Treating Constipation in Pregnancy and Lactation

Last updated February, 2025

Authored by Lauren Tailor, Anna Pupco, Pina Bozzo and reviewed by the First Exposure Medical Review Team.

Lauren Tailor, PharmD, MPH, PhD Candidate, is a pharmacist with a masters in Public Health. She is working towards her PhD at the Dalla Lana School of Public Health at the University of Toronto.

Anna Pupco and Pina Bozzo are Clinical Content Advisors at First Exposure.

* The information provided is the expert opinion of the First Exposure Medical Advisors. It is for informational purposes only and does not replace medical care and advice from a healthcare provider. Please contact your healthcare provider if you have any concerns or to discuss any questions that you believe may be relevant to you or your baby. In case of emergency, please go to the emergency room or call 911.

If you do not have a healthcare provider, please go to: Finding a Healthcare Provider

Clinical scenario:

I have been constipated since I had my baby 3 weeks ago. I am nursing. What can I do?

Q. What is constipation?

A. Constipation is defined as passing less than 3 stools per week (infrequent bowel movements) or difficulty passing stool. Difficulty passing stools can involve straining, hard lumpy stools (see image below), a feeling that there is still stool remaining after a bowel movement, or blockage. Constipation looks different from person to person because everyone’s “normal” bowel movements are different.

Source: https://www.medicalnewstoday.com/articles/bristol-stool-scale

Q. Why is constipation more common in pregnancy and/or after giving birth?

A. Constipation affects almost half of all pregnant individuals. Constipation during pregnancy and after giving birth (postpartum) is likely caused by a combination of factors:

changes in hormones levels, such as increase in progesterone levels, cause the muscles of the bowel wall to relax which slows down the movement of the bowel
the growing uterus pressing on the bowels
reduced physical activity for some
dietnot eating enough food containing dietary fibre and/or not drinking enough water (or other non-alcoholic/non-sugary beverages), especially when taking care of a baby
pain during bowel movements, when recovering from a caesarean section or from conditions such as hemorrhoids or injury (e.g. tear or a cut) during vaginal birth. This pain may cause one to avoid having a bowel movement which can lead to constipation
iron supplements may cause constipation or diarrhea. To read more on iron supplementation during pregnancy please see Non-Anemic Iron Deficiency and Iron Deficiency Anemia in Pregnancy Health Topic

Q. Are there dietary and lifestyle approaches to help prevent and relieve constipation during pregnancy and lactation?

A. To prevent and relieve constipation:

drink enough fluids to stay well hydrated. Aim for 8-12 cups of water or other non-alcoholic/non-sugary beverages per day
have at least 28 grams of fibre per day. To read more about fibre and foods rich in fibre please see Dietary Approaches to Preventing and Relieving Constipation and Fibre and your health
limit intake of highly processed and sugary foods. You can read more at Top 4 Food and Drinks to Avoid When Constipated
keep active. Please talk to your healthcare provider before increasing your activity level during pregnancy. You can find more information in Exercise during pregnancy

Q. What are the medications available for management of constipation and what is their safety during pregnancy and lactation?

A. There are various medications available to treat constipation when dietary and lifestyle changes do not help. Some of these medications are called laxatives. Below is information on the safety of available medications for treatment of constipation during pregnancy and lactation. Speak with a healthcare provider to see if any are right for you.

Medication	General Information	Information in Pregnancy and Lactation
Stool-bulking agents (e.g., Psyllium husk, dietary bran, wheat fibre)	· increase stool bulk which improves bowel movements · must be taken with plenty of water. Taking stool bulking agents without drinking enough water may lead to bloating, and bowel obstruction · can take several days to work	· not absorbed into the blood stream, and therefore will not reach the developing baby or pass into breastmilk · are often considered a first-choice treatment for constipation during pregnancy and lactation
Osmotic laxatives (e.g., salts such as, polyethylene glycol (PEG)), magnesium salts, lactulose, sodium or potassium chloride, sorbitol)	· pull/retain water in the bowel which improves bowel movements	· minimal absorption into the blood stream, and therefore are not expected to reach the developing baby or pass into the breastmilk · PEG and lactulose are both effective for treating constipation in pregnancy · magnesium and sodium salts may cause higher than normal “salt” (sodium) levels. Other agents may be preferred in mid-to-late pregnancy
Stool softener (Docusate sodium)	· softens the stool	· minimal absorption into the blood stream and is therefore not expected to reach the developing baby or pass into the breastmilk · limited data suggest no increased risk of birth defects · there is one case report of a woman who used 150-250 mg or more of docusate sodium daily during most of her pregnancy. Her newborn had low magnesium levels which may have been caused by the chronic high dose of docusate sodium
Lubricant laxative (mineral oil)	· lubricates the stool	· minimal absorption into the blood stream and is therefore not expected to reach the developing baby or pass into the breastmilk · use may affect the absorption of vitamins. It is thought that regular use may cause vitamin deficiencies – other treatments may be preferred
Glycerin suppository	· pulls water into the bowel, which helps have a bowel movement	· minimal absorption into the blood stream and is therefore not expected to reach the developing baby or pass into the breastmilk · there are no data in pregnancy and breastfeeding, but occasional use is not expected to be a concern
Stimulant laxatives (e.g., senna, bisacodyl, castor oil)	· make bowel muscles contract and move the stool along · typically used if other treatments do not help to relieve constipation	· bisacodyl has minimal absorption into the blood stream and is therefore not expected to reach the developing baby · based on limited data bisacodyl and its active metabolite are not detected in breastmilk and are not expected to be a concern when used while nursing · limited data on senna in pregnancy do not suggest an increased risk of birth defects · senna was reported to pass into breastmilk in small amounts in some cases, and not to pass at all in others. Although loose stools were reported in a small number of infants, no concerns were reported in most cases · use of castor oil is not recommended during pregnancy as it may lead to uterine contractions. No information on safety of use while nursing is available

Q. What are the medications prescribed to people diagnosed with chronic constipation? And what is known about their safety during pregnancy and lactation?

A. Prucalopride and linaclotide are medications prescribed to adults diagnosed with chronic constipation. Below is information on their safety during pregnancy and lactation:

Medication

General Information

Information in Pregnancy and Lactation

Prucalopride

· increases bowel movement to help stool move more easily

· used for chronic constipation

· there are no studies on the use of prucalopride in pregnancy

· based on data provided by the company making prucalopride, it can pass into breastmilk

Linaclotide

· increases the amount of fluid in the bowel and improves its movement to help stool pass more easily

· is used for chronic constipation

· minimal absorption into the blood stream therefore it is not expected to reach the developing baby or pass into the breastmilk

· there are no studies of linaclotide in pregnancy

· based on limited data linaclotide is not detected in breastmilk

Q. Where to get more information?

A. Resources for Patients (some included above)

Constipation and pregnancy

Dietary Approaches to Preventing and Relieving Constipation

Fibre and your health

Top 4 Food and Drinks to Avoid When Constipated

Key References

American College of Obstetricians and Gynecologists. How much water should I drink during pregnancy?[Internet] Washington, DC: American College of Obstetricians and Gynecologists; 2020 [updated October 2020; cited 2025 March 11]. Available from: https://www.acog.org/womens-health/experts-and-stories/ask-acog/how-much-water-should-i-drink-during-pregnancy.

Anderson PO. Laxative and Cathartic Use During Breastfeeding. Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine. 2021;16(9):675-7. [PMID: 34096783].

Asayama K, Imai Y. The impact of salt intake during and after pregnancy. Hypertens Res. 2018;41(1):1-5. [PMID: 29046520].

Bashir A, Sizar O. Laxatives [Updated 2024 Jan 30]. 2025 Jan- [cited March 11, 2025]. In: StatPearls [Internet] [Internet]. Treasure Island (FL): StatPearls Publishing, [cited March 11, 2025]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537246/.

Bowles-Jordan J. Constipation [CPS Internet] Ottawa (ON): Canadian Pharmacists Association; 2018 [updated May 16, 2023; cited 2025 March 11]. Available from: https://cps-pharmacists-ca.myaccess.library.utoronto.ca/search.

Bradley CS, Kennedy CM, Turcea AM, Rao SS, Nygaard IE. Constipation in pregnancy: prevalence, symptoms, and risk factors. Obstetrics & Gynecology. 2007;110(6):1351-7. [PMID: 18055731].

Brigstocke S, Yu V, Nee J. Review of the Safety Profiles of Laxatives in Pregnant Women. J Clin Gastroenterol. 2022;56(3):197-203. [PMID: 35050942].

Chang L, Chey WD, Imdad A, Almario CV, Bharucha AE, Diem S, et al. American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation. Am J Gastroenterol. 2023;118(6):936-54. [PMID: 37204227]. [PMC10544839].

Crittenden N, McGeeney D, Assouline-Dayan Y, Boutros K, Syrzycka M, Bartolini W, et al. Linaclotide is not detectable in breast milk of lactating women: an open-label, Phase 1 study [Abstract A236]. J Can Assoc Gastroent 2021;4:285-7. [PMID. [N/A].

Cullen G, O’Donoghue D. Constipation and pregnancy. Baillieres Best Pract Res Clin Gastroenterol. 2007;21(5):807-18. [PMID: 17889809].

de Bellfonds C, Wu J. The Best Pregnancy Workouts and Exercises You Can Do While Expecting [Internet]: Everyday Health; 2021 [updated July 29, 2021; cited 2025 March 11]. Available from: https://www.whattoexpect.com/pregnancy/exercises-for-pregnant-women.

Derbyshire E, Davies J, Costarelli V, Dettmar P. Diet, physical inactivity and the prevalence of constipation throughout and after pregnancy. Matern Child Nutr. 2006;2(3):127-34. [PMID: 16881925].

Drugs and Lactation Database (LactMed®) [Internet]. Docusate. Bethesda (MD): National Institute of Child Health and Human Development; 2006 [updated November 15, 2024; cited 2025 March 11]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501331/.

Drugs and Lactation Database (LactMed®) [Internet]. Senna Bethesda (MD): National Institute of Child Health and Human Development; 2006 [updated November 15, 2024; cited 2025 March 11]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501349/pdf/Bookshelf_NBK501349.pdf.

Drugs and Lactation Database (LactMed®) [Internet]. Linaclotide. Bethesda (MD): National Institute of Child Health and Human Development; 2006 [updated June 15, 2024; cited 2025 March 11]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK500873/pdf/Bookshelf_NBK500873.pdf.

HealthLinkBC. Fibre and your health – Nutrition series – Number 68H [Internet] 2021 [updated March, 2021; cited 2025 March 11]. Available from: https://www.healthlinkbc.ca/sites/default/files/documents/healthfiles/hfile68h.pdf.

La Leche League Canada. Water — How Much Should I Drink? [Internet] Pickering, ON: Laleche League of Canada; 2024 [updated 2024; cited 2025 March 11]. Available from: https://www.lllc.ca/water.

Moriarty KJ, Irving MH. ABC or colorectal disease. Constipation. BMJ. 1992;304(6836):1237-40. [PMID: 1515801].

Olshansky B, Chung MK, Budoff MJ, Philip S, Jiao L, Doyle RT, Jr., et al. Mineral oil: safety and use as placebo in REDUCE-IT and other clinical studies. Eur heart j suppl. 2020;22(Suppl J):J34-J48. [PMID: 33061866].

Ponce J, Martinez B, Fernandez A, Ponce M, Bastida G, Pla E, et al. Constipation during pregnancy: a longitudinal survey based on self-reported symptoms and the Rome II criteria. Eur J Gastroenterol Hepatol. 2008;20(1):56-61. [PMID: 18090992].

Rome Foundation. Rome IV Criteria: Appendix A: Rome IV Diagnostic Criteria for FGIDs [Internet] Raleigh, NC2021 [updated n.d.; cited 2025 March 11]. Available from: https://theromefoundation.org/rome-iv/rome-iv-criteria/.

Rungsiprakarn P, Laopaiboon M, Sangkomkamhang US, Lumbiganon P, Pratt JJ. Interventions for treating constipation in pregnancy. Cochrane Database of Systematic Reviews. 2015(9):CD011448. [PMID: 26342714].

Schindler AM. Isolated neonatal hypomagnesaemia associated with maternal overuse of stool softener. Lancet. 1984;2(8406):822. [PMID: 6207396].

Syed H, Slayman T, DuChene Thoma K. ACOG Committee Opinion No. 804: Physical Activity and Exercise During Pregnancy and the Postpartum Period. Obstet Gynecol. 2021;137(2):375-6. [PMID: 33481513].

Trottier M, Erebara A, Bozzo P. Treating constipation during pregnancy. Can Fam Physician. 2012;58(8):836-8. [PMID: 22893333].

Trull K, Morales-Brown L. What to know about the Bristol Stool Form Scale Medical News Today [Internet]. 2024 February 20, 2024. Available from: https://www.medicalnewstoday.com/articles/bristol-stool-scale#summary.

U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Definition & Facts for Constipation [Internet] Bethesda, MD: National Institutes of Health; 2018 [updated May 2018; cited 2025 March11]. Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/definition-facts.

UpToDate LexiDrugs. Bisacodyl [Internet] Waltham (MA): UpToDate Inc.; 2010 [updated March 14, 2025; cited 2025 March 11]. Available from: http://online.lexi.com.

UpToDate LexiDrugs. Bisacodyl [Internet], in Briggs Drugs in Pregnancy and Lactation section Waltham (MA): UpToDate Inc.; 2010 [updated May 23, 2022; cited 2025 March 11]. Available from: https://online.lexi.com.

UpToDate LexiDrugs. Castor Oil [Internet], in Briggs Drugs in Pregnancy and Lactation section Waltham (MA): UpToDate Inc.; 2010 [updated May 23, 2022; cited 2025 March 11]. Available from: https://online.lexi.com.

UpToDate LexiDrugs. Docusate Sodium [Internet], in Briggs Drugs in Pregnancy and Lactation section Waltham (MA): UpToDate Inc.; 2010 [updated May 23, 2022; cited 2025 March 11]. Available from: https://online.lexi.com.

UpToDate LexiDrugs. Glycerin [Internet] Waltham (MA): UpToDate Inc.; 2010 [updated February 13, 2025; cited 2025 March 11]. Available from: http://online.lexi.com.

UpToDate LexiDrugs. Glycerin [Internet], in Briggs Drugs in Pregnancy and Lactation section Waltham (MA): UpToDate Inc.; 2010 [updated May 23, 2022; cited 2025 March 11]. Available from: https://online.lexi.com.

UpToDate LexiDrugs. Lactulose [Internet] Waltham (MA): UpToDate Inc.; 2010 [updated March 7, 2025; cited 2025 March 11]. Available from: http://online.lexi.com.

UpToDate LexiDrugs. Linaclotide [Internet] Waltham (MA): UpToDate Inc.; 2010 [updated January 17, 2025; cited 2025 March 11]. Available from: http://online.lexi.com.

UpToDate LexiDrugs. Linaclotide [Internet], in Briggs Drugs in Pregnancy and Lactation section Waltham (MA): UpToDate Inc.; 2010 [updated May 23, 2022; cited 2025 March 11]. Available from: http://online.lexi.com.

UpToDate LexiDrugs. Mineral Oil [Internet] Waltham (MA): UpToDate Inc.; 2010 [updated February 18, 2025; cited 2025 March 11]. Available from: http://online.lexi.com.

UpToDate LexiDrugs. Polyethylene Glycol 3350 [Internet] Waltham (MA): UpToDate Inc.; 2010 [updated March 4, 2025; cited 2025 March 11]. Available from: http://online.lexi.com.

UpToDate LexiDrugs. Prucalopride [Internet] Waltham (MA): UpToDate Inc.; 2010 [updated March 15, 2025; cited 2025 March 11]. Available from: http://online.lexi.com.

UpToDate LexiDrugs. Senna [Internet] Waltham (MA): UpToDate Inc.; 2010 [updated March 14, 2025; cited 2025 March 11]. Available from: http://online.lexi.com.

UpToDate LexiDrugs. Senna [Internet], in Briggs Drugs in Pregnancy and Lactation section Waltham (MA): UpToDate Inc.; 2010 [updated May 23, 2022; cited 2025 March 11]. Available from: https://online.lexi.com.

Disclaimer

First Exposure does not offer health care treatment. If you have an urgent question about your pregnancy or your baby’s health, you should contact your health care provider directly. If you don’t have a health care provider and you live in Ontario, you have a variety of health care options. In the case of an emergency, visit a hospital emergency room or call 911.