Almost nothing is sacred in new-mom conversations: leaky boobs, C-section scars, stretch marks, the dread of having sex again. But there’s one side effect that even oversharers usually view as TMI. “No one talks about the fact that constipation is one of the worst complications of having a baby,” says Jennifer Wider, M.D., a women’s health expert in Fairfield, Connecticut, and author of The New Mom’s Survival Guide. “I had no idea how painful it would be, and I’m a doctor.”
For moms who have it, constipation typically begins in pregnancy, peaks after birth, drags on through the breastfeeding stage, and continues to bum us out even when our toddler is barging into the bathroom—or banging on the door. Statistics on the prevalence of mom constipation are scarce, since most people don’t seek help, but one Canadian study found that 60 percent of women experience it weekly. A staggering 90 percent say it happens at least once a month.
The problem is easy to brush off, especially when you’ve got so much else to deal with. But remember: The issue isn’t just that you’re not pooping—it’s also that you’re stomaching constant discomfort. And no matter how busy you are, you deserve to feel better. What’s more, if you don’t find ways to treat your constipation and then get pregnant again, you could easily develop a chronic issue that’s much harder to fix. We promise, these strategies will help make things come out all right.
Yep, Grandma has it right. Consistently eating beans, bran cereal, whole grains, fruits, and vegetables can prevent and relieve constipation. The average woman needs 25 grams of fiber daily (30 grams during pregnancy), but most people get only about 15. “I lived on prunes and prune juice postpartum and they worked,” says Dr. Wider. (Find prunes embarrassing? Chin up: They’re now individually wrapped and labeled “dried plums,” so you can discreetly throw a few into your diaper bag.) Studies show that eating two or three of them is as helpful as taking a laxative. Not only are prunes high in fiber (1 cup provides 12 grams), they also contain sorbitol, a sugar alcohol that has a natural laxative effect.
Then have more. When you’re nursing, some of the water that would normally go straight to your colon—to help food keep moving—gets used for milk production. Without the water it needs, your colon soaks up the fluid left in your food waste, resulting in harder stools that won’t budge. So if you’re breastfeeding, aim for ten to 12 glasses a day instead of eight, says Christy Dibble, D.O., director of the Center for Women’s Gastrointestinal Health at Women & Infants Hospital of Rhode Island, in Providence. This advice is also important if you’re upping your fiber intake. Without extra water, fiber can actually make constipation worse and cause gas, bloating, and reflux.
“Physical activity increases blood and oxygen flow to all organs, including the gut, which is why sedentary people have higher rates of constipation,” says Toyia James-Stevenson, M.D., a gastroenterologist at IU Health in Indianapolis. It’s hard to fit in exercise when you’re sleep deprived and on 24/7 mom duty, but you don’t have to run a marathon to see results. Pushing a stroller or a playground swing counts, as does gentle stretching. Your goal can be getting off the couch as often as possible.
“Many options are fairly benign and very therapeutic,” says Dr. Wider. Lots of women begin with a bulking agent (essentially, fiber in powder form) like Metamucil or Citrucel. It’s a good idea to run this by your doctor before you start, as a precaution. “I have my patients take one quarter of the recommended dose, then slowly increase it to the full amount over a few weeks,” says Dr. Dibble. “If they build up gradually, they avoid the bloat and abdominal pain that sometimes come with the extra fiber.” Stool softeners such as Colace are also effective and safe. If you still need help, try a gentle laxative such as MiraLAX or Milk of Magnesia, which draws extra fluid into the intestines. (If you take one of these, be sure to drink plenty of water.) Avoid stimulant laxatives that contain senna or cascara, as they can become ineffective over time. Osmotic laxatives, such as GlycoLax, may be gentler and better tolerated, especially in pregnancy.
Sitting may seem more civilized, but squatting is the most effective way to do your business. When you sit or stand, a muscle called the puborectalis creates a kink in your colon that keeps stool from sliding out. (This is helpful at work and during car pool, but not when you’ve finally managed to find five minutes alone in the bathroom.) Fortunately, lifting your feet—so that your knees are higher than your pelvis—will relax the puborectalis muscle and straighten the kink, giving your poop a smoother route out, says Dr. James-Stevenson. When nature calls, try sitting on the toilet and putting your feet on a step stool. You can also purchase a Squatty Potty toilet stool for about $25.
The large intestine likes a regular schedule. To move things in the right direction, take note of the time of day when you typically feel the urge, and have a meal or a snack around then, along with a little coffee or tea. No caffeine? No problem. A cup of warm water or herbal tea can also be effective. If morning seems to be your go time, try eating a high-fiber snack before bed so peristalsis can work its magic while you sleep.
When you’re trying to poop, take it slow. “Spend less than five minutes or so on the toilet and try some deep breathing. The pelvic floor is actually a respiratory muscle,” says Carrie Pagliano, DPT, founder of Carrie Pagliano Physical Therapy, in Arlington, Virginia, and an American Physical Therapy Association spokesperson. “When you inhale, the pelvic floor drops, and when you exhale, it rises.” Slow, deep breathing introduces a nice gentle movement that can push poop down the road, and it helps you rediscover your pelvic muscles if you’re having trouble with sensation. Making a low humming sound or slowly repeating a mantra also helps some women.
If you know where to apply the pressure, abdominal massage can be a simple and effective way to stimulate a bowel movement, says Dr. Pagliano. A physical therapist can teach you, or you can use how-to videos on YouTube (search for “abdominal massage for constipation”). Your fingers should follow the path of the colon itself: Press over the hip bone on the bottom right, move up across the belly to just below the rib cage, go down again toward the left hip bone, then back to the belly button, and finally straight down to the pubic area. For best results, perform the massage directly before or after a meal.
If leaking urine or painful intercourse accompanies your constipation, or if you don’t experience the urge to go, the muscles and nerves in your pelvis may have been damaged or traumatized during pregnancy or childbirth. You can ask your ob-gyn for a referral to a physical therapist who specializes in pelvic-floor health, or find one on your own at the American Physical Therapy Association. A physical therapist will do an assessment of your pelvic bones, muscles, and nerves, then teach you exercises that can help facilitate a bowel movement. “We often find that women are bearing down too much, which could make the muscles in the exit ramp close instead of open,” says Laurie Kilmartin, DPT, clinical specialist at the Women’s Health Physical Therapy Program at NYU Langone Health’s Rusk Rehabilitation.
Sometimes constipation warrants further medical attention. If you’re experiencing a chronic mix of bloating, cramping, gas, or abdominal pain, or have alternating bouts of diarrhea and constipation, you could have irritable bowel syndrome (IBS), a disorder that affects 10 to 15 percent of the population. Women are up to twice as likely as men to have IBS, and symptoms are often worse during or just before one’s period. Doctors don’t know what causes IBS, but potential culprits include intestinal muscle contractions that may be too weak or too strong, inflammation, changes in gut bacteria, and poorly coordinated signals between the brain and the intestines.
There’s no cure for IBS, but it can be managed with diet, medication, and therapy. “And while it’s still rare, we are seeing an increasing number of young women with colon cancer,” Dr. Dibble notes. All rectal bleeding should be brought to the attention of your doctor.