Constipation is one of the most common discomforts of pregnancy, affecting up to half of all pregnant people at some point. The main culprit is progesterone, a hormone that rises sharply during pregnancy and slows the movement of food through your digestive tract. The good news: a combination of diet changes, movement, positioning, and breathing techniques can make a real difference, and safe medication options exist when those aren’t enough.
Why Pregnancy Makes It Harder to Go
Progesterone is essential for maintaining a healthy pregnancy, but it has a well-known side effect: it relaxes smooth muscle throughout your body, including the muscles that push food and waste through your intestines. This slowing means your colon absorbs more water from stool, leaving it harder and more difficult to pass. The result is constipation, gas, and bloating that can start in the first trimester and often intensify as hormone levels climb.
On top of hormonal changes, the growing uterus physically compresses the intestines later in pregnancy, further reducing their ability to move things along. Iron in prenatal vitamins is another common contributor. All three forms of supplemental iron (ferrous sulfate, ferrous gluconate, and ferrous fumarate) can worsen constipation, and there’s no strong evidence that one form is gentler than another. If your prenatal vitamin seems to be making things worse, it’s worth trying a different formulation to see what you tolerate best.
How Much Fiber and Water You Actually Need
The daily fiber target during pregnancy is 25 to 36 grams, depending on your age and calorie intake. Most people fall well short of that. Reaching it doesn’t require a dramatic diet overhaul. A bowl of oatmeal with berries, a pear, a cup of lentil soup, and a serving of broccoli gets you close. Spread fiber intake throughout the day rather than loading it into one meal, which can cause bloating.
Good high-fiber options include beans, lentils, whole grains, raspberries, pears, prunes, chia seeds, and leafy greens. Prunes deserve special mention because they contain both fiber and a natural compound that draws water into the intestines. Even three or four prunes a day can help.
Fiber only works if you’re drinking enough water to keep stool soft. National guidelines recommend pregnant people consume between 1.9 and 3 liters of water daily. That’s roughly 8 to 12 cups. Hydration becomes even more important in the second and third trimesters, when your body needs additional water to form amniotic fluid, carry nutrients, and support digestion. If you’re increasing your fiber and not increasing your water, you can actually make constipation worse.
Toilet Positioning and Breathing Techniques
How you sit on the toilet matters more than most people realize. Elevating your feet on a small stool (about 6 to 8 inches high) so your knees are above your hips straightens the angle of your rectum, making it easier for stool to pass without excessive straining. Lean slightly forward with your elbows on your knees and let your belly relax.
Straining hard is something to actively avoid during pregnancy. It increases pressure on your pelvic floor and can contribute to hemorrhoids, which are already more common during pregnancy due to increased blood volume and pressure from the uterus. Instead, try a breathing technique sometimes called “brace and bulge”:
- Step one: Take four or five deep breaths in a row, letting your lower abdomen relax forward with each inhale.
- Step two: Make your waist wide by humming an “M” sound. This generates gentle abdominal pressure without bearing down hard.
- Step three: Transition to an “OO” sound while bulging your lower abdomen forward. This relaxes the pelvic floor muscles and allows stool to pass. Repeat the “M” sound if you need more pushing pressure.
This approach works with your body instead of against it. It feels odd at first, but many people find it surprisingly effective once they get the rhythm down. Give yourself time on the toilet without rushing, and try going at the same time each day, ideally after a meal, when your body’s natural digestive reflexes are strongest.
Movement and Daily Habits
Regular physical activity stimulates the muscles in your intestines. Even a 20 to 30 minute walk each day can noticeably improve bowel regularity. Swimming, prenatal yoga, and light stretching are also helpful. The key is consistency rather than intensity.
A few other habits that help: don’t ignore the urge to go. Delaying a bowel movement allows the colon to absorb even more water from the stool. A warm drink first thing in the morning (coffee, tea, or just warm water with lemon) can trigger the gastrocolic reflex, which is your body’s natural signal to move the bowels after something enters the stomach.
Safe Medications When Diet Isn’t Enough
Sometimes fiber, water, and movement aren’t sufficient, especially in the third trimester. Several types of laxatives are considered safe during pregnancy.
Bulk-forming laxatives like psyllium (sold as Metamucil and similar products) work the same way dietary fiber does, by absorbing water and adding bulk to stool. They aren’t absorbed by the body and are typically the first option to try. Mix them with a full glass of water and expect results within one to three days rather than immediately.
Stool softeners containing docusate sodium (Colace is the most familiar brand) moisten the stool so it passes more easily. Only a minimal amount of the active ingredient is absorbed, making them unlikely to affect the baby. These work best for prevention rather than relief of severe constipation.
Osmotic laxatives like magnesium hydroxide (Phillips’ Milk of Magnesia) or lactulose draw water into the intestines and usually produce results within 6 to 12 hours. Stimulant laxatives such as bisacodyl are also considered safe but are generally reserved for when gentler options haven’t worked, since they can cause cramping.
Even though these options are widely considered safe, it’s still worth mentioning them to your provider, especially if you’re using them regularly. If constipation persists for more than a few weeks despite trying these strategies, or if you notice any rectal bleeding, bring it up at your next appointment.
Quick Reference: A Daily Routine That Works
Putting all of this together into a practical daily routine makes it easier to stay consistent:
- Morning: Start with a warm drink, eat a high-fiber breakfast (oatmeal, whole grain toast, or fruit), and sit on the toilet for five to ten minutes using the elevated-feet position.
- Throughout the day: Aim for 25 to 36 grams of fiber spread across meals and snacks. Drink water consistently, targeting at least 8 cups.
- Afternoon or evening: Take a 20 to 30 minute walk or do gentle movement.
- As needed: Use a stool softener or bulk-forming laxative if diet and movement aren’t enough. Three or four prunes as a snack can also help.
Most pregnant people find that combining two or three of these strategies produces noticeable improvement within a week. The approaches that tend to make the biggest difference are increasing water intake, using the squatting position with a foot stool, and learning to breathe rather than strain.