 25% of defecations
• Lumpy or hard stools in at least 25% of defecations
• Sensation of incomplete evacuation for at least 25% of defecations
• Sensation of anorectal obstruction/blockage for at least 25% of defecations
• Manual manoeuvres to facilitate at least 25% of defecations (e.g., digital evacuation,
support of the pelvic floor) f. Fewer than three defecations per week
2. Loose stools are rarely present without the use of laxatives
3. Insufficient criteria for irritable bowel syndrome
*Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis.
Reproduced with permission from the Rome Foundation.
A study demonstrated that pregnant women are most prone to developing constipation in the
first two trimesters.
The prevalence of functional constipation in the first and second trimester varies between 35%
and 39%, is 21% in the third trimester and 17% peurperium.
