Constipation in Pregnancy: What's the Holdup?
Congratulations! You got your BFP and are coasting into the beginning of your first trimester. You have been warned about fatigue, breast tenderness, and nausea starting soon, but no one warned you about another, possibly very uncomfortable symptom in early pregnancy - significant constipation.
Constipation in pregnancy can present in multiple ways, whether it is going days without going, pebble sized stools (poop) that are hard to pass (we call them rabbit pellets in my family), or a feeling of not emptying out completely when you are able to go. It is often accompanied by increased bloating, gas, and other symptoms that make you feel even less glam in the first trimester.
As a dietitian specializing in fertility, I put emphasis on regular (1-2x per day) and easy to pass stools, so this downshift can be very distressing. The good news is, it is a very common symptom and does not indicate there is anything wrong with the pregnancy or the developing baby. A benefit of this is that your body has more time to absorb all the nutrients it needs for you and your growing baby.
Why Does Pregnancy Cause Constipation, and Why So Early?
Blame progesterone. The “pro-gestation” hormone ramps up very quickly in early pregnancy and is partially responsible (along with HcG) for telling your body not to menstruate and instead, maintain the pregnancy. The downside of progesterone is that it is a hormone that causes smooth muscle to relax even more. And what lines your intestines? Smooth muscle.
As a result, the rhythmic contractions that your intestines use to move food/water along (peristalsis), slow down and/or aren’t as powerful, leading to further delays in stool transit time. Some women, especially those who are utilizing supplemental progesterone as part of their fertility treatments, may have constipation as one of their earliest symptoms.
Another factor that will likely impact constipation in early pregnancy is food aversions, nausea, and vomiting. Your diet leading up to conception likely looks very different from the “beige” diet of simple and easy to digest foods that many women find it is all they can tolerate without feeling ill in the first trimester.
The decrease in both food and fiber volume leads to less stool bulk, which can also slow down transit time. When your digestive tract slows down, you absorb more water from your stool, creating smaller and harder stools, which, you guessed it, are also harder to pass. If you are experiencing significant nausea and vomiting, your fluid intakes might also be impacted, which can make the problem even worse.
TL:DR, many first trimester symptoms can stack on top of one another to make constipation downright terrible.
What Can I Do About Pregnancy Constipation?
There are food, lifestyle changes, over the counter supplements, and medications you can ask your doctor about to help with this constipation. As always, this is not meant to be provided as medical advice, and always speak to your OBGYN before starting a new medication or supplement.
Here are some of the interventions that I recommend to my clients for helping with constipation:
Hydration
If water has been an issue, let's figure out ways to boost hydration. Many women report plain water can be nauseating in the first trimester, so we might discuss electrolyte powders, iced or hot herbal teas, bottled electrolyte drinks, coconut water, or flavor boosters, like fruit infused water to help reduce nausea. I also recommend exploring different beverage temperatures.
Fiber in Food
Find sneaky ways to increase food sources of fiber:
This can look like focusing on the “P”oop fruits, like prunes, pears, peaches, papayas, and pineapples. Berries are also a great source of fiber. Liquids easier? Let's make a smoothie. Cold better? Blend it up and make a popsicle out of it.
Seeds, like ground flax, hemp, and chia, which can be added to things like yogurt, baked goods, or smoothies. I will also give my clients a recipe for chia pudding made with coconut milk, which for many can have a mild stool softening/laxative effect.
Beans are a fiber powerhouse. While many pregnant people may not have an appetite for plain beans, blended bean soups and bean dips, like hummus, can help with increasing fiber intake.
Increase oats. If a bowl of oatmeal is less than appetizing, you can swap out some oat flour for regular flour in baked goods, like pancakes and muffins.
Fiber Supplements
Psyllium is the gold standard for helping with constipation, however the texture can be rough to tolerate. I have had a client describe it as slimy wood shavings, but it does work well!
Sunfiber is a soluble guar gum fiber that dissolves completely in water, similar to MiraLax. It is also less gas producing than many OTC fibers, which means less bloat. Yay!
Discuss these with your doctor as there are risks of dehydration and electrolyte imbalances with long term use along with other concerns noted below:
Magnesium supplementation can aid in increasing regular bowel movements. Magnesium citrate or glycinate are my top 2 choices and can also help with muscle cramps and sleep quality.
OTC options, like milk of magnesia (MoM), MiraLax or Colace. MiraLax and MoM both help by pulling more water into your poop, while colace helps to dissolve more fat in your poop to soften it. All of these can help with straining and increase frequency of bowel movements.
Stimulant laxatives, like Dulcolax and Senokot should be discussed thoroughly with your doctor as they can cause uterine contractions.
Movement
Move when and where you can. Physical activity can help activate the muscles in your intestines and get things moving. Nothing crazy required, just a walk works!
When Will Constipation in Pregnancy Ease Up?
The timeline to relief is unfortunately not something I can predict and there are many factors that will influence if and when your constipation will improve. Many expectant parents note that returning to normal eating after the first trimester can be a turning point.
Other significant contributors to pregnancy constipation include: iron supplements, low fiber intake, fatigue leading to reduced physical activity, changes in fluid needs, and physical pressure of the uterus compressing the intestines in the 3rd trimester.
Special Considerations
For those who have a history of disordered eating:
Especially if your ED behaviors included purging or laxative use, this period may feel wildly uncomfortable and out of control, but your body is doing what it is supposed to in order to maintain the pregnancy. The bloating and gas can also be very triggering, so I encourage anyone struggling with this to choose non-restrictive clothing, elastic waists, and other comfortable outfits.
This is a physiologically very intense time of change for your body and it is very common for digestion to feel different day to day. It does not reflect changes to your body itself. If you start to notice strict thoughts or rules coming in about the shoulds/shouldn’ts related to your food intake, fiber, water, exercise etc, please reach out to your team ASAP for support.
For those who have a history of infertility:
We here at BNT get it. You have been through the wringer and waited a very long time to grow your family. As a result, you are likely someone who is VERY aware of every twinge and sensation in your pelvic region. Constipation, and the cramps that can come along with it, can be very triggering and may lead down a panic spiral of “am I having a miscarriage?”
Try to be as gentle as possible with yourself during this time and remind yourself that this is a physically expected part of early pregnancy. If it triggers thoughts of wanting to over correct with diet or supplements, working with a dietitian at BNT can help make small changes to support your mental health and physical comfort during this time.
When to Seek Help from a Medical Provider:
No bowel movement for 4–5 days
Significant pain, cramping, or any bleeding
Constipation + severe vomiting/dehydration
History of GI conditions
If constipation worsens anxiety or disordered eating thoughts
And, if a bean soup sounds like something you want to try, here is one of my favorite ones from “Budget Bytes”: Rosemary and White Bean Soup. It can also be blended completely if that is more to your taste.
Cameron Sisler, MS, RD, LDN is a registered dietitian who has spent six years working in higher levels of care, helping clients navigate the complex journey of eating disorder recovery. She is also St. Louis’s leading expert on fertility nutrition, and has used science-backed nutrition and lifestyle guidance to help many people achieve their dream of conceiving. Cameron loves cooking and developing new recipes, and uses her skills in the kitchen to help clients find nutritional solutions that fit their taste preference and lifestyle.