Postpartum Laxatives: Safe?

Constipation is a common issue for people who have recently given birth, affecting around 52% of new parents. While it's an unpleasant and often embarrassing issue, there are several ways to treat it. It's important to consult a healthcare professional before taking any new medication, including laxatives.

Laxatives are medications used to treat constipation and can come in the form of osmotics, fibre or bulk, stool softeners, stimulants, and lubricants. Osmotic laxatives work by pulling water into the intestines, while fibre or bulk laxatives include psyllium and methylcellulose. Stool softeners such as Colace are also considered safe for people who are breastfeeding. Stimulants and lubricants may cause stomach cramps, which can be severe.

Before turning to laxatives, it's recommended to try treating constipation through diet and lifestyle changes. This includes staying hydrated, eating fibre-rich foods, and engaging in gentle exercise.

When to take a laxative after giving birth

Constipation is a common issue after giving birth, affecting around 52% of people. It is usually caused by a combination of factors, including changes to the anal sphincter or pelvic floor muscles, medications, iron supplementation, and perineal pain or discomfort. It is important to address constipation as it can lead to further complications such as rectal prolapse or fecal impaction.

Understand the causes of postpartum constipation:

Postpartum constipation is often caused by a combination of factors, including changes to the body during pregnancy and delivery, such as stitches from an episiotomy or C-section, damage to the pelvic floor or anal sphincter muscles, and the added weight gain and pressure of carrying a baby. Understanding these causes can help you identify when you might need to take a laxative.

Monitor your bowel movements:

Keep track of your bowel movements, especially during the first few days after giving birth. Postpartum constipation usually shows up within the first few days and can last for three to six months or even longer. If you notice that you haven't had a bowel movement for four days after giving birth, it may be time to consider taking a laxative.

Make dietary and lifestyle changes:

Before taking a laxative, try making some dietary and lifestyle changes to see if they help relieve constipation. Drink plenty of water and other fluids, eat high-fiber foods such as whole grains, fruits, and vegetables, and increase your physical activity. These changes can help promote healthy bowel movements and may reduce the need for a laxative.

Try over-the-counter options:

If dietary and lifestyle changes don't provide relief, you can try over-the-counter options such as bulking agents or fiber supplements like psyllium or methylcellulose. These are generally safe and effective for most people. However, it's always a good idea to consult your healthcare provider before taking any medication, including over-the-counter laxatives.

Consult your healthcare provider:

If your constipation persists despite your efforts, consult your healthcare provider. They may recommend a stronger laxative or stool softener, such as docusate sodium (Colace), to help rev your digestive tract and relieve constipation. They can also advise you on whether any medications or supplements you are taking could be causing constipation and discuss any potential changes.

Remember, it is important to seek help for any lasting symptoms of constipation as it can lead to more serious complications. Don't suffer in silence – there are effective treatments available to help you manage postpartum constipation.

Types of laxatives to take

Laxatives are a type of medicine that can treat constipation. They are available over the counter in pharmacies and supermarkets, as well as on prescription from a doctor. There are four main types of laxatives: bulk-forming, osmotic, stool softeners, and lubricants.

Bulk-Forming Laxatives

Bulk-forming laxatives work by increasing the weight of faeces, which stimulates the bowel. They typically take two to three days to work. Examples include Fybogel (ispaghula husk), psyllium (Metamucil®), and methylcellulose (Citrucel®).

Osmotic Laxatives

Osmotic laxatives draw water from the rest of the body into the bowel, softening faeces and making it easier to pass. They also take two to three days to work. Examples include lactulose (Duphalac, Lactugal), macrogol (Movicol, Laxido, CosmoCol, Molaxole, Molative), and magnesium hydroxide (Milk of Magnesia®).

Stool Softener Laxatives

Stool softeners, also called emollient laxatives, increase the water and fat that faeces absorb, softening it. An example is docusate (Colace®).

Lubricant Laxatives

Lubricant laxatives coat the colon, preventing it from absorbing water from faeces, so it stays soft. An example is mineral oil.

Other Types of Laxatives

There are other types of laxatives available, such as stimulant laxatives, which activate the nerves that control the muscles in the colon. Examples include bisacodyl (Dulcolax®) and senna (Fletcher's® Laxative).

It is important to note that laxatives are not suitable for everyone. They are not usually recommended for children or people with certain health conditions. It is always best to consult a healthcare professional before taking any new medication, including laxatives.

What to eat to avoid constipation

Constipation is a common issue after giving birth, and it can be uncomfortable and distressing. It is important to know that it is a common issue for many new parents and that there are ways to help manage it.

• Increase your fibre intake: Fibre is the part of plant foods that the body cannot break down. It helps keep stools soft and speeds up digestion. Aim for 25 grams of fibre per day if you're a woman, and 38 grams if you're a man. Good sources of fibre include whole grains, bran, lentils, beans, fruits, and vegetables.
• Eat natural laxatives: Prunes are a great natural laxative. They are high in fibre and contain sorbitol, a sugar alcohol with a natural laxative effect.
• Stay hydrated: Drink plenty of water and other fluids. This is especially important if you are breastfeeding, as some of the water that would normally go to your colon is used for milk production.
• Eat more "binding" foods: Include bananas and rice in your diet. These foods can help bind stools and make them easier to pass.
• Follow the BRAT diet: The BRAT diet consists of bananas, rice, applesauce, and toast. This diet can be helpful for 48 hours, but it is not recommended for long-term use as it lacks important nutrients.
• Avoid caffeine and artificial sweeteners: Caffeine and artificial sweeteners can trigger bowel movements, so it is best to limit your intake if you are struggling with diarrhoea.
• Increase your physical activity: Physical activity increases blood and oxygen flow to all organs, including the gut. Try to get up and move around as much as possible, even if it's just gentle stretching or pushing a stroller.

In addition to these dietary and lifestyle changes, there are also some over-the-counter options that can help relieve constipation:

• Bulking agents: These are essentially fibre in powder form, such as Metamucil (psyllium fibre) or Citrucel (methylcellulose fibre). Start with a low dose and slowly increase it to avoid bloating and abdominal pain.
• Gentle laxatives: These draw extra fluid into the intestines. Stool softeners like Colace (docusate sodium) are also effective and safe.

It is important to consult your healthcare provider before taking any medications or making significant dietary changes, especially if you are breastfeeding. They can provide guidance and advice based on your individual needs and circumstances.

How to make bowel movements easier

Bowel movements are an instinctive and natural part of life, but they can be difficult and uncomfortable, especially after giving birth. Here are some tips to make bowel movements easier:

Diet

• Drink plenty of water to soften the stool and make it easier to pass. Water is essential for healthy bowel movements.
• Eat more fibre-rich foods, such as whole grains, bran, lentils, beans, fruits, nuts, seeds, and vegetables. Fibre adds bulk to the stool and stimulates the bowels to move. Introduce fibre-rich foods slowly to your diet, adding a serving every 5 days.
• Eat natural laxatives, such as prunes, which are high in fibre and contain sorbitol, a natural laxative.
• Avoid irritating foods, such as caffeinated drinks, tea, coffee, and foods containing sugar alcohols that end in "-ol" (e.g. sorbitol, mannitol, xylitol). These can irritate the stomach and cause loose stools.

Exercise

Increase your physical activity level to stimulate the intestines and promote bowel movements. Even short amounts of activity, such as 10 to 15 minutes, can help. Walking, running, swimming, and gentle exercises like squats can all be beneficial.

Bathroom Posture

Use a footstool to raise your feet while sitting on the toilet, so that your knees are higher than your pelvis. This posture change helps straighten the colon, making it easier for the stool to pass.

Mental Relaxation

• Try not to stress about having a bowel movement. Stress and anxiety can negatively impact your digestive system and make it harder to go to the bathroom. Find ways to relax, such as deep breathing, meditation, or taking a warm bath.
• Don't hold it in when you feel the urge to go. Go to the bathroom when you feel the need and try to establish a regular bowel movement routine, preferably after a meal.

When to seek medical advice

Postpartum constipation is a common issue for new mothers, but it's important to seek medical advice if your symptoms persist or worsen. Here are some scenarios where you should seek medical advice:

• No bowel movement after 3-4 days: If you haven't had a bowel movement within 3-4 days of giving birth, it's recommended to see your doctor right away. They may prescribe a stronger laxative or stool softeners to help relieve constipation.
• Constipation lasting longer than two weeks: While postpartum constipation usually resolves within a few days to a week, if it persists for longer than two weeks, it's important to consult your healthcare provider. They can advise on treatment options and rule out any underlying complications.
• Concerning symptoms: If you experience any red flag symptoms, such as blood or mucus in your stool, constipation alternating with diarrhea, excessive rectal bleeding, or severe and painful bulging in the vaginal or perineal area, contact your doctor immediately. These could be signs of a bigger problem and should not be ignored.
• Medications or supplements as a cause: If you suspect that your constipation is caused by medications or supplements, such as pain medications, antibiotics, iron tablets, or a multivitamin, talk to your doctor. They may advise you to stop or change your medication to help relieve constipation.
• Pelvic floor issues: If you experience leaking urine or painful intercourse along with postpartum constipation, it's important to see a healthcare provider. These issues could indicate damage or trauma to the muscles and nerves in your pelvis during pregnancy or childbirth. A referral to a physical therapist who specializes in pelvic floor health may be beneficial.
• Chronic constipation and complications: If your constipation becomes chronic and leads to complications such as rectal prolapse, fecal incontinence, urinary incontinence, hemorrhoids, or fecal impaction, seek medical advice. These complications can have a significant impact on your quality of life and may require specific treatments or interventions.

Frequently asked questions