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Constipation in pregnancy

Also known as Pregnancy constipation. Any trimester, common in the second and third.

Slower digestion, a growing uterus pressing on the bowel, and the iron in your prenatal vitamin: put them together and constipation becomes almost predictable in pregnancy. Between a quarter and nearly half of pregnant people deal with going less, straining, and feeling backed up. It is uncomfortable but rarely serious, and it responds well to the basics: fiber, fluids, and movement. When those fall short, there are stool softeners and laxatives safe in pregnancy. This page covers what works and the warning signs that mean more than constipation.

Know the warning signs When to call a provider
How common
A quarter to nearly half
Estimates range from about 1 in 5 to up to half of pregnancies.
When
Any trimester
Common in the second and third trimesters as the uterus grows.
Urgency
Routine
Uncomfortable but usually managed at home; specific warning signs need care.
Outlook
Very manageable
Responds well to fiber, fluids, activity, and safe medicines.

Understanding it

What is constipation in pregnancy?

Constipation in pregnancy means infrequent, hard, or difficult bowel movements: fewer than three a week, straining, lumpy or hard stools, and a feeling you have not fully emptied. It is one of the most common digestive complaints of pregnancy, rarely serious but uncomfortable day to day.

Three causes overlap. Progesterone relaxes smooth muscle, including the intestinal muscles, so the gut moves waste more slowly. That slower transit lets the intestines reabsorb more water, leaving stool drier and harder. The growing uterus presses on the bowel and rectum. Add the iron in most prenatal vitamins, and it is easy to see why it is so common.

The mainstay of relief is not medicine but the everyday basics: more fiber, more fluids, regular movement. Aim for roughly 25 to 30 grams of fiber a day from fruits, vegetables, whole grains, and beans; drink plenty of water; and keep moving most days.

When lifestyle is not enough, several medicines are safe in pregnancy, from bulk-forming fiber supplements and stool softeners to gentle osmotic laxatives. If iron is the culprit, your provider can often adjust the dose rather than stop it. You do not have to just live with it, and constant straining can bring on hemorrhoids.

Symptoms

What are the symptoms?

Constipation means going less often and with more difficulty. It is uncomfortable but not, on its own, dangerous. A few specific signs point to something more.

Early signs

  • Fewer than three bowel movements a week
  • Hard, dry, or lumpy stools
  • Straining to go, or pain when passing stool
  • A feeling of being bloated, gassy, or not fully emptied
  • Belly discomfort or a swollen, full feeling

Emergency signs — call 911

  • Blood in the stool or rectal bleeding beyond a streak from a small tear
  • Severe belly pain or cramping
  • No passage of stool or gas at all, with vomiting and a swollen belly, which can signal a blockage
  • Constipation alternating with diarrhea, or leaking of loose stool around a hard blockage
  • Unexplained weight loss or persistent vomiting

Why it matters

Risks to you and baby

It does not harm the baby

Constipation is uncomfortable for you but does not affect your baby. It is a comfort and quality-of-life problem, not a danger to the pregnancy.

Hemorrhoids

The most common consequence is hemorrhoids, swollen veins around the anus from straining and pressure. They itch, hurt, and bleed a little. Keeping stool soft is the best way to prevent and ease them.

Anal fissures

Passing hard stool can cause a small tear at the anus, painful and able to leave a streak of bright red blood on the toilet paper. These heal as stools soften.

Discomfort and quality of life

Chronic bloating, straining, and that backed-up feeling wear on you. Treating it is worthwhile and effective.

How it's found

How is it diagnosed?

Constipation in pregnancy is diagnosed from your symptoms. No tests are needed in the routine case, only for warning signs that suggest something more.

Clinical history

The pattern of infrequent, hard, difficult stools makes the diagnosis. Your provider will ask about fiber, fluids, activity, and your iron supplement.

Checking for red flags

Your provider makes sure there is no rectal bleeding beyond a minor tear, severe pain, or signs of a blockage, which would need further evaluation.

Further testing when warranted

Labs or imaging are used only if alarm features are present, not for ordinary pregnancy constipation.

Whenever symptoms are bothersome. Most cases need no testing at all.

Treatment

How is it managed?

Treatment starts with fiber, fluids, and movement, which resolve many cases. When more is needed, several laxatives are safe in pregnancy, and iron can often be adjusted.

Treatment paths

The first line is dietary and behavioral: about 25 to 30 grams of fiber a day, plenty of water, and regular gentle exercise like walking or swimming. Give these a real try before medicine.

Medication

If lifestyle is not enough, bulk-forming fiber supplements such as psyllium are a safe first choice, as the body does not absorb them. Stool softeners like docusate are also safe. Osmotic laxatives such as polyethylene glycol (MiraLAX) and lactulose are poorly absorbed and commonly used, polyethylene glycol often preferred. Stimulant laxatives like senna are used sparingly and short term. Ask your provider first, and avoid castor oil and mineral oil.

Can it recur?

Constipation often persists through pregnancy and returns in a later one, because the causes, hormones, the uterus, and iron, recur too. If your iron supplement is contributing, your provider may lower the dose, switch the type, or move to every-other-day dosing rather than stopping it.

What you can do

Can it be prevented?

  • Get enough fiber

    Aim for roughly 25 to 30 grams a day from fruits, vegetables, whole grains, beans, and prunes. Increase it gradually to avoid gas, and pair with plenty of water.

  • Drink plenty of fluids

    Fiber works best with water. Aim for around 8 to 12 cups a day to keep stool softer and easier to pass.

  • Keep moving

    Regular gentle activity, walking, swimming, or prenatal yoga, keeps the bowel active. Even 20 to 30 minutes most days makes a difference.

  • Talk to your provider about iron

    If your iron supplement is constipating, do not just stop it. Your provider can lower the dose, change the formulation, or switch to alternate-day dosing, which is often gentler.

Who is more at risk

Risk factors

Iron supplements
The iron in most prenatal vitamins is a leading contributor and hardens stool for many people.
Associated with about 3.5 times the odds of constipation.
A history of constipation
If you were prone to constipation before pregnancy, you are more likely to have it during, often worse.
Prior constipation raises the odds roughly 3.6-fold.
Later in pregnancy
As the uterus grows and presses on the bowel, and activity often drops, constipation becomes more common in the second and third trimesters.
Low fiber, fluids, or activity
A low-fiber diet, not drinking enough, and being less active all slow the bowel and make constipation more likely.

Do not wait

When to call your provider or 911

  • Call for blood in the stool or rectal bleeding beyond a small streak, so it can be checked.
  • Seek urgent care for severe belly pain, or for no stool or gas with vomiting and a swollen belly, which can signal a blockage.
  • Call if constipation is severe, lasts despite fiber, fluids, and activity, or alternates with diarrhea.
  • Reach out before starting a laxative, so your provider can recommend one that is safe in pregnancy.
  • Ask about adjusting your iron if you think it is contributing, rather than stopping it on your own.

Talking to your team

Questions to ask your provider

  • How much fiber and fluid should I be aiming for?
  • Which laxatives are safe for me to use, and in what order?
  • Could my iron supplement be the cause, and can we adjust it?
  • Is a bulk-forming supplement or a stool softener better for me?
  • What symptoms would mean this is more than constipation?
  • How can I prevent or treat hemorrhoids from straining?

Keep reading

More on constipation in pregnancy

All pregnancy guides articles

Good to Know

Constipation in pregnancy FAQs

Common questions about constipation in pregnancy, answered.

Why am I so constipated now that I am pregnant?

Three things combine. Progesterone slows the intestinal muscles; the slower transit lets your gut pull more water from the stool, hardening it; and the growing uterus presses on the bowel. The iron in prenatal vitamins adds to it.

What is the fastest safe way to get relief?

Start with fiber, fluids, and movement, which help many within days. If you need more, a stool softener like docusate or an osmotic laxative such as polyethylene glycol (MiraLAX) works gently and is safe. Avoid castor oil and mineral oil.

Are laxatives safe during pregnancy?

Several are. Bulk-forming supplements like psyllium and stool softeners like docusate are not absorbed and are safe. Osmotic laxatives such as polyethylene glycol and lactulose are commonly used, and senna short term. Avoid castor oil and mineral oil.

Could my prenatal vitamin be causing this?

Very likely, if it contains iron, which most do. Do not stop it on your own. Your provider can lower the dose, switch to a gentler formulation, or move you to every-other-day dosing, often easier on the gut and still effective.

How much fiber and water do I actually need?

Roughly 25 to 30 grams of fiber a day from fruits, vegetables, whole grains, beans, and prunes, and around 8 to 12 cups of water. Increase fiber gradually, and keep fluids up, since fiber needs water to work.

Can constipation cause hemorrhoids?

Yes, the most common consequence. Straining and the pressure of the growing uterus can swell veins around the anus that itch, hurt, and sometimes bleed a little. Keeping stool soft is the best prevention.

When should I worry?

Call your provider for blood in the stool beyond a small streak, severe belly pain, or no stool or gas with vomiting and a swollen belly, which can signal a blockage. Constipation alternating with leaking loose stool also needs attention.

Will it go away after the baby comes?

It usually improves after delivery as hormones settle and the uterus no longer presses on the bowel, though the early postpartum weeks can bring their own constipation from iron, pain medicines, or fear of straining. The same approach helps then too.

Medically Reviewed · Updated

Reviewed by Dr. Grace Lin, MD, FACOG · OB-GYN

Obstetrician-gynecologist focused on reproductive and sexual health for women: pregnancy, BV, yeast, trichomoniasis and HPV/cervical screening. Our editorial guidelines →

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