• Bulk-forming: ispaghula husk, methylcellulose, sterculia and frangula
• Osmotic: lactulose and macrogols (polyethylene glycols)
• Stimulant: bisacodyl, senna and sodium picosulfate

In depth

• Advise dietary measures, including an adequate fluid intake (8–10 cups a day), to prevent or treat constipation in pregnancy.
• Regular light or moderate exercise can also be helpful.
• Consider laxatives only if dietary measures fail:
• Consider a bulk-forming laxative first.
• 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.
• 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.

In depth

• Manage in the same way as during pregnancy.
• For further information on the use of laxatives during breastfeeding, contact the UK Drugs in Lactation Advisory Service on 0121 311 1974, or see their website at www.ukmicentral.nhs.uk/drugpreg/guide.htm.

In depth

• In general, the diet should be balanced and contain whole grains, fruits, and vegetables.
• Fibre intake should be increased gradually (to minimize flatulence and bloating) and maintained for life.
• Adults should aim to consume 18–30 g fibre per day.
• Although the effects of a high fibre diet may be seen in a few days, it may take as long as 4 weeks.
• Adequate fluid intake is important (particularly with a high fibre diet or fibre supplements), but can be difficult for some people (e.g. frail or elderly).
• Fruits high in fibre and sorbitol (e.g. apricots and prunes) and fruit juices high in sorbitol can help prevent and treat constipation.

In depth

• Defecation should be unhurried, with enough time to ensure that defecation is complete.
• Attempt defecation first thing in the morning, or about 30 minutes after a meal.
• Respond immediately to the sensation of needing to defecate.
• Inadequate privacy can contribute to constipation.

In depth

• Refer for suspected cancer if 'red flags' are present.
• Consider surgical referral when there is pain and bleeding on defecation (e.g. from an anal fissure) that is severe or does not respond to treatment for constipation.
• Refer for assessment by a specialist with an interest in constipation when:
• An underlying cause is suspected.
• Treatment is unsuccessful.
• Management may require further tests.
• Assessment is required prior to referral for other interventions (such as psychology, psychiatry).
• Consider referral to a Continence Service (when available) if faecal incontinence is a problem.
• Consider dietetics referral for more detailed support of diet.

In depth