Interventions for treating postpartum constipation

Women may experience constipation during the postpartum period. Consipation is defined as a functional bowel disorder that is characterised by pain and discomfort, straining, hard lumpy stools and a sense of incomplete bowel evacuation. Haemorrhoids, pain at the episiotomy site, effects of pregnancy hormones and iron supplementation can increase the risk of postpartum constipation; as can damage to the anal sphincter or pelvic floor muscles during childbirth. It is a source of concern to the new mother who is recovering from the stress of delivery. The discomfort does not only affect the mother's health, but also impacts on the new baby's well-being, since it needs most of the mother's attention at this time.

A high fibre diet and increased fluid intake can prevent constipation in the puerperium period. Pain-relieving drugs and laxatives are common drugs in relieving constipation. Laxatives are grouped according to their function, as bulk-forming laxatives (such as bran, psyllium and methycellulose) that increase the weight and water content of the stool to facilitate bowel movement; osmotic laxatives (such as lactulose and polyethylene glycol (PEG)) that add water to the colon to improve bowel movement; and stimulant laxatives (such as bisacodyl, castor oil and senna), which act by irritating the intestinal wall. Stool softeners lubricate stools to improve their passage.

This review aimed to evaluate the effectiveness and safety of the available interventions to treat postpartum constipation. We did not find any randomised controlled trials where women diagnosed with postpartum constipation were treated with different interventions. We are thus unable to make any conclusions. There is a need for large trials to evaluate the effectiveness and safety of interventions (such as laxatives, surgery, as well as educational and behavioural interventions) during the postpartum period.

Authors' conclusions: 

We could not make explicit conclusions on interventions for treating postpartum constipation because we found no studies for inclusion in this review. Rigorous and well-conducted large randomised controlled trials aimed at treating postpartum women diagnosed with constipation would be beneficial. These trials should also address the criteria for administering the intervention (time and stage of a diagnosis of postpartum constipation), and the safety and effectiveness of such interventions.

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Background: 

Constipation is a functional bowel disorder that can reduce quality of life in the puerperium period. The diagnosis of postpartum constipation is both subjective and objective. It is characterised by symptoms such as pain or discomfort, straining, hard lumpy stools and a sense of incomplete bowel evacuation. Haemorrhoids, pain at the episiotomy site, effects of pregnancy hormones and hematinics used in pregnancy can increase the risk of postpartum constipation. Although a high fibre diet and increased fluid intake is encouraged to assist defecation in the puerperium, pain-relieving drugs and laxatives are common drugs of choice to alleviate constipation. However, the effectiveness and safety of laxatives on the nursing mother need to be ascertained.

Objectives: 

To evaluate the effectiveness of interventions for treating postpartum constipation.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 March 2014), the metaRegister of Controlled Trials, the US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov), the Australian New Zealand Clinical Trials Registry (ANZCTR), the World Health Organization International Clinical Trials Registry platform (ICTRP), the ProQuest database, Stellenbosch University database and Google Scholar (28 March 2014). We also searched the reference lists of potentially relevant studies identified by the search, reviewed articles for relevant trials and contacted experts to identify any additional published or unpublished trials (10 April 2014).

Selection criteria: 

All randomised controlled trials comparing any intervention for the treatment of postpartum constipation to another intervention, placebo or no intervention.

Interventions could include laxatives, surgery, as well as educational and behavioural interventions.

Data collection and analysis: 

Two review authors independently screened the results of the search to select potentially relevant studies using pre-designed eligibility inclusion criteria. Discrepancies were resolved through discussion. We did not identify any studies for inclusion.

Main results: 

We did not identify any studies that met our inclusion criteria. We excluded nine studies.

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