Clinically encountering constipation during pregnancy, don't just think of lactulose, and these can be used!

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

The effects of constipation during pregnancy can be large or small, mild manifestations of abdominal pain, bloating, severe constipation will lead to intestinal obstruction, and even cause premature birth, endangering the health of the mother and baby. In the third trimester of pregnancy, constipation may also affect the delivery process, causing prolonged labor, and even difficult labor and postpartum haemorrhage, and can also lead to reproductive system diseases.

Treatment: the goal of treatment is to relieve symptoms, restore normal intestinal motility and defecation physiological function.

General treatment

Lifestyle modifications such as increasing dietary fiber and water intake and increasing exercise are the basic treatments for chronic constipation.

Diet: Dietary fiber has an antihydrolytic effect on certain enzymes in the small intestine and is not absorbed by the colon, so it retains intestinal fluids and increases the volume of stool. However, it should be noted that some patients with constipation may aggravate bloating, abdominal pain, bowel sounds and other discomforts after increasing dietary fiber, which is caused by increased intestinal gas production due to increased dietary fiber.

Consuming 2 L of water per day enhances the laxative effect of dietary fiber, so several constipation guidelines recommend a water intake of 1.5-2.0 L/day.

Moderate exercise: Especially for patients who have been bedridden for a long time and have little exercise.

Establish good bowel habits: The morning standing reflex promotes colon movement and helps to produce stool intentions. In addition, patients with constipation are advised to try to defecate in the morning and within 2 hours after a meal. When defecating in the toilet, you need to concentrate, avoid being disturbed by factors unrelated to defecation, develop good defecation habits, and each stool should not be too long (

Cognitive therapy: Cognitive therapy in patients with refractory constipation has shown improvement in subjective symptoms in 71% of patients, and special psychological scores have shown significant improvements.

During constipation, patients try to avoid taking drugs containing iron and calcium, and supplementation with iron and calcium can aggravate or lead to constipation.

drug therapy

Criteria for the selection of laxatives for pregnant women

If symptoms of constipation are ineffective through lifestyle modifications, laxative medication may be given as appropriate. Due to the peculiarity of pregnancy, the choice of laxative drugs in pregnant women should be based on ensuring the safety of the mother and fetus. The ideal laxative should meet the characteristics of good efficacy, no absorption into the blood, no teratogenic effect, and good tolerance.

Recommendations for the use of laxative drugs commonly used by pregnant women

(1) Volumetric laxatives:

Wheat cellulose: It is made of wheat bran as raw material and extracted from wheat cellulose. The FDA is classified as Grade B during pregnancy. Uk.K. maternal health guidelines state that wheat fiber is used in pregnant women to treat constipation, increase the frequency of bowel movements, alleviate difficulty in defecation, and the evidence-based medicine level is I.A. It can be safely applied to pregnant women, including those with abnormal glucose tolerance, and rarely causes allergies, so it can be safely applied to constipation in pregnant women.

Psyllium: A natural water-soluble fiber extracted from the shell of psyllium. In Western developed countries, Europa plantain shells have been used as over-the-counter drugs in the market for decades and maintain an excellent safety record. Psyllium hydrophilic adhesive powder does not contain sugar, with aspartame as a flavoring agent, and patients with phenylketonuria should be used with caution.

Precautions: Therapeutic doses of volumetric laxatives are often accompanied by bloating, nausea and other discomforts; before taking ou che, it is necessary to pay attention to serious adverse reactions that may cause bronchial asthma and life-threatening allergic reactions.

(2) Osmotic laxatives :

Polyethylene glycol (PEG) (FDA Class C): The drug of choice recommended by the American Gastroenterological Association for the treatment of chronic constipation during pregnancy. Patients usually tolerate it very well. PEG is not absorbed and metabolized by the intestine 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.

Precautions: Diarrhea may occur with high-dose medication, and a few adverse reactions such as bloating, abdominal pain, and nausea can disappear after stopping the drug for 24-48 hours, and then the dose can be reduced to continue treatment.

Lactulose oral solution: is currently used in mainland China to treat constipation during pregnancy and childbirth commonly used laxative drug, approved by the US FDA for the treatment of maternal constipation, is the World Gastroenterology Organization (WGO) recognized prebiotics.

Precautions: Abdominal distention may occur in the first few days of treatment, usually continued treatment can disappear, when the dose is higher than the recommended dose, abdominal pain and diarrhea may occur, at this time the dose should be reduced. Long-term high-dose use leads to diarrhea, and patients may have electrolyte abnormalities and need to reduce the dose.

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

Other drugs

Lubricating laxatives kaisereau 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 carragee ester plugs, and it is forbidden to use musk-containing Chinese medicine suppositories and creams. Docusate sodium has a mild and slow onset of action and can be applied to pregnant women in the short term.

Maternal constipation treatment process

According to the "Expert Consensus on the Rational Application of Laxative Drugs in Obstetrics and Gynecology", the treatment process of maternal constipation is as follows:

Prophylactic drugs: people at high risk of constipation (cervical insufficiency cyclotracyclery, placenta previa, etc.), preferred drugs: disaccharide osmotic laxatives (such as lactulose), secondary drug selection: volumetric laxatives.

Therapeutic agents: first assessment of constipation symptoms, first-line laxatives are preferred: disaccharide osmotic laxatives (e.g., lactulose), secondary agents: other osmotic laxatives such as polyethylene glycol.

If the above treatment is ineffective, second-line drugs should be used: compound carragee ester suppositories and dolcuriate sodium (short-term application) can be considered.

In general, the key to solving constipation is to develop good living habits, and if it cannot be alleviated, only consider drug treatment. In general, constipation will be alleviated after childbirth, and without the influence of hormones, intestinal peristalsis will slowly return to normal, and constipation will be easy to control.

Curator: Mango

Caption: Stand Cool Helo

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oDate "Normal and Abnormal Progression of Labor"