When encountering constipation during pregnancy clinically, don’t just think of lactulose, there are also these that can be used!

Constipation is more common during pregnancy, with studies finding that it occurs in up to 40% of pregnant women. As the saying goes, constipation and hemorrhoids during pregnancy may form a vicious circle, making both more and more serious.

The impact of constipation during pregnancy can be large or small, ranging from abdominal pain and bloating in mild cases. Severe constipation can lead to intestinal obstruction and even premature birth, endangering the health of mothers and babies. In the third trimester of pregnancy, constipation may also affect the delivery process, causing prolonged labor, even dystocia and postpartum hemorrhage, as well as reproductive system diseases.

Treatment: The goal of treatment is to relieve symptoms and restore normal bowel motility and bowel physiology.

General Treatment

Increase dietary fiber and water intake, increase exercise and other lifestyle adjustments are the basic treatment measures for chronic constipation.

Diet:Dietary fiber is resistant to hydrolysis by certain enzymes in the small intestine and is not absorbed by the colon, thus retaining water in the lumen and increasing stool bulk . However, it should be noted that some patients with constipation may aggravate abdominal distension, abdominal pain, bowel sounds and other discomforts after increasing dietary fiber, which is caused by the increase in intestinal gas production caused by the increased dietary fiber.

A daily intake of 2L of water enhances the laxative effect of dietary fiber, so multiple constipation guidelines recommend a water intake of 1.5-2.0L/day.

Moderate exercise: This is especially beneficial for bedridden patients with limited exercise.

Establish good bowel habits: The rising reflex in the morning promotes colonic movement, which can help with the urge to have a bowel movement. In addition, patients with constipation are advised to try to defecate in the morning and within 2 hours after meals. When going to the toilet to defecate, you need to concentrate, avoid being interfered by factors unrelated to defecation, develop a good defecation habit, and not take too long to defecate each time (

Cognitive Therapy: A study of cognitive therapy in patients with refractory constipation showed improvement in subjective symptoms in 71% of patients, as well as specific psychological scores significantly improved results.

Patients with constipation try to avoid taking iron and calcium-containing medicines. Iron and calcium supplements can aggravate or cause constipation.

Medication

Criteria for Maternal Use of Laxatives

If constipation symptoms do not respond to lifestyle changes, laxatives may be given as appropriate. Due to the special nature of pregnancy, the choice of laxatives in pregnant women should be based on ensuring the safety of the mother and the fetus. An ideal laxative should meet the characteristics of good curative effect, no absorption into the blood, no teratogenic effect and good tolerance.

Recommendations for commonly used laxatives in pregnant and lying-in women

(1) Bulk laxatives:

Wheat cellulose: It is prepared by extracting wheat cellulose from wheat bran as raw material. FDA pregnancy classification is Class B. The British Pregnant Women’s Health Guidelines pointed out that the use of wheat fiber in pregnant women to treat constipation, increase the frequency of defecation, and relieve difficulty in defecation. The level of evidence-based medicine is grade IA. It can be safely used in pregnant women including impaired glucose tolerance and rarely causes allergies, so it can be safely used in pregnant women with constipation.

Psyllium: It is a natural water-soluble fiber extracted from the husk of psyllium. In developed Western countries, psyllium husk has been used in the market as an over-the-counter drug for decades and has maintained an excellent safety record. Psyllium Hydrophilic Powder contains no sugar and uses aspartame as a flavoring agent, so patients with phenylketonuria should use it with caution.

Precautions: Bulk laxatives in therapeutic doses are often accompanied by abdominal distension, anorexia and other discomforts; before taking psyllium, it is necessary to pay attention to serious adverse reactions such as bronchial asthma and life-threatening allergic reactions.

(2) Osmotic laxatives:

Polyethylene glycol (PEG) (FDA Class C): Recommended by the American Gastroenterological Association as the drug of choice for the treatment of chronic constipation during pregnancy. It is usually well tolerated by patients. PEG is not absorbed and metabolized by the intestinal tract after oral administration, its sodium content is low, it does not cause the absorption or loss of intestinal net ions, and there are few adverse reactions.

Notes: Diarrhea may occur with large doses of medication, and a few have adverse reactions such as abdominal distension, abdominal pain, nausea, etc., which disappear within 24-48 hours after stopping the medication, and then the dose can be reduced to continue the treatment.

Lactulose Oral Liquid: It is currently a commonly used laxative for the treatment of constipation during pregnancy and childbirth in China. WGO) approved prebiotic.

Notes: Abdominal distension may occur in the first few days of treatment, which usually disappears with continued treatment. When the dose is higher than the recommended dose, abdominal pain and diarrhea may occur, and the dose should be reduced at this time. . Long-term high-dose use may cause diarrhea, and patients may experience electrolyte imbalance, which needs to be reduced.

Salt osmotic laxatives have a rapid onset of action after oral administration, and are only suitable for short-term symptom relief. Long-term use can cause severe water and electrolyte disorders such as hypermagnesemia, hyperphosphatemia, and dehydration.

Other Drugs

The lubricating laxatives Kaisailu and castor oil are contraindicated in pregnant women; mineral oil should be used with caution in pregnant women. Pregnant women with hemorrhoids complicated by constipation can use compound carrageenate suppositories, and Chinese medicine suppositories and creams containing musk are prohibited. Docusate sodium has a mild effect and a slow onset of action, and can be used for short-term use in pregnant and lying-in women.

Maternal constipation treatment process

According to the “Expert Consensus on the Rational Application of Laxatives in Obstetrics and Gynecology”, the treatment process for maternal constipation is as follows: