Introduction: Constipation commonly occurs in pregnancy, affecting 11-44% of pregnant women. It can have severe consequences on maternal and foetal wellbeing. The management of antenatal constipation is often difficult due to the physiological changes of pregnancy and safety concerns with certain aperients. This report aims to review the literature surrounding management of severe antenatal constipation and to assist clinicians with future management decisions.
Methods: Current literature related to the management of severe constipation in pregnancy was reviewed, in the context of a case of a 30-year-old woman at 24 weeks gestation with severe constipation despite three weeks of oral aperients and enemas.
Results: Current literature suggests that stimulant laxatives are more likely to improve constipation than bulk-forming laxatives, but cause increased side effects including abdominal discomfort. Fibre supplementation in pregnancy has been shown to improve stool consistency and increase the frequency of passage compared to no intervention. There is no concrete evidence comparing other types of laxatives such as osmotic or lubricant laxatives, stool softeners, enemas and suppositories. Many aperients (including Psyllium, Lactulose, Paraffin, Glycerol and Sodium Picosulfate) have not been categorised by the Therapeutic Goods Administration in regards to safety in pregnancy, despite their common use. Docusate, Coloxyl, Bisacodyl and Senna have been listed as category A, with no links to congenital abnormalities, however many health guidelines recommend avoiding stimulant laxatives, particularly if there is a history of preterm labour.
Discussion: There is insufficient evidence to guide treatment of constipation during pregnancy and further randomised control trials are required to examine a broader use of aperients. We therefore recommend a multidisciplinary approach, including both non-pharmaceutical and pharmaceutical measures tailored to the patient’s specific bowel habits and needs. A stepwise approach is suggested, beginning with lifestyle modifications, then introducing bulk forming aperients, osmotic laxatives and lastly stimulant laxatives as required.