Constipation in Pregnancy
Dietary modifications, such as increased fluid and fiber intake, are the most physiologic and safest approachs to constipation during pregnancy. As with all patients, pregnant women should be warned that fiber can cause abdominal bloating or flatulence and that sufficient amounts of fluid should be consumed daily. Fiber supplements should be started with small amounts and gradually increased as tolerated.
In our experience, PEG is not as problematic in terms of abdominal bloating and flatulence as is sorbitol and lactulose. Although safety during pregnancy has not been established (Federal Drug Administration pregnancy Category C), PEG is inert, absorption is minuscule, and toxicity is unlikely. Of the stimulant laxatives, senna is both safe and effective when combined with bulk-forming agents in pregnancy. Cascara is also mild and produces little or no colic.
Although bisacodyl is safe for use in pregnancy, it tends to produce more colic than the anthraquinone laxatives, especially when administered orally. Agents to be avoided during pregnancy include castor oil, which can cause premature uterine contractions, and osmotic agents such as magnesium laxatives and phosphosoda, which may produce sodium and water retention.
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