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Constipation - Management
How should I manage constipation in a pregnant woman?

  • Dietary measures, including an adequate fluid intake, should be advised first-line to prevent or treat constipation in pregnancy.
  • Regular light or moderate exercise can 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
  • For further information on the use of laxatives during pregnancy, contact the UK Teratology Information Service (UKTIS), formerly the National Teratology Information Service (NTIS), on 0844 892 0909.
Basis for recommendation

The following recommendations are based on expert advice on drug safety during pregnancy [Schaefer et al, 2007]:

  • Bulk-forming laxatives are not absorbed from the gastrointestinal tract and are therefore suitable for use during pregnancy.
  • Lactulose is poorly absorbed from the gastrointestinal tract and is also suitable for use during pregnancy.
  • Macrogols with a molecular weight of more than 3000 are not absorbed from the gastrointestinal tract.
  • Bisacodyl is poorly absorbed from the gastrointestinal tract (only about 5%). It has not been reported to cause teratogenic or fetotoxic effects and is therefore suitable for use during pregnancy.
  • Senna is partially absorbed from the gastrointestinal tract but does not appear to be teratogenic. Concerns have been raised that senna should be avoided in the third trimester because a stimulating effect on uterine contractions has been reported with other anthraquinone derivatives. However, this has not been reported with senna.
  • Glycerol suppositories are also suitable for use during pregnancy [ABPI Medicines Compendium, 2002].
  • Laxatives that are not recommended:
    • Docusate is less preferred because there is a single case report of neonatal hypomagnesaemia after maternal overuse of oral docusate sodium. However, docusate could be considered in low doses if the recommended laxatives (above) are unsuccessful [Schaefer et al, 2007].
    • Sodium picosulfate: there is less experience with its use in pregnancy, so it is therefore not recommended [ABPI Medicines Compendium, 2006].
    • Sodium citrate and sodium phosphate enemas should be avoided if possible during pregnancy, because they may cause fluid and electrolyte imbalances [NTIS, 2002].

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