- The first remedy should be to increase fruit, vegetable and fibre intake, along with additional water consumption.
- Exercise may also help to relieve symptoms.
- If the mother is taking an analgesic (pain relief) medication containing codeine e.g. co-codamol, codydramol, this should be stopped and paracetamol and / or a non steroidal drug such as ibuprofen or diclofenac substituted
- when a medication is required to resolve constipation during breastfeeding, osmotic or bulk laxatives are preferable, at least initially, to stimulant laxatives
- Bulk Laxatives are particularly useful where stools are small and hard. However there may be a delay of up to 72 hours before they exert their full effect. Bulk laxatives absorb water within the gut and swell to produce a greater volume of soft stool which is easier to pass
- Absorption of bulk laxatives is minimal and they can all be used during breastfeeding
- example: Fybogel®, Regulan®, Isogel®, Normacol
- Work by increasing the amount of fluid in the large bowel. These also have a delay in action but it is generally shorter than bulk laxatives. They help to produce softer bowel movements, which are easier to pass
- example: Magnesium Hydroxide, Magnesium Sulphate, Lactulose, Movicol
- Passage of osmotic laxatives into breastmilk is low and they can all be used during breastfeeding
Stimulant Laxatives
- should not be used routinely by anyone as they can lead to a reliance on their action. They may cause evacuation of all bowel contents, which then need to re-build before a regular normal bowel action is resumed.
- They are however, useful for occasional use.
- They have a more rapid onset of action than bulk or osmotic laxatives, are usually given at night to help produce a bowel motion the following morning
- Example: Senna (Senokot® Ex Lax®,) Bisacodyl (Dulcolax®), Sodium Picosulphate (Laxoberal®, Picolax®)
- Side effects in breastfeeding infants have not been proven although loose bowel motions have been reported even with undetectable levels of senna in breastmilk
- Products such as liquid paraffin, magnesium salts, suppositories and enemas may be used occasionally to treat faecal impaction, but are not for regular use
- Jones W. Question from practice: Constipation after a caesarean section. The Pharmaceutical Journal2012; 288:715
- British National Formulary
- Hale T. Medications in Mothers Milk 2012 (15th Ed)
- Jones W Breastfeeding and Medication 2013 Routledge
- Lactmed website http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
- Martindale, the Extra Pharmacopia 2007
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