Constipation is common during pregnancy, occurring in up to one-third of women. Constipation during pregnancy is probably caused by progesterone-related changes in both small bowel and colon motility, and by the increased absorption of water and electrolytes during pregnancy. The subjective experience of the pregnant woman (a feeling of fullness due to the growing uterus) ccrtainly also plays a role. Therefore, before prescribing laxatives it must be determined whether there is, in fact, any constipation (hard, dry stool, painful, less than three times a week).
Therapeutically, an improvement should first be attempted with dietary changes, including increased fluid and fiber intake, training of the defecation reflex, and increased physical activity. When these measures are not successful, it may be necessary to use a laxative to enhance the effectiveness of defecation.
Habituation to these medications, resulting in the abuse of excessively high doses, should be counteracted because water loss, electrolyte imbalance and, in advanced pregnancy, uterine contractions, can endanger the fetus.
Laxatives should only be used in pregnancy when dietary and physical measures have been unsuccessful. In this case, stool-bulking agents are the drugs of choice (Bonapace 1998).
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