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Constipation - Management
How should I manage constipation in a woman who is breastfeeding?
- Dietary measures, including an adequate fluid intake (8–10 cups of fluid a day) should be advised first-line to prevent or treat constipation during breastfeeding.
- Regular light or moderate exercise may also be helpful.
- Laxatives should be considered only if dietary measures fail:
- A bulk-forming laxative is a reasonable first choice.
- If stools remain hard, add or switch to lactulose or a macrogol.
- If stools are soft but the woman still finds them difficult to pass or complains of inadequate emptying, consider a short course of bisacodyl or senna.
- Occasional use of glycerol or bisacodyl suppositories are also an option.
Clarification / Additional information
Basis for recommendation
The following recommendations are based on expert advice on drug safety during breastfeeding [Schaefer et al, 2007; UK Drugs in Lactation Advisory Service, 2007]:
- The following laxatives are not absorbed from the gastrointestinal tract, and are therefore suitable for use while breastfeeding:
- Bulk-forming laxatives
- Lactulose
- Macrogols with a molecular weight of more than 3000
- Bisacodyl is poorly absorbed from the gastrointestinal tract (only about 5%) and is therefore considered to be suitable for use during breastfeeding.
- Senna is partially absorbed from the gastrointestinal tract. However, the risk of causing colic and diarrhoea in breastfed infants is small, provided that high doses are avoided.
- Glycerol suppositories are also suitable for use while breastfeeding [ABPI Medicines Compendium, 2002].
- Laxatives that are not recommended for first-line use:
- Docusate is excreted in breast milk [Micromedex, 2007]. However, the risk of causing colic and diarrhoea in breastfed infants is small, provided that high doses are avoided.
- Sodium picosulfate is not known to be excreted in breast milk, but there is less experience with its use. It could be considered in moderate doses if the laxatives recommended above are unsuccessful.
- Sodium citrate or sodium phosphate enemas could also be used if the laxatives recommended above are unsuccessful.
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