Postpartum Constipation: How to Make Your First Bowel Movement Easier After Birth

I didn't know that...

Constipation after birth is remarkably common, affecting up to 52% of women in the immediate postpartum period [1]. For many new mums, the fear of that first poo after birth is worse than the bowel movement itself. This is something I experienced after my first birth and at the time I had no idea how common it was or that there were simple things you can do to help. Here's what I wish I'd known after having my first baby, before I qualified as a doctor.

Why does it happen?

There isn't just one reason why constipation happens after birth. Instead, it's usually caused by several factors happening at the same time. During pregnancy, hormones naturally slow your digestive system. After birth, your tummy muscles are stretched and your pelvic floor may be bruised or healing from stitches. It's completely understandable that many women become anxious about opening their bowels, which can make constipation worse [2].

Other factors include the use of certain pain relief during labour (like epidurals or opioids), dehydration during labour and birth and taking medication like iron supplements often prescribed to treat anaemia, all of which can significantly harden the stool [3].

Practical strategies for relief

The goal is to make the stool as soft as possible and to reduce the amount of straining required. Straining can put unnecessary pressure on healing perineal tissue or a C-section incision.

Self-Care Tips

• Drink plenty of fluids: Aim to drink regularly throughout the day. If you're breastfeeding, you'll usually need more fluid because you're producing milk. A good guide is to drink enough so that your urine is pale yellow.
• Raise your feet: Use a small stool or even a stack of books to elevate your feet while on the toilet. This straightens the anorectal angle and allows for a much easier passage [4].
• Support your stitches: If you have perineal stitches and constipation after vaginal birth, holding a clean maternity pad firmly against your perineum while you go can provide psychological and physical support. Remember to breathe normally rather than holding your breath, as this can reduce unnecessary straining.
• Don't ignore the urge: Your body’s signals may be muffled right now. When you feel the urge to go, don't wait. However, try not to strain, take your time on the toilet.
• Eat fibre little and often: Fruit, vegetables, porridge oats, wholegrain cereals and pulses can all help soften stools. If your appetite is low, start with small amounts and increase gradually while drinking plenty of water.
• Gentle movement: A short walk around the house or garden can help stimulate your bowel, even if it's only for a few minutes.

Is it safe to take something?

Many women worry about taking laxatives while breastfeeding. If lifestyle measures aren't enough, speak to your midwife, GP or pharmacist and they may recommend a laxative such as an osmotic laxative (like Macrogol) or a stool softener (like Docusate). These work by drawing water into the bowel rather than chemically stimulating the muscles. They are commonly used after childbirth and are generally considered compatible with breastfeeding, but always check with the healthcare professional treating you before starting any medication [5].

When to seek medical advice

While discomfort is normal, you should contact your GP or midwife if:

• You have not had a bowel movement by day 4 or 5 after birth.
• You experience severe abdominal pain, or vomiting.
• You notice significant bright red blood that isn't from your lochia.
• You are unable to pass wind or have a swollen or increasingly bloated abdomen.
• You have a fever.

Remember, your body has just achieved something extraordinary. It needs time, hydration and patience to get everything working normally again.

Read the NHS advice on constipation after pregnancy and childbirth

Frequently Asked Questions

Will my stitches come apart when I poo?

It’s very unlikely. Perineal stitches are designed to withstand the normal pressure of having your first poo after having a baby. While it may feel uncomfortable, they are very unlikely to split during a bowel movement.

If you have constipation after c-section, it's also completely normal to feel nervous about using your abdominal muscles. Holding a clean folded towel gently against your tummy when you open your bowels can make you feel more supported and comfortable.

References

1. Kuronen, M., et al. (2021). "Pregnancy, puerperium and perinatal constipation—an observational hybrid survey." BJOG: An International Journal of Obstetrics & Gynaecology.
2. Turawa, E. B., et al. (2020). "Interventions for preventing postpartum constipation." Cochrane Database of Systematic Reviews.
3. Bradley, C. S., et al. (2007). "Constipation in pregnancy: prevalence, symptoms, and risk factors." Obstetrics & Gynecology.
4. Sikirov, D. (2003). "Comparison of straining during defecation in three positions." Digestive Diseases and Sciences.
5. LactMed (2023). "Laxatives and Breastfeeding." National Institute of Child Health and Human Development.

Looking for more support?

My Six-Week Postpartum Recovery Programme provides week-by-week guidance through the first six weeks after birth, with short videos and downloadable resources to help you recover with confidence.

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