Constipation Treatment in BreastFeeding Mothers

• 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

• 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

Osmotic Laxatives

• 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

Others

• Products such as liquid paraffin, magnesium salts, suppositories and enemas may be used occasionally to treat faecal impaction, but are not for regular use

Reference:

1. Jones W. Question from practice: Constipation after a caesarean section. The Pharmaceutical Journal2012; 288:715
2. British National Formulary
3. Hale T. Medications in Mothers Milk 2012 (15th Ed)
4. Jones W Breastfeeding and Medication 2013 Routledge
5. Lactmed website http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
6. Martindale, the Extra Pharmacopia 2007