How safe are laxatives to use during pregnancy?

Question

Hello doctor,

My 29-year-old daughter has chronic constipation, which has worsened significantly during her second pregnancy. She is currently 32 weeks pregnant and has not had a bowel movement in six days, despite trying multiple remedies. The straining is causing hemorrhoids and anal fissures that bleed and cause severe pain. Her obstetrician prescribed Docusate and Polyethylene glycol, but neither seems to be effective anymore.

She is worried about the baby because her abdomen is extremely distended and uncomfortable. Iron supplements prescribed for her anemia, her hemoglobin is 9.2, are making the constipation even worse, though she needs them. Yesterday, she developed severe abdominal cramping that prompted us to visit the emergency room.

Can chronic constipation during pregnancy harm the baby? What safe and effective treatments are available that will not affect fetal development? She is also becoming increasingly concerned about possible delivery complications due to her ongoing bowel issues.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I am sorry for this harrowing and frightening situation. Please tell her I understand her worry, but let us tackle this together. First, chronic constipation itself rarely directly harms the baby, but the severe discomfort, straining, and potential complications like obstruction do need urgent attention.

Safe steps can now be taken -

ER (emergency room) assessment is crucial; it rules out obstruction or other issues causing that cramping and distension.
Gentle relief, if PEG (percutaneous endoscopic gastrostomy) and Docusate (Dioctyl sulfosuccinate) fail, Lactulose or Sorbitol syrup are often safe next steps; they draw water into the bowel. In severe impaction, manual removal by an expert might be needed.
Iron switch to IV (intravenous) iron infusions bypasses the gut, solving the anemia without worsening constipation. Ask her gynecologist about this immediately.
For pain relief, Sitz baths and prescription topical Lidocaine can soothe fissures or hemorrhoids.
Delivery preparation, discuss hemorrhoid management with her OB (obstetrician and gynecologist) team, options like early epidural or perineal support can help during pushing.

Long-term goals include focusing on soluble fiber (such as oats and chia), consuming ample water, and engaging in safe movement. You are doing great advocating for her to keep working closely with her OB. Relief is possible.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.