Features of diet therapy for pregnant women with constipation

Co-author, editor and medical expert - Klimovich Elina Valerievna.

Number of views: 109 807

Last updated: 02/16/2022

Average reading time: 8 minutes

While causing discomfort to the woman herself, constipation can also have a negative impact on both the course of pregnancy and the development of the fetus. Therefore, their timely and correct treatment is a priority. And one of the most important stages of therapy is diet.

Causes of stool retention in pregnant women

Constipation during pregnancy can develop for many reasons. But the most common are the following:

Decreased physical activity

. Pregnant women often try to limit physical activity to reduce the likelihood of premature termination of pregnancy. But such a measure is justified only if these risks exist in reality, and not in the imagination of the expectant mother. In the absence of healthy physical activity (walking in the fresh air, performing a special set of gymnastics, etc.), pregnant women experience a fairly rapid weakening of the muscles of the anterior abdominal wall and pelvic floor, which play an important role in maintaining normal intestinal function.

Diet features

. During pregnancy, symptoms such as nausea, heartburn, and a feeling of heaviness in the stomach are often observed, caused by hormonal changes in the woman’s body and the pressure that the enlarging uterus puts on the abdominal organs. This forces a woman to adjust her diet in favor of refined foods and reduce the daily amount of food so that the stomach does not react with unpleasant symptoms. As a result, the volume of intestinal contents decreases, which impairs its motor function.

Fluid deficiency

. Preventing or treating edema during pregnancy often involves reducing fluid intake. This leads to dehydration of stool and difficulty moving through the intestines.

Other reasons

. These include natural changes in the body of a pregnant woman - hormonal changes and enlargement of the uterus, which themselves can cause temporary disruption of the intestines. But in the presence of the above circumstances, these disorders can become entrenched, transforming into chronic constipation.

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Causes of constipation during pregnancy

While carrying a child, a woman's body undergoes hormonal and other changes, so constipation is considered a common occurrence. There may be several mechanisms for its development.

Researchers Zaidieva and Lukyanova point to one of the most likely causes of constipation during pregnancy: “Increased levels of progesterone and its metabolites, which activate inhibitory gastrointestinal hormone and inhibit substances that stimulate peristalsis (gastrin, cholecystokinin, enkephalins, substance P). A decrease in the level of motilin in the period from the 16th to the 36th week of gestation (returns to normal a week after birth)” (Zaidieva Z.S., Lukyanova E.V., 2010, p. 209).

That is, hormonal processes are the main cause of stool retention - it is hormones that affect the tone of the intestinal muscles and fluid retention in the tissues.

Gastroenterologist Burkov draws attention to the fact that constipation is the most common intestinal pathology during pregnancy and occurs in 11-62% of women.

The specialist explains this by saying that “there is a weakening of the automatic rhythmic activity of the intestine in pregnant women due to an increase in the threshold of excitability of its receptors to biologically active substances (serotonin, acetylcholine, histamine)” (Burkov S.G., 2006, p. 28).

That is, the tone of the smooth muscles becomes less susceptible to irritants; this is necessary to prevent excessive contractile activity of the uterus and make it possible to bear a child. Progesterone relaxes smooth muscle tissue, reduces the tone of the uterus, which leads to relaxation of the intestinal muscles.

There are other reasons and factors that contribute to increased bowel problems.

• Reduced physical activity - many types of exercise are prohibited, and a woman may refuse activity to prevent premature birth and miscarriage.
• Diet changes, including those related to toxicosis, nausea, heartburn, possible stomach pain and other pregnancy companions.
• Lack of fluids - your doctor may recommend drinking less water to prevent or correct swelling. According to the data indicated in the work of the authors Zaidieva and Lukyanova, “the consistency of stool is determined by the amount of water in it. In solid feces, its amount does not exceed 40%, in normal feces - 70%, and in liquid feces - 95%" (Zaidieva Z.S., Lukyanova E.V., 2010, p. 209). Dehydration of stool makes it denser, which causes stool retention.
• Taking certain medications. During pregnancy, you may need to use medications such as iron supplements, tocolytics, etc. They may contribute to stool retention.

It is important to remember that pregnancy causes compression of internal organs as the uterus enlarges. This often leads to changes in intestinal motility and constipation.

Types of constipation in pregnant women

During pregnancy, spastic and atonic constipation may occur.

Spastic

. Caused by chaotic, uneven contractions of the intestinal walls in any part of it, which does not allow the creation of a normal peristaltic wave and leads to fecal retention. In this case, there are sharp, cramping pains in the abdomen, stool is difficult, and the feces look like several hard and dry fragments (the so-called sheep feces). Between episodes of excessive spasticity, stool is usually normal and does not cause complaints.

Atonic

. Caused by decreased intestinal tone, which causes slow movement of intestinal contents and dehydration. The feces are dense, voluminous, and defecation is accompanied by discomfort or pain and leaves behind a feeling of incomplete bowel movement.

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The danger of constipation in pregnant women

Constipation during pregnancy requires the closest attention and timely treatment, since stool retention can negatively affect the health of the expectant mother, and in unfavorable circumstances, even provoke premature termination of pregnancy.

First of all, stool retention leads to intoxication of the body with fecal breakdown products, which, instead of being removed from the intestines, remain in it. Also, with constipation, the absorption function of nutrients, which are necessary both for the health of the woman herself and for the growth and proper development of the fetus, is impaired. In addition, an increase in the volume of the intestine due to the accumulation of feces in it can cause pressure on the walls of the uterus, which is quite sensitive to such irritants, especially in the first and last trimester.

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Why is this happening?

The main theory explaining constipation in pregnant women is hormonal. During pregnancy, the hormone progesterone is actively produced, it relaxes the smooth muscles of the uterus, and is needed primarily to maintain pregnancy and prevent premature birth. It is believed that progesterone directly or indirectly affects the smooth muscles of the intestine, slowing down the transit of contents through it.

In the first trimester of pregnancy, the situation may be aggravated if the woman experiences nausea and vomiting, which means the amount of fluid and dietary fiber in the diet may be reduced.

Perhaps, towards the end of pregnancy, the growing uterus, which slightly presses the intestines, contributes to the development of constipation.

Some changes also occur in the condition of the pelvic floor. Muscles and connective tissues are affected by straining during bowel movements, increasing intra-abdominal pressure, and softening of the ligamentous apparatus under the influence of progesterone. The changes that occur can make defecation difficult and create a feeling of obstruction during bowel movements (obstructive defecation). But still, the obstructive mechanism during pregnancy plays a lesser role than slowing down transit.

Pregnant women may suffer from iron deficiency anemia. A side effect of iron supplements prescribed in this case is constipation.

Basic nutrition during pregnancy to prevent constipation

The main principles of nutrition for constipation during pregnancy are the following:

• a sufficient amount of food that will allow the formation of the required volume of intestinal contents for the pregnant woman;
• consuming enough liquid - starting from the first trimester, you should include at least 2–2.5 liters of water in your diet (you can drink weak herbal teas);
• exclusion from the diet of foods that can stimulate excessive intestinal spasticity or worsen its motor functions.
• increase in calories consumed - starting from the second trimester by about 300 per day;
• frequent meals in small portions - this advice is relevant for the first, second, and third trimester.

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Diet for constipation during pregnancy

Nutrition for constipation in pregnant women should meet all the needs of the body of the expectant mother and baby. There are several fundamental principles that should be followed during pregnancy:

• When steaming, boiling, baking, it is important to avoid frying in oil.

• Including fresh vegetables, fruits, berries, dried fruits in the diet;
• A sufficient amount of food that will help form the required volume of feces. Remember that caloric intake increases to 2200–2700 kcal per day in the 1st trimester, up to 2800 kcal in the 2nd trimester.
• Refusal of foods that provoke stool retention or cause excessive contraction of the intestinal muscles.
• Adequate fluid intake. At the same time, not only clean water is calculated, but also tea, broths, and fruit drinks. Mineral water can be useful, including being prescribed for toxicosis, heartburn, and exacerbation of chronic diseases of the gastrointestinal tract of a pregnant woman.
• Fractional meals. Meals should be frequent, small portions. It is advisable to do this in all trimesters of pregnancy.

The diet should be balanced in the amount of proteins, fats and carbohydrates, and contain a sufficient amount of vitamins and minerals. This will help improve intestinal function and prevent excess weight gain. It should be remembered that some vitamins can be additionally prescribed by a doctor in the form of special complexes.

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Drinking regime

What can you drink for constipation during pregnancy? In the absence of edema, you should adhere to the usual drinking regimen with increasing fluid volume. Already from the first trimester, it is important to increase the volume of fluid consumed to 2-2.5 liters. This volume includes not only the clean water we drink, but also teas, broths, fruit drinks, and mineral water.

When edema appears, you may hear a recommendation that you need to reduce the amount of fluid you drink. But it is more advisable to adhere to a salt-free diet while maintaining the required volume of water: it is better to reduce the amount of salt consumed.

Keep in mind that sodium is found in most prepared foods, bread is no exception. Therefore, when preparing most dishes, it is better to use as little salt as possible or avoid it altogether.

During pregnancy, you can drink chamomile and rosehip decoction, weak black or green tea, mineral water - Essentuki 4 or 17, Borjomi and other types of table mineral water are suitable. It is better to avoid strong tea and coffee: the first helps to consolidate stool, and the second increases diuresis, which will also lead to constipation.

Foods to help with constipation during pregnancy

Products for constipation during pregnancy are prescribed first of all; in many cases, you can get rid of the problem with diet alone. Doctors Lukyanova and Zaydieva point out that “prunes, dried apricots, and kefir help reduce the manifestations of constipation” (Zaydiyeva Z.S., Lukyanova E.V., 2010, p. 209).

But a high content of ballast substances is also typical for other food products, these include:

• fresh cabbage;
• carrot;
• cucumbers;
• tomatoes;
• beet;
• bananas;
• dates;
• apples;
• zucchini;
• wholemeal bread, rye bread.

Natural yoghurts, yogurt, and bran will also help cope with constipation. Buckwheat and corn are suitable as porridges. It is important to include sea fish, vegetable oils, and nuts in your diet. But a sharp increase in fiber-rich foods in your diet can lead to bloating and abdominal pain.

If it is not possible to consume enough vegetables and fruits without negative consequences, an additional source of dietary fiber may be needed. For example, the English drug “Fitomucil Norm” contains the shell of plantain seeds and the pulp of domestic plum fruits.

This is a natural source of fiber that will help normalize bowel movements softly and predictably. "Fitomucil Norm" is approved for long-term use, including during pregnancy. Thanks to its composition, which includes mainly soluble dietary fiber, it does not cause bloating and increased gas formation, which means it helps to cope with constipation gently and quickly, without discomfort.

Foods contraindicated for constipation during pregnancy

It is important to limit the consumption of black tea, coffee, cocoa, and chocolate.

It is also better to avoid white bread, baked goods, canned food, sausages, sweets, dishes with mayonnaise and other fatty sauces. Hot and spicy dishes, marinades, and soda are also prohibited.

Some products have a fixing effect: jelly, jellied meat, astringent products like quince, pears, persimmons, rice, crackers, etc. You should also avoid them. All drinks with a diuretic effect cause constipation because they promote increased diuresis. That is why strong coffee and black tea are prohibited during pregnancy.

Constipation is also caused by fermented milk products older than two days, fatty meats, confectionery products with rich cream, and whole milk. You need to watch how the body reacts to certain dishes.

Weekly menu for constipation during pregnancy

You can also drink a glass of kefir or yogurt before going to bed.

Recommended and non-recommended foods on pregnant women's menus

Diet during pregnancy with constipation requires a responsible attitude to menu planning. Preference should be given to the following products and dishes:

• Carbohydrates
  . Oatmeal, buckwheat, corn porridge, bran bread, bananas, dates.
• Squirrels
  . Any lean meat, fish and seafood, cottage cheese, yogurt, whole milk, kefir, fermented baked milk.
• Fats
  . Sea fish of fatty varieties, vegetable oils, butter, nuts.
• Cellulose
  . Any vegetables and fruits (preferably seasonal), bran.

Food products such as canned food and sausage products, baked goods made from premium flour, sweets, dishes with the addition of mayonnaise or other fatty sauces, hot and spicy foods, pickles, smoked meats, carbonated drinks, strong tea and coffee should be excluded from the diet. What to eat for constipation during pregnancy is also determined by the type of constipation - spastic or atonic.

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Diet for spastic constipation in pregnant women

With such constipation, the diet should be gentle. This avoids overstimulation of intestinal receptors responsible for peristalsis. When creating a menu, all products from the recommended list can be used, but their preparation is of great importance. Thus, vegetables and fruits should be consumed in the form of purees, cream soups, baked and boiled. You should also eat porridge cooked with plenty of water, milk or broth so that its consistency is slimy. The presence of fats of animal and plant origin in a pregnant woman’s diet is mandatory.

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Basic menu for constipation in pregnant women

1st breakfast.

A serving of oatmeal or muesli with the addition of a baked or finely grated fresh apple, a glass of yogurt.

2nd breakfast.

Weak green tea with crispy bread and a slice of cheese.

Dinner.

Vegetable puree soup, buckwheat porridge with stewed meat and vegetable salad, milk dessert.

Afternoon snack.

Cottage cheese with raisins and honey, fruit and berry compote.

Dinner

. Baked fish with mashed potatoes, vegetable salad, prune broth.

In addition to creating the right menu, you also need to take care of normalizing your nutrition schedule. This means that in order to avoid constipation, a pregnant woman should eat in small portions, but at least 4-5 times a day.

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Pay attention to food processing!

It should be remembered that to feed pregnant women, all products must be fresh and well-processed. Remember to wash vegetables, fruits or herbs before eating.

To avoid undesirable consequences, it is necessary to thoroughly heat treat meat, poultry, fish and semi-finished products.

Do not eat raw eggs, meat or fish as this is hazardous to your health. Raw foods that are used in some dishes can cause poisoning and more serious consequences.