Laxatives During Pregnancy: Are They Safe?

Constipation is a common issue during pregnancy, affecting 11% to 38% of pregnant women. While increasing fibre and fluid intake and exercising regularly are recommended as the first line of treatment, these methods may not always provide relief. In such cases, the use of laxatives during pregnancy may be considered. Laxatives are medications that treat constipation and come in various forms, including over-the-counter (OTC) options such as osmotics, fibre or bulk-forming agents, stool softeners, stimulants, and lubricants. This paragraph introduces the topic of laxative use during pregnancy, including their types, safety considerations, and alternative treatments for constipation.

Are laxatives safe during pregnancy?

Constipation is a common issue during pregnancy, and it can cause pain and other health problems like cramps, hemorrhoids, and breakdown of the anal tissue. While it is always best to try natural methods of relieving constipation first, if these prove ineffective, you may consider taking a mild laxative.

According to the available literature, when used in recommended doses, over-the-counter laxatives are not expected to increase the chance of birth defects. However, it is important to consult your doctor before taking any medication, especially during pregnancy. They can advise on the safest course of action and recommend specific laxatives that are considered safe during pregnancy.

Some mild laxatives that are generally considered safe to take during pregnancy include:

• Milk of Magnesia (magnesium hydroxide)
• Metamucil (psyllium)
• Colace (docusate sodium)
• Fibercon (calcium polycarbophil)
• Miralax (polyethylene glycol)

These laxatives have minimal systemic absorption, meaning they are not expected to be associated with an increased risk of congenital anomalies. However, it is important to note that overuse of laxatives can lead to diarrhea and fluid loss, and they should not be used as a long-term solution.

In addition, while the use of osmotic and stimulant laxatives may be recommended for short-term relief, they should be used cautiously and occasionally to avoid dehydration or electrolyte imbalances in pregnant women.

Natural Remedies for Constipation During Pregnancy

Before considering laxatives, it is advisable to try natural methods to relieve constipation. Here are some suggestions:

• Eat more high-fiber foods, such as whole grains, fresh fruits, and vegetables.
• Drink plenty of water.
• Exercise regularly.
• Increase your fluid intake.
• Try probiotics that can alter the colonic flora and improve bowel function.

It is worth noting that cod liver oil is not recommended during pregnancy as it can hinder the absorption of specific vitamins and minerals.

What are some natural alternatives to laxatives?

Constipation is a common issue, especially during pregnancy, and laxatives are often used to treat it. However, before taking any medication, it is always best to try natural methods of relieving constipation. Here are some natural alternatives to laxatives that can help keep things regular:

• Drink more water and stay hydrated. This is important because dehydration can cause constipation. Water helps to lubricate the digestive system and soften stools, making them easier to pass.
• Increase your fibre intake, especially soluble, non-fermentable fibre. Fibre increases the bulk and consistency of bowel movements, making them easier to pass. Good sources of fibre include whole grains, fresh fruits and vegetables, legumes (beans, chickpeas, lentils, peas, and peanuts), nuts, seeds, and some fruits and vegetables.
• Exercise regularly. A sedentary lifestyle is associated with an increased risk of constipation. Moderate exercise, such as brisk walking, can help improve digestive symptoms and quality of life.
• Drink coffee, especially caffeinated coffee. Coffee stimulates the muscles in the digestive system and may contain small amounts of soluble fibre, which can help prevent constipation. However, people with irritable bowel syndrome (IBS) should be cautious as caffeine may worsen their symptoms.
• Take Senna, an herbal laxative that is generally considered safe for adults in the short term. Senna stimulates the nerves in the gut and helps speed up bowel movements. However, it is not recommended for pregnant or breastfeeding women or those with certain health conditions.
• Eat probiotic foods or take probiotic supplements to improve the balance of gut bacteria. Probiotics include Bifidobacteria and Lactobacillus, which can be found in Greek yoghurt and other fermented foods.
• Try a low FODMAP diet, which can help treat irritable bowel syndrome (IBS) and relieve IBS-related constipation. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, and the diet involves limiting these foods before gradually reintroducing them.
• Eat prebiotic foods, which are indigestible carbohydrate fibres that improve digestive health by feeding the beneficial bacteria in the gut. Prebiotic fibres include oligosaccharide and inulin, and can be found in foods such as Jerusalem artichokes.
• Try magnesium citrate, an over-the-counter osmotic laxative that can help relieve constipation. Magnesium supplements can be taken in moderate amounts to relieve constipation, and higher doses are used to prepare the bowel for medical procedures.
• Eat prunes or drink prune juice, which are a natural laxative due to their high fibre content and the presence of sorbitol, a sugar alcohol with a laxative effect.
• Try avoiding dairy if you suspect you may have an intolerance. Dairy can cause constipation in those with an intolerance due to its effect on gut movements.

What are some over-the-counter laxatives?

Laxatives are medications used to treat constipation. They come in different forms, including over-the-counter (OTC) options such as osmotics, fiber or bulk, stool softeners, stimulants, and lubricants.

Osmotics are laxatives that work by pulling water into the intestines. Examples of osmotics include salts such as magnesium hydroxide (Milk of Magnesia) and sodium bisphosphate (OsmoPrep), and sugars such as lactulose and polyethylene glycol (Miralax).

Fiber or bulk laxatives include psyllium (Metamucil) and methylcellulose (Citrucel). These supplements can give you the fiber you need to prevent constipation. Most fiber supplements are in powder form, which you can mix with water or juice.

Stool softeners include docusate sodium (Colace) and glycerin. They help mix fluid into stools to soften them and make them easier to pass.

Stimulants include senna (Senokot), bisacodyl (Correctol), and castor oil. These laxatives stimulate the intestine to help push stools through the colon faster. They also increase hydration in the stool and provide fast relief for extreme or severe constipation. However, they should be taken in moderation as they can cause severe cramping and diarrhea.

Lubricants like mineral oil draw fat and water to hard, dry stools, making them easier to pass. Lubricants typically work within 6-8 hours.

Other types of laxatives include hyperosmolar and osmotics, rectal suppositories, and bulk-forming or bulking agents. The latter absorb fluids from the intestine and soften stools, usually working within 12-72 hours.

While laxatives can provide relief, it is always best to try natural methods of relieving constipation first, such as increasing fibre and fluid intake, and exercising regularly. If these methods do not work, consult your doctor, who may suggest a mild laxative or a bulk-producing agent.

What are some prescription laxatives?

Constipation is a common issue during pregnancy, and it is always recommended to try natural remedies first, such as increasing fibre and fluid intake, before turning to laxatives. If these remedies prove ineffective, laxatives may be considered. Osmotic laxatives, for example, are considered safe to use during pregnancy as they are not well absorbed by the intestine, so exposure to the foetus is expected to be small.

If natural remedies and over-the-counter laxatives do not work, prescription laxatives may be considered. These are much safer for long-term use and should be taken under the supervision of a healthcare provider. There are several types of prescription laxatives on the market, and if one doesn't work, another might. Prescription laxatives are most often used to treat chronic constipation, constipation related to a condition, and opioid-induced constipation.

• Osmotic laxatives draw water into the bowel to help soften stool so it passes more easily. Prescription-only osmotics include Cholac/Generlac (lactulose), which is approved for constipation, including that related to barium retention.
• Prokinetic agents cause the gastrointestinal tract to contract and push materials through. Motegrity (prucalopride) is the only drug in this class currently available in the United States and is approved for chronic idiopathic constipation in adults.
• Secretagogues pull more water into the bowel to soften the stool. Drugs in this class include Amitiza (lubiprostone), approved for chronic constipation in adults, and Linzess (linaclotide), approved for chronic constipation, including that stemming from IBS-C, in adults.
• Opioid antagonists are used to relieve constipation caused by opioid painkillers. These include Relistor (methylnaltrexone), Movantik (naloxegol), and Symproic (naldemedine).

What are the side effects of laxatives?

Constipation is a common issue during pregnancy, and many people turn to laxatives to ease their discomfort. While laxatives can be effective in providing relief, they can also have side effects and risks, especially for pregnant women.

Laxatives are medications that stimulate or facilitate bowel movements. They come in different forms, such as osmotics, bulk-forming agents, stool softeners, and stimulants. While some laxatives are available over the counter, it is important to consult a doctor or pharmacist before use, especially during pregnancy.

One of the most common side effects of laxatives is increased constipation if they are not taken with enough water. This can lead to a cycle of dependency on laxatives to have a bowel movement. Overuse of laxatives can result in the intestines losing muscle and nerve response, leading to further complications.

Additionally, laxatives can interact with other medications, including heart medications, antibiotics, and bone medications. This interaction can affect how these medications work and may lead to adverse effects. For example, frequent or long-term use of laxatives can worsen constipation in people with certain conditions, such as diverticulosis, by decreasing the colon's ability to contract.

Laxative use can also result in diarrhoea, which can cause dehydration and electrolyte imbalances. This is especially important for pregnant women, as dehydration can affect the developing fetus. Some ingredients in laxatives may also be passed to the baby through breast milk, potentially causing diarrhoea or other problems in the infant.

Furthermore, laxatives may cause stomach cramps, which can be severe. In rare cases, laxatives have been associated with more serious side effects, such as severe cramps or pain, weakness or unusual tiredness, skin rash or itching, and swallowing difficulties.

While the use of laxatives during pregnancy has not been extensively studied, it is generally recommended to try natural methods of relieving constipation first, such as increasing fibre and fluid intake and regular exercise. If these methods are ineffective, consult your doctor, who may suggest a mild laxative that is considered safe during pregnancy, such as Milk of Magnesia or a bulk-producing agent like Metamucil.

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