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Treating constipation and heartburn in pregnancy

Any doctor or midwife confronted with the problem of constipation should first and foremost proffer a dietary solution. This does help in a lot of cases, though not all. High fiber and fresh fruit should be prominent in the diet. It is only when this does not work that drug preparations should be considered.

Ø Lactulose is a synthetic sugar that is known to be safe in pregnancy. It is contraindicated in people with the rare condition known as galactosaemia (the body's inability to change galactose, a sugar derived from milk sugar, into glucose). It is probably vital for the mother to know that lactulose is not absorbed from the gut and therefore has no chance of reaching the baby. Brand names of lactulose include Cephulac®, Constillac®, Duphalac®, Actilax ®etc

Ø Fybogel® (isphagula) is one of a group of "bulk-forming laxatives". These need to be taken with plenty of fluids. Other preparations of a similar compound come with names such as Regulan®, Fibrelief®, Isogel® and Konsyl®. Also related are bran and Sterculia (Normacol®) etc. All these are safe as they do not stimulate the uterus and are not absorbed from the gut and therefore do not reach the fetus.

Ø Bisacodyl is one of the "stimulant laxatives". The orally taken stimulant laxatives have no known harmful effect on the fetus. However, there is a theoretical possibility that they could stimulate the uterus and precipitate a miscarriage or preterm labor. They are generally avoided in pregnancy. An exception to this is the rectally administered suppository (Glycerine). The action of this is mild and is confined to the rectum. There is no danger of miscarriage or preterm labor. It can therefore be used safely in pregnancy.

Ø Phosphate enema will be used in pregnancy when the situation gets desperate. Its action is local and there is no danger of causing damage to the baby. By its very nature, an enema cannot be used on a regular basis. Use in early pregnancy may cause slight concern of the theoretical risk of precipitating miscarriage. This is highly unlikely but in the presence of several and arguably more user-friendly alternatives, its use at this stage of pregnancy is rarely justified.

Ø Picolax represents a group of the powerful laxatives used in preparing the bowel before surgery. It is not used in pregnancy.

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Treating constipation and heartburn in pregnancy

The laxative Lactulose is safe to use at any stage of pregnancy. It will not reach the baby as it passes through the mother’s intestine unabsorbed.