Last Updated: January 2026 | By Heather Marra, PT, MPT, PRPC, PCES, CAPP

Struggling with constipation during pregnancy? You're far from alone. Research shows that up to 50% of pregnant women experience constipation at some point during their pregnancy, compared to only 15% of non-pregnant women. This uncomfortable condition can make an already challenging time even more difficult—but it doesn't have to be this way.

As a pelvic floor physical therapist who has worked with hundreds of pregnant women, I understand how frustrating pregnancy constipation can be. Beyond the immediate discomfort, chronic constipation during pregnancy can increase your risk for hemorrhoids, pelvic organ prolapse, and anal fissures—complications you definitely want to avoid.

In this comprehensive guide, you'll learn:

• Why pregnancy causes constipation (and when it typically starts)
• Safe, effective strategies to find relief
• Specific foods and amounts to help you stay regular
• Which medications are safe and which to avoid
• How proper toilet positioning makes a huge difference
• Warning signs that require medical attention
• Prevention strategies for each trimester

Why Does Pregnancy Cause Constipation?

Understanding why constipation happens during pregnancy empowers you to address it more effectively. Multiple factors combine to slow your digestive system:

1. Hormonal Changes - The Primary Culprit

Progesterone: This essential pregnancy hormone relaxes smooth muscle tissue throughout your body, including your intestinal muscles. While this relaxation helps your uterus expand and prevents premature contractions, it also slows the movement of food and waste through your digestive tract.

The longer waste stays in your colon, the more water gets absorbed from it, making stools harder, drier, and more difficult to pass. Progesterone levels rise dramatically in early pregnancy and remain elevated, which is why constipation can begin in the first trimester and persist throughout pregnancy.

Relaxin: Another hormone that increases during pregnancy, relaxin loosens ligaments and joints (preparing your pelvis for childbirth) but can also affect bowel motility.

2. Physical Pressure from Your Growing Uterus

As your baby grows, your expanding uterus puts increasing pressure on your intestines and rectum. This pressure is particularly pronounced in the second and third trimesters and can physically slow the passage of stool through your digestive system.

By trimester:

• First trimester (Weeks 1-12): Hormones are the main factor
• Second trimester (Weeks 13-27): Both hormones and increasing uterine size contribute
• Third trimester (Weeks 28-40): Maximum pressure on intestines; constipation often worsens

3. Iron Supplements and Prenatal Vitamins

While iron is essential for preventing anemia during pregnancy, iron supplements are notorious for causing or worsening constipation. The elemental iron in prenatal vitamins can slow bowel movements and harden stools.

What you can do:

• Take iron with plenty of water
• Consume iron-rich foods alongside vitamin C to enhance absorption
• Ask your healthcare provider about switching to a different prenatal vitamin formulation
• Consider taking smaller doses throughout the day rather than one large dose
• Some women tolerate liquid iron supplements better than pills

4. Decreased Physical Activity

Pregnancy fatigue, morning sickness, and physical discomfort often lead to reduced exercise. Physical activity stimulates intestinal contractions that move waste through your system, so decreased movement can worsen constipation.

5. Dietary Changes

Pregnancy cravings, aversions, and nausea can significantly alter your normal eating patterns. You might be:

• Avoiding fiber-rich vegetables that trigger nausea
• Eating more processed, convenient foods
• Consuming more dairy products (which can be constipating)
• Drinking less water due to frequent urination concerns

6. Dehydration

Your body requires significantly more water during pregnancy to:

• Support increased blood volume (about 50% more by the third trimester)
• Produce amniotic fluid
• Support fetal development
• Maintain your own bodily functions

Many pregnant women don't increase their water intake enough to meet these additional demands, leading to dehydration that contributes to hard, difficult-to-pass stools.

When Does Constipation Start During Pregnancy?

Most women first experience pregnancy constipation in the second or third month (around weeks 8-12), when progesterone levels surge. However, the timeline varies:

Early pregnancy (First trimester):

• Constipation can begin as early as 2-3 weeks after conception
• Often accompanies other early pregnancy symptoms (nausea, fatigue, breast tenderness)
• Primarily hormone-driven

Mid-pregnancy (Second trimester):

• May improve slightly as morning sickness subsides and eating normalizes
• Some women experience their first constipation issues during this phase
• Both hormonal and physical factors at play

Late pregnancy (Third trimester):

• Often the worst period for constipation
• Maximum uterine size creates most physical pressure on intestines
• Baby's position can affect bowel function
• Reduced mobility due to size and fatigue

Important to know: Some women experience constipation throughout their entire pregnancy, while others only have issues during specific trimesters. Neither pattern is "abnormal"—every pregnancy is different.

Is Constipation Harmful to Your Baby?

No, constipation itself does not harm your baby. Your baby is well-protected in the amniotic sac and receives nutrients through the placenta, regardless of your bowel movements.

However, chronic constipation can cause complications for you:

Potential complications:

• Hemorrhoids: Straining during bowel movements causes swollen, painful veins around the anus
• Anal fissures: Small tears in the anal tissue from passing hard stools
• Severe abdominal pain: From gas and stool buildup
• Worsening pelvic floor dysfunction: Chronic straining weakens pelvic floor muscles
• Increased risk of pelvic organ prolapse: Especially postpartum if pelvic floor is weakened
• Rectal prolapse: In severe cases (rare)

When constipation becomes a medical concern:

While constipation alone doesn't threaten your baby, certain symptoms accompanying constipation require immediate medical attention (see "When to Call Your Doctor" section below).

7 Evidence-Based Strategies for Constipation Relief During Pregnancy

Based on both research and my extensive clinical experience with pregnant women, here are the most effective approaches to relieving and preventing pregnancy constipation:

1. Start Your Day with Hot Water

This simple strategy jumpstarts your digestive system after overnight fasting and natural dehydration.

Why it works:

• Warm liquid stimulates peristalsis (intestinal contractions)
• Rehydrates you after 7-8 hours without fluids
• The heat helps relax intestinal muscles
• Signals your body it's time for elimination

How to do it:

• Drink 8-12 ounces of hot water first thing in the morning
• Drink it before your coffee or tea
• If plain hot water is unappealing, add:
  • Fresh lemon juice (vitamin C also aids iron absorption)
  • A drop of lemon essential oil
  • Fresh mint leaves
  • A small amount of honey

Pro tip: Keep a thermos of hot water on your nightstand so you can drink it before even getting out of bed.

2. Increase Your Fluid Intake Significantly

Target: 10-12 cups (80-96 ounces) of water daily during pregnancy

This is significantly more than the standard 8 cups recommended for non-pregnant adults because your body needs extra fluid for:

• Increased blood volume
• Amniotic fluid production
• Preventing urinary tract infections
• Softening stools

Practical strategies:

• Carry a large water bottle everywhere (aim for a 32-ounce bottle and refill it 3 times daily)
• Set hourly reminders on your phone to drink
• Drink a full glass of water with each meal and snack
• Flavor water with fruit, cucumber, or herbs if plain water is unappealing

Signs you're well-hydrated:

• Pale yellow urine (dark urine indicates dehydration)
• Urinating every 2-3 hours
• Softer, easier-to-pass stools

What about frequent urination?

Yes, drinking more water means more bathroom trips—but avoiding water to reduce urination makes constipation worse and increases UTI risk. The solution is to drink steadily throughout the day rather than gulping large amounts at once.

3. Eat 25-30 Grams of Fiber Daily

Fiber adds bulk to stools and helps them move through your digestive system more easily. Most Americans only get about 15 grams daily—half of what's needed during pregnancy.

Two types of fiber:

Soluble fiber: Dissolves in water, forming a gel that softens stools

• Oats, oatmeal
• Beans and lentils
• Apples, pears
• Flax seeds
• Psyllium husk (Metamucil)

Insoluble fiber: Doesn't dissolve; adds bulk and speeds transit time

• Whole wheat products
• Brown rice
• Nuts and seeds
• Vegetables (especially skins and stalks)
• Wheat bran

High-Fiber Foods Chart (with fiber grams):

Fruits:

• Prunes (dried plums) - 12g per cup
• Raspberries - 8g per cup
• Pears (with skin) - 5.5g per medium pear
• Apples (with skin) - 4.5g per medium apple
• Strawberries - 3g per cup
• Oranges - 3g per medium orange
• Peaches - 2g per medium peach

Vegetables:

• Artichoke - 10g per medium artichoke
• Broccoli (cooked) - 5g per cup
• Brussels sprouts - 4g per cup
• Carrots (cooked) - 4.5g per cup
• Spinach (cooked) - 4g per cup
• Sweet potato (with skin) - 4g per medium potato

Grains:

• Bran cereal - 10-14g per cup (check labels)
• Oatmeal - 4g per cup cooked
• Whole wheat bread - 2g per slice
• Brown rice - 3.5g per cup cooked
• Whole wheat pasta - 6g per cup cooked

Legumes:

• Lentils - 15.6g per cup cooked
• Black beans - 15g per cup cooked
• Chickpeas - 12.5g per cup cooked
• Split peas - 16g per cup cooked

Nuts and Seeds:

• Chia seeds - 10g per 2 tablespoons
• Ground flaxseed - 3g per 2 tablespoons
• Almonds - 3.5g per ounce (23 almonds)

Important: Increase fiber gradually!

Adding too much fiber too quickly can cause bloating, gas, and abdominal discomfort. Increase your fiber intake by 5 grams every few days while also increasing water consumption.

Foods to limit (can worsen constipation):

• Excessive dairy products (cheese, milk, ice cream)
• White bread and refined grains
• Processed snack foods
• Red meat
• Fried foods
• Bananas (especially unripe)

4. Use a Squatty Potty or Footstool

This is one of the most underrated yet highly effective strategies for easier bowel movements during pregnancy!

Why toilet position matters:

The modern sitting toilet places your body at a 90-degree angle, which actually kinks your rectum and makes elimination more difficult. When you elevate your feet and lean slightly forward, you create a 35-degree squatting angle that:

• Straightens the anorectal angle
• Relaxes the puborectalis muscle (which normally keeps the rectum kinked)
• Allows gravity to assist elimination
• Reduces straining significantly

How to use proper positioning:

1. Place a sturdy footstool, Squatty Potty, or overturned wastebasket in front of your toilet
2. Sit on the toilet with your feet elevated on the stool (knees higher than hips)
3. Lean slightly forward with your back straight
4. Rest your elbows on your thighs
5. Relax your abdominal muscles (imagine "bulging" them out rather than pulling in)
6. Breathe normally—never hold your breath

Height recommendations:

• 7-9 inches for standard toilets
• 5-7 inches for taller "comfort height" toilets

[Link to Squatty Potty video]

Safety note: If you have pregnancy-related balance issues, make sure your stool is stable and consider having someone nearby the first few times.

5. Practice Diaphragmatic Breathing

Diaphragmatic breathing isn't just for stress relief—it directly impacts your digestive function through the "rest and digest" parasympathetic nervous system response.

How diaphragmatic breathing aids digestion:

• Activates the vagus nerve, which stimulates intestinal motility
• Massages internal organs, including the colon
• Reduces stress hormones that can slow digestion
• Improves oxygen delivery to tissues
• Releases tension in the pelvic floor muscles

How to practice:

1. Sit or lie comfortably
2. Place one hand on your chest, one on your belly
3. Inhale slowly through your nose, expanding your rib cage and belly (the hand on your belly should rise while the chest hand stays relatively still)
4. Exhale slowly through your mouth, allowing your belly to fall
5. Practice for 5-10 minutes, 2-3 times daily
6. Use this breathing technique while sitting on the toilet

Specific benefit during pregnancy:

As your baby grows, you lose some trunk rotation and rib expansion. Diaphragmatic breathing maintains mobility in your torso and prevents the shallow chest breathing that can worsen digestive issues.

[Link to diaphragmatic breathing article]

6. Stay Physically Active

Regular exercise stimulates intestinal contractions and helps move waste through your digestive system more efficiently.

Safe pregnancy exercises for constipation relief:

Walking:

• 20-30 minutes daily
• Best done after meals to stimulate digestion
• Low-impact and safe throughout pregnancy

Prenatal yoga:

• Specific poses that massage abdominal organs
• Twists (gentle, open twists only in pregnancy)
• Cat-Cow pose
• Child's pose
• Helps reduce stress that worsens constipation

Swimming or water aerobics:

• Excellent cardiovascular exercise
• Water buoyancy relieves pressure on intestines
• Safe for all trimesters

Pelvic tilts:

• Strengthens core muscles
• Promotes optimal pelvic alignment
• Can be done standing, sitting, or on hands and knees

Important exercise guidelines:

• Get clearance from your healthcare provider
• Avoid exercises that require lying flat on your back after the first trimester
• Stop if you experience pain, dizziness, vaginal bleeding, or contractions
• Stay hydrated before, during, and after exercise

7. Establish Regular Toilet Habits

Your bowel works best on a consistent schedule. Training your body to expect elimination at certain times can improve regularity.

Optimal timing:

• First thing in the morning (the gastrocolic reflex is strongest then)
• 20-30 minutes after meals (food stimulates intestinal contractions)

Good toilet habits:

• Don't ignore the urge to go—respond promptly
• Allow adequate time (but don't strain for extended periods)
• Avoid reading or phone use that prolongs sitting
• Never force or strain excessively
• Use proper positioning (feet elevated, leaning forward)
• Practice relaxation breathing

What NOT to do:

• Strain forcefully (increases hemorrhoid and prolapse risk)
• Hold your breath while pushing
• Sit for longer than 10-15 minutes
• Delay when you feel the urge to go

Safe Medications and Supplements for Pregnancy Constipation

If dietary and lifestyle changes aren't providing enough relief, your healthcare provider may recommend medications. Always consult your doctor before taking any medication during pregnancy.

Generally Safe Options:

Bulk-forming laxatives (First choice):

• Psyllium (Metamucil, Fybogel)
• Methylcellulose (Citrucel)
• How they work: Add fiber to increase stool bulk
• Safety: Not absorbed into bloodstream; safe throughout pregnancy
• Start with: Lower dose and increase gradually
• Must take with plenty of water

Stool softeners:

• Docusate sodium (Colace)
• How it works: Helps water mix with stool to soften it
• Safety: Minimal absorption; considered safe during pregnancy
• Note: Works best for prevention; less effective for existing constipation

Osmotic laxatives:

• Polyethylene glycol (MiraLAX)
• Lactulose
• Magnesium hydroxide (Milk of Magnesia)
• How they work: Draw water into the intestines to soften stool
• Safety: Generally considered safe but consult your doctor
• Note: Can cause electrolyte imbalances with prolonged use

Glycerin suppositories:

• How they work: Lubricate and stimulate the bowel
• Safety: Work locally; minimal absorption
• Use: For more immediate relief

Use with Caution (Only Under Medical Supervision):

Stimulant laxatives:

• Senna (Senokot)
• Bisacodyl (Dulcolax)
• Castor oil
• Concerns: May stimulate uterine contractions
• Use: Only short-term and under doctor's guidance

AVOID During Pregnancy:

Mineral oil:

• Reduces absorption of fat-soluble vitamins (A, D, E, K)
• Can cross the placenta
• Never use during pregnancy

Harsh laxatives:

• Sodium phosphate products
• Can cause severe dehydration and electrolyte imbalances

Herbal laxatives (unless approved by your doctor):

• Many herbal products haven't been studied in pregnancy
• Some may cause uterine contractions

Important medication guidelines:

• Start with the gentlest option first
• Use the lowest effective dose
• Aim for short-term use to establish regularity
• Never use laxatives as a long-term solution without medical supervision
• Some over-the-counter products aren't safe—always check with your healthcare provider first

When to Call Your Doctor About Pregnancy Constipation

While constipation itself is usually just uncomfortable, certain symptoms require immediate medical evaluation:

Call your doctor immediately if you experience:

🚨 Severe abdominal pain:

• Sharp, intense pain
• Pain that worsens progressively
• Pain accompanied by fever
• Could indicate: Appendicitis, bowel obstruction, or other serious conditions

🚨 Rectal bleeding:

• Blood in your stool (more than tiny streaks)
• Blood in the toilet bowl
• Black, tarry stools (could indicate upper GI bleeding)
• Could indicate: Hemorrhoids, anal fissures, or more serious conditions

🚨 Alternating constipation and diarrhea:

• Especially with abdominal pain
• Passing mucus
• Could indicate: Infection, inflammatory bowel disease

🚨 No bowel movement for more than one week:

• Despite trying home remedies
• Accompanied by severe bloating
• Could indicate: Bowel obstruction

🚨 Nausea and vomiting with constipation:

• Inability to keep food or liquids down
• Could indicate: Bowel obstruction or severe constipation

Schedule a regular appointment if:

• Home remedies aren't working after 1-2 weeks
• Constipation is severely impacting your quality of life
• You're unsure which medications are safe to try
• You develop painful hemorrhoids
• You have a history of digestive disorders

The Pelvic Floor Connection: Why Constipation Matters Long-Term

As a pelvic floor physical therapist, I want to emphasize the connection between chronic constipation and long-term pelvic health—especially important during and after pregnancy.

How Chronic Straining Damages Your Pelvic Floor:

During pregnancy:

• Weakens already-stressed pelvic floor muscles
• Increases downward pressure on pelvic organs
• Can worsen pregnancy-related incontinence
• Contributes to hemorrhoid development

Postpartum risks:

• Higher likelihood of pelvic organ prolapse
• Worsened urinary or fecal incontinence
• Painful hemorrhoids that interfere with recovery
• Prolonged healing of perineal tears
• Difficulty with pelvic floor rehabilitation

The straining cycle:

Chronic constipation → Bearing down forcefully → Pelvic floor muscles stretch and weaken → Paradoxically, weakened muscles make it harder to have complete bowel movements → More straining → Further weakness → Potential prolapse

Breaking the cycle:

This is why addressing constipation properly during pregnancy is so important. Using the strategies in this article—especially proper toilet positioning, avoiding excessive straining, and seeking help when needed—protects your pelvic floor for the long term.

Pelvic floor physical therapy can help:

If you're struggling with chronic constipation, painful bowel movements, or concerns about pelvic floor function, consider seeing a pelvic floor physical therapist who can:

• Assess your pelvic floor muscle function
• Teach proper bowel mechanics
• Provide biofeedback training
• Address any pelvic floor dysfunction
• Develop a comprehensive treatment plan

[Link to pelvic floor therapy article]

Preventing Constipation Throughout Your Pregnancy

First Trimester Prevention:

• Start high-fiber eating habits early
• Establish hydration routine (before morning sickness limits fluids)
• Begin diaphragmatic breathing practice
• Discuss prenatal vitamin options with your doctor

Second Trimester Prevention:

• Maintain fiber intake as appetite returns
• Increase physical activity as energy improves
• Set up footstool for toilet positioning
• Monitor bowel patterns and address issues quickly

Third Trimester Prevention:

• Don't reduce fluids due to frequent urination
• Continue gentle exercise even when uncomfortable
• Be especially vigilant about toilet positioning
• Seek help early if constipation worsens

Frequently Asked Questions About Constipation During Pregnancy

Q: Is constipation a sign of pregnancy?

While constipation alone isn't a reliable pregnancy test, it can be an early pregnancy symptom for some women. Progesterone levels rise quickly after conception, potentially causing constipation as early as 2-3 weeks. However, many conditions cause constipation, so take a pregnancy test if you suspect pregnancy rather than relying on digestive symptoms.

Q: Can constipation cause cramping during pregnancy?

Yes, constipation commonly causes abdominal cramping during pregnancy. Gas buildup and intestinal stretching from stool accumulation create cramping sensations that can feel similar to menstrual cramps. However, if cramping is severe, accompanied by bleeding, or you're unsure of the cause, contact your healthcare provider to rule out other complications.

Q: Does constipation get worse as pregnancy progresses?

For many women, yes. Constipation often worsens in the third trimester when your uterus is largest and putting maximum pressure on your intestines. However, some women experience the worst constipation in early pregnancy when hormone changes are most dramatic. Each pregnancy is unique, and symptom patterns vary.

Q: How long does pregnancy constipation last?

For most women, constipation improves significantly within days to weeks after delivery as hormone levels normalize and uterine pressure is relieved. However, some women continue experiencing constipation for a few months postpartum, especially if breastfeeding (which can be dehydrating) or if they had perineal tearing that makes bowel movements uncomfortable.

Q: Can I use an enema during pregnancy?

Generally, enemas are not recommended during pregnancy unless specifically prescribed by your healthcare provider. They can cause uterine contractions in some women and may lead to dehydration or electrolyte imbalances. Always consult your doctor before using an enema while pregnant.

Q: Is it safe to drink prune juice during pregnancy?

Yes, prune juice is safe and can be very effective for relieving constipation during pregnancy. Prunes contain both fiber and sorbitol (a natural laxative). Start with 4-8 ounces daily and increase if needed. However, prune juice is high in natural sugars, so if you have gestational diabetes, check with your healthcare provider about appropriate amounts.

Q: Why do prenatal vitamins cause constipation?

The iron in prenatal vitamins is the primary culprit. Iron supplements can slow bowel motility and harden stools. To minimize this effect, take your prenatal vitamin with plenty of water, eat high-fiber foods, and ask your doctor about alternative formulations if constipation becomes severe. Never stop taking prenatal vitamins without consulting your healthcare provider.

Q: Can severe constipation cause premature labor?

Severe constipation itself doesn't typically cause premature labor. However, very forceful or prolonged straining could theoretically trigger contractions in some women. This is rare, but it's another good reason to address constipation promptly rather than letting it become severe. If you experience contractions along with constipation, contact your healthcare provider.

Q: Is magnesium citrate safe during pregnancy for constipation?

Magnesium citrate is generally considered safe during pregnancy when used occasionally and at appropriate doses, but you should always consult your healthcare provider before using it. Your doctor can recommend the correct dose and ensure it won't interact with other supplements you're taking or affect your electrolyte balance.

Q: Can constipation affect my baby's movements?

Constipation itself doesn't affect fetal movement. However, the bloating and discomfort from severe constipation might make it harder for you to notice subtle fetal movements. If you're concerned about decreased fetal movement for any reason, contact your healthcare provider immediately—this is always worth checking, regardless of whether you're constipated.

The Bottom Line: Taking Control of Pregnancy Constipation

Constipation during pregnancy is extremely common, affecting up to half of all pregnant women—but common doesn't mean you have to suffer through it. Understanding why it happens and implementing the evidence-based strategies in this guide can provide significant relief while protecting your pelvic floor health for the long term.

Key takeaways: ✅ Start prevention strategies early, even before constipation becomes a problem
✅ Focus on the fundamentals: water, fiber, movement, and proper positioning
✅ Never ignore persistent or severe symptoms
✅ Protect your pelvic floor by avoiding excessive straining
✅ Consult your healthcare provider before taking any medications
✅ Address constipation promptly rather than waiting for it to worsen
✅ Remember that what you're experiencing is temporary—it will get better

Your comfort and health during pregnancy matter. If you're struggling with constipation despite trying these strategies, or if you have any concerns about your pelvic floor function, don't hesitate to reach out to your healthcare provider or consult with a pelvic floor physical therapist.

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About the Author

Heather Marra, PT, MPT, PRPC, PCES, CAPP is a pelvic health physical therapist and Women's Health Specialist with over 25 years of experience helping women navigate life transitions with confidence. She specializes in pregnancy-related pelvic health, postpartum recovery, and addressing pelvic floor dysfunction to help women feel strong, healthy, and empowered.

Medical Disclaimer: This article is for educational purposes only and does not replace medical advice from your healthcare provider. Always consult your OB/GYN or healthcare provider before starting new treatments, taking medications, or if you experience concerning symptoms during pregnancy.