Imagine being pregnant and unable to have a bowel movement for over a month. This happened to Ivana Gogh* from Pittsburgh. Needless to say, she was very uncomfortable. Her stomach hurt a lot and she felt bloated. Her belly was distended, and it wasn't from the pregnancy—because at 8 weeks she was too early to be showing as much as she was. Gogh was extremely fatigued and barely had enough energy to take care of herself, much less her toddler. Many days it was a struggle to even shower. Unfortunately, Gogh's predicament—while extreme in its length—is common for pregnant women.
More than 50 percent of all pregnant women suffer some degree of constipation, says Dr. Ken Troffater, director of Maternal-Fetal Medicine at the University of South Carolina. "It is probably only second to headaches among common pregnancy complaints. Think of it as 'nature's way' of getting the mother to absorb the most food and fluid from her diet she possibly can to help maintain the pregnancy."
The Three Ws: What, When, and Why
The standard definition of constipation is having a bowel movement less than three times per week, but in Dr. Trofatter's experience, even this can't be defined as constipation unless it's accompanied by hard, dry stool that requires straining to eliminate. This discomfort can start early in the first trimester, but usually becomes more of a problem from 20 weeks on, Dr. Troffater says. He says that some people are unusually prone to constipation because of poor fluid or fiber intake in their diets, so it can be a chronic problem throughout the pregnancy.
What causes this lovely side effect of pregnancy, anyway? A primary cause is the hormone progesterone, which is made in large amounts by the placenta by the end of the first trimester. "One of the major effects of progesterone is to cause relaxation of 'smooth muscles,'" Dr. Trofatter says. "Progesterone decreases the strength and frequency of bowel contractions. The slower the motility of the bowel, the greater the opportunity for absorption of fluids and foods. Unfortunately, by the end, if the remaining waste becomes very dehydrated, the stool becomes compact and hard, making it more uncomfortable to pass, sometimes getting to the point where a woman will not have a bowel movement for five or more days. This is constipation and it can be very uncomfortable." He says other causes are iron and calcium supplements, poor fluid and fiber intake, and too little exercise during pregnancy.
There is also an anatomical effect, says Dr. Madhuri Bewtra, an OB-GYN in Bergen County, New Jersey. The uterus enlarges, the fetal head is in the pelvis, and the pelvic floor relaxes as the pregnancy progresses, causing the lower intestine and rectum to become compressed.