How to deal with postpartum constipation

Postpartum constipation is the worst. Here’s how you can get things moving.

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Laura Fisher* expected the early days of life with her newborn to be, ahem, hard, but she didn’t expect weeks of pain, embarrassment and frustration because of constipation that exacerbated a brutal infection of her third-degree vaginal tear. Just thinking about it causes the mom of one to shudder, even six years later.

While most new moms will have a bowel movement within three days of delivery—in fact, many hospitals won’t discharge you until you do—constipation is thought to affect 25 to 50 percent of women during the first two weeks postpartum.

Just when you thought the pushing was over
Postpartum constipation is primarily caused by a one-two punch of dehydration and a diet low in fibre, fresh fruit and veggies, so when friends ask what they can do to help in those early days, tell them to make you a kale salad. A slew of pregnancy and labour hormones, including progesterone, also slow bowel function. Unfortunately, some of the pills the nurse sends you home with probably aren’t helping either. Iron supplements (vital if you are anemic or have low iron after birth) are constipating, as are painkillers, including ibuprofen, codeine and the fast-acting narcotics sometimes used during C-sections. Moms who have had a Caesarian have another strike against them: “When you open up an abdomen for surgery, the bowels go to sleep for 12 to 24 hours,” explains Elaine Herer, deputy chief of obstetrics and gynaecology at Sunnybrook Health Sciences Centre in Toronto. Having that first bowel movement after a Caesarian often takes longer (four to five days) than after a vaginal delivery.

The biggest impediment, however, might be fear. “For many women, the thought of a bowel movement after delivery is downright scary,” says Kelly Hayes, vice-president of the Midwives Association of British Columbia. Fear of popping stitches may cause moms to ignore their bodies’ cues and withhold stool, making constipation worse. Hayes notes, however, that in 10 years as a midwife, she’s never seen torn stitches due to a bowel movement.

When the going gets tough
Top treatment options, according to Herer and Hayes, include drinking tons of water (aim for a minimum eight glasses per day, especially if you’re breastfeeding), eating a healthy diet, loading up on prunes and prune juice, and avoiding processed foods.

If those don’t do the trick within a few days, a stool softener (often provided by your doctor or midwife at discharge) or a laxative can help, but not all are safe postpartum, so check with your healthcare provider first. Hayes suggests putting counter-pressure on the perineum (the area between your vagina and anus) with a clean cloth or gauze, or pressing a pillow gently against your C-section incision for increased comfort during bowel movements. Using a sitz bath two or three times a day will help keep the perineum clean and speed healing. For some, weaning off pain meds naturally leads to constipation relief, but if iron supplements are the culprit, you may need to try a different dosage or formulation, or try to get iron naturally. And get walking. “Movement encourages, um…movement,” says Hayes.

For Fisher, it took more than two weeks of trips to the ER, calls to her family doctor, a visit from a public health nurse and, eventually, a follow-up with her obstetrician to get the care she needed to break the vicious cycle of constipation and the effect of straining on the infected tear. Though the experience is part of the reason Fisher has been hesitant about having another baby, ultimately, she’s made peace with it. “Of all the things that could have gone wrong, it pales in comparison,” she says. “We’re all fine, we’re all healthy, and it was totally worth it.”

* name has been changed

EXPERT TIP: Iron supplements, while necessary for some women after delivery, can make constipation worse. To wean off them, start adding iron into your diet naturally. Sources of iron include dark, leafy greens, beef, tofu, chickpeas, beans, pumpkin seeds and fortified grains. Kelly Hayes, vice-president of the Midwives Association of BC, also recommends nettle-leaf tea.

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