Constipation during pregnancy is super common. It is also hard to treat effectively. Are probiotics the answer? We are all about the emerging research around the power of the gut microbiome for health. Particularly when it comes to all things hormones, fertility, conception, pregnancy and beyond. However, research remains in its infancy and the booming probiotic market as it stands is not necessarily always the answer. In fact, the trouble is the market is largely unregulated and there is a huge difference between strains, brands, mixtures etc which makes it hard to say what ‘works’ and what doesn’t. Click here for much more. Against this, we take a look a some of the evidence suggesting that probiotics could hold the key to relieving this common complication. 

So, what’s the real deal with constipation during pregnancy? 

Evidence suggests that constipation during pregnancy impacts almost 40% of women (1-3). So pretty common! In fact, it is second only to nausea as the most common GI complaint in pregnancy. (1) 

What causes it? 

As usual there appear to be a wide variety of causes and contributors. However the evidence suggests that it is both hormonal and physical changes that play a part. 

A couple of big hormonal culprits: rising progesterone and reduction in motilin hormone (1). Progesterone and its metabolites cause relaxation of smooth muscles which has a knock on effect. Essentially slowing down the body’s ability to push waste out the door. (2,3)

Other causes: rising water absorption from the intestines (harder stools), decreased maternal activity and supplements containing certain vitamins like iron and calcium can work against this. (1) Later in during pregnancy an enlarged uterus might also slow ‘onward movement’. 

So what are the current options for dealing with it? 

Aside from the fact the body needs to eliminate waste, constipation can be really uncomfortable and distressing. Anyone that has it, wants to get rid of it fast. However, it is tough to know what to do that

a) doesn’t carry risk to the pregnancy and your baby

b) what actually works. 

The basics for dealing with pregnancy constipation: first port of call: 

There are some basic, easy and obvious things you can do in the first instance. 

Fibre: time to up the ante? 

The research shows most of us simply aren’t get enough. Constipation aside there is compelling research suggesting that during pregnancy getting ‘enough’ is key. Specifically for a developing baby’s immune system (yep, true story) The research suggests that it could even help reduce risk of certain autoimmune conditions in our kids.

What classifies as ‘enough’?

The recommended intake is 25-28g a day for women and 38g a day for men but research shows most people struggle to get 17g/day. Click here for our ‘how to’ and some of our favourite ways to incorporate more fibre into your daily diet. 

In a nutshell: our favourites are prebiotic fibre (feeding the good bacteria in the gut): think things like: raspberries, organic unrefined oats, garlic, onion, asparagus, artichoke and banana. 

Hydration, hydration, hydration: 

Research suggests that decreased fluid intake has been linked to constipation in pregnancy, particularly in the third trimester (3). We also know that there is increased water absorption from the intestines during pregnancy. So: drink up! 

Exercise and movement: 

We also know that staying active is key. This is crucial not only for keeping things ‘moving’ internally, but is crucial for maintaining a healthy pregnancy weight, hormonal balance but can also have positive long term effects for a baby. Even walking is better than nothing at all. 

But do these methods always work for constipation during pregnancy? 

Whilst every one of these measures is a smart (and evidence-backed) way to improve pregnancy outcomes, when it comes to relieving pregnancy constipation the evidence on effectiveness is mixed. The reality is, it doesn’t always work for everyone. You can be doing all of the above yet still be troubled by it.  

So what are the alternatives? 

Now the more obvious answer can be laxatives. However, they too have mixed evidence around effectiveness, depending on which you use. There are of course on top of this the obvious questions about safety and side effects. Certain bulk-forming agents, stool softeners etc which are not broadly ‘systemically absorbed’ and are deemed ‘safe’ to use. However, these too are also not always effective. Further, others such as stimulative laxatives or those that use osmosis can have some not particularly nice side effects. The bottom line is that taking any medication during pregnancy for most people is usually a very last resort. We don’t always know the impact of drugs on the body and a developing baby. It is also imperative to discuss fully with your doctor before you do anything. 

So, what else? Can probiotics safely help provide some relief?? 

The reality is, as the medical literature suggests there are not that many effective interventions when it comes to treating pregnancy constipation. However, there is some supportive and positive evidence around the use of probiotics. Given the fact we are mega for anything that can help improve the all important balance of our internal microbes We think it is well worth a look. 

Here’s what we know about probiotics to treat pregnancy constipation: 

‘A recent review found that strains of Lactobacilli and bifidobacterium increased the defecation frequency and improved stool constituency.’ (3)

The good news is that although there haven’t been many comprehensive studies specifically looking at pregnant women and constipation, those that have been published are supportive (1-4). Further, it appears to have a positive impact on other people (including kids) who are similarly suffering. 

So how might this actually work? 

They appear to have two ways of ‘helping the cause’: (3) 

Firstly; it is assumed (pregnancy aside) that some degree of dysbiosis (imbalance) in the gut flora plays a role in constipation. Probiotics in theory help tackle this. 

Secondly: probiotics are able to reduce the pH of the colon by producing lactic, acetic and other short chain fatty acids (click to read more about these heroes). (3) What does this mean? Well a lower pH enhances colonic movement (peristalsis) and reduces the transit time in the colon. 

But does it really work? 

The reality remains that the work around probiotics and prebiotics, the microbiome and supplements remains very much in its infancy. There are not a huge amount of studies looking at this specifically and there is variance (once again around strains used and combinations) which make a hard conclusion tricky. However, the theory (and the small studies that have been released so far) DO suggest that it is worth considering. Their use has also been suggested to help in babies and children struggling with the same issue (3, 4). 

So do we use probiotic supplements or something else? 

Everyone has a unique make-up of bacteria, fungi and viruses in their microbiome. Which makes a one size fits all solution quite tricky. It is also why the most interesting research is coming out around very specific and targeted strains used for specific complications. That being said, the generally recognised ‘good’ bacteria: Bifidobacterium and Lactobacillus used in the trials that do exist have shown positive results. Most OTC probiotic brands will contain these two in some way shape or form. However, always chat to your doctor before starting to take any form of supplement, especially during pregnancy. 

Is diet a better way to get what we need to combat pregnancy constipation? 

We know that the microbiome can be influenced in as little as 24hrs by what we eat. This includes pre and probiotic foods. Click here to read more. 

The obvious are fermented foods and foods full of fibre. However, the Mediterranean diet (lots of whole foods, unprocessed, plant based with fish and whole healthy fats) is another obvious route. Once again, chat to your doctor before making any major changes, especially if you have existing gastro issues. 

Bottom line?

Alas, constipation is a common side effect of pregnancy. There is also no real ‘silver bullet’ slam dunk way to treat it. Hydration, exercise and fibre are the obvious first line approach. However, they do not always do the job and it appears that probiotics could be another tool to tackle. We like this as frankly focusing on making your microbiome (not just the gut) as healthy as possible has been said to yield several positive potential outcomes for having healthy kids. Click here for more. As always, if in doubt chat to your doctor first. 

References:

1) Trottier M, Erebara A, Bozzo P: Treating constipation during pregnancy: Canadian Family Physician: 2012 Aug; 58(8): 836-838

2) Vazquez JC: Consipation, haemorrhoids and hearburn in pregnancy: BMJ: Clinical Evidence: 2010

3) Milliano I, Tabbers MM, Benninga MA: Is a multispecies probiotic mixture effective in constipation during pregnancy? Nutrition Journal: 2012: 11: 80

4) Griffin C: Probiotics in obstetrics and gynaecology – a review: Journal of Obstetrics and Gynaecology: 2015: 55: 201-209 

————————————————————————————————————————————————————

This article is for informational purposes only. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The information on this website has been developed following years of personal research and from referenced and sourced medical research. Before making any changes we strongly recommend you consult a healthcare professional before you begin.

Copyright © 2023