Constipation in pregnancy

Key content Constipation affects up to 38% of pregnancies. Rising progesterone levels in pregnancy contribute to slow gut motility. The standard clinical measures of chronic constipation are the Rome III criteria, which are based on frequency and difficulty in the passage of stool. Secondary constipation is due to primary disease of the colon (anal fissure, stricture and neoplasia), metabolic disturbances (hypothyroidism and hypercalcaemia) and neurological disorders. Severe constipation may result in faecal impaction, retention of urine, pain or abdominal discomfort, rectal bleeding and/or rectal prolapse. A treatment algorithm using laxatives that are effective, safe and non‐teratogenic will be discussed. Learning objectives To understand the prevalence and pathophysiology of this condition in pregnancy. To understand the management of constipation in pregnancy. Ethical issues The studies on safety of laxatives in pregnancy have small sample sizes although they have not shown any effect on congenital malformations. When to involve a gastroenterologist or a colorectal surgeon in the care of a woman with constipation in pregnancy.