Constipation can be a common aspect of pregnancy for many of us, but it can be harder to manage when you have HG and are struggling with what you can eat. 

What is constipation?

Everyone’s bowel habits are different and there is a wide variation constituting a “normal” bowel habit. Constipation broadly means a reduction in your bowel habits sufficient to cause discomfort i.e.: pooing less often than usual, with pain or difficulty. Signs of constipation include:

• passing small, hard stool
• having a bowel motion that is very difficult to pass
• Discomfort, pain, cramps, or bloating in your stomach
• can make you feel more nauseated. 

As well as being uncomfortable and painful, constipation can also increase your risk of developing piles, pelvic floor issues, or - sometimes - needing hospital treatment (e.g.: enema, manual disimpaction).

For patients on cyclizine (Valoid) or ondansetron (Zofran), constipation is a common side-effect - even if you are not usually prone to it, or able to eat much. Please read here first if you are being advised to reduce/stop your medications. 

So what can help? 

Dietary Changes

These are usually the first thing your doctor or dietitian will recommend - however they can also be difficult with HG. 

• Stay well-hydrated - try diversifying your intake of fluids as often plain water can be very nauseating with HG. Sucking an ice cube, having some frozen fruit or using a cordial to add some flavour to ice-cold water can help. Taking small sips of fluid throughout the day can be much easier to tolerate than a full glass of water. 
• Eat high-fibre foods like beans, cereals (especially bran), and fruit. 
• Exercise daily, even if just walking or 15 minutes of gentle movement 

Some other tips on eating and drinking here. It is totally understandable if these are not options for you at the moment - there are other things you can do. 

Over-the-counter supplements and medications

• Ground flaxseed is available in most supermarkets/health food shops. You don’t need a lot so it is easy to add to soft foods such as porridge, yoghurt, milkshakes, or smoothies. Some have also found psyllium husk helpful. 
• Fibre supplements such as Fybogel (NB: this is dissolved in water to drink)
• Lactulose may be more tolerable, as you just need to take 1-2 spoonfuls. Some patients find putting into a child's medication syringe is easier to swallow. This softens the stool and usually takes a few days to kick in.
• Dulcoease: this has the active ingredient macrogol and is a liquid which can be added to other liquids, or taken alone like lactulose. 
• Senna - this comes as tablets, such as Senokot. 
• Microlax: this is a mini-enema which you insert rectally to soften poo. 

Prescription Options

• Movicol - this is a powder which you mix into a small amount of water (it has the same active ingredient, macrogol, as Dulcoease) It has a naturally salty taste; flavoured versions are available but it may still be difficult to swallow or keep down. 
• Glycerol suppositories: these go up the back passage to soften stool.

When to get help from your GP/hospital

• If you haven’t had a bowel motion for 3 days
• You notice blood in your poo or when you wipe - this can be a sign of various conditions, including piles. There are treatment options for piles that are safe to take in pregnancy. Bleeding in pregnancy from the back passage should never be ignored and should trigger review by your doctor.
• You have bad cramping in your stomach