Miralax in Pregnancy

Disclaimer: The following blog is for education only. Always consult with your doctor before starting any treatment.

Hyperemesis Gravidarum (HG) sufferers often face a frustrating side effect: constipation. This is particularly common when taking ondansetron (Zofran), a medication prescribed in up to 30% of pregnant women in the United States for nausea and vomiting. HG already places women in a near-constant state of dehydration, which alone can lead to constipation. When you add Zofran into the mix, the digestive system can grind to a halt. According to the National Institute of Health, constipation is defined as “fewer than three bowel movements a week; stools that are hard, dry, or lumpy; stools that are difficult or painful to pass; or a feeling that not all stool has passed.” While this may sound unbearable to a healthy, non-pregnant person, for HG moms on Zofran, three bowel movements a week might feel like a luxury.

Constipation was not openly or proactively discussed in past decades. Fortunately, it is now a common topic of discussion throughout online support groups where posts can be anonymous, removing any self-imposed embarrassment. For those reading, please know there is no reason to be embarrassed. In fact, not discussing treatment options with your healthcare provider could land you in the emergency room with impacted stools. There are no official guidelines or FDA-approved treatments specifically for medication-induced constipation in pregnancy, unlike conditions like opioid use, Crohn’s Disease or Irritable Bowel Syndrome (IBS). Here’s a guide to relieving constipation during pregnancy compiled by years of retail and hospital pharmacy experience.

Preventing Constipation:

The best way to manage constipation is to prevent it. Taking a daily probiotic can help maintain digestive health. Other options include digestive enzymes, yogurt and kombucha, if it’s tolerable.

How to Choose a Product:

• Cost: Prices can vary from extremely cheap to very inexpensive. If an option seems out of your price range, price compare on multiple sites.
• Formulation: Options include oral, rectal, and more.
• Time to Take Effect: Some work in minutes, others in days.
• Product Quality: Consider gluten-free, dye-free, or non-GMO options.

Note that many products labeled gluten-free still contain trace amounts of gluten, up to 20 parts per million, which is FDA-approved. Always check the source of flavors and dyes to ensure they’re safe for pregnancy.

Important Considerations:

• Diarrhea can cause electrolyte imbalances, so always use the minimum amount needed to find relief.
• Manufacturers often change product names and formulas, so look at the active ingredient, not just the brand name.
• If you have diabetes, liver, or gastrointestinal issues, consult your doctor before trying any treatment.
• If over-the-counter remedies aren’t offering relief, ask for a referral to a gastroenterologist, who can prescribe and monitor more aggressive treatments.

Top 10 Constipation Remedies for HG Moms

1. Docusate (Colace)

• How it Works: Softens stools by drawing in water and fat. Oral forms take 1-2 days to work; rectal options take 2-15 minutes.
• Dose: 50-360mg daily, in one or divided doses.
• Pros: Non-addictive; available in tablets, capsules, liquid, and rectal enema.
• Cons: Needs to stay down to be effective.

2. Magnesium Citrate

• How it Works: Brings water into the colon to help stools pass more easily.
• Dose: 195-300 mL at once or in divided doses.
• Pros: Fast-acting (30 minutes to 6 hours), inexpensive.
• Cons: Won’t work if you can’t keep it down.

3. Magnesium Hydroxide (Milk of Magnesia)

• Similar to magnesium citrate, this pulls water into the colon and helps the muscles move stools along.
• Pros: Inexpensive, available over-the-counter.
• Cons: As with all oral solutions, it has to stay down to be effective.

4. Magnesium Sulfate (Epsom Salts)

• How it Works: Soaking in an Epsom salt bath allows magnesium to be absorbed through the skin. Do NOT ingest epsom salts while pregnant.
• Pros: Inexpensive, can relieve muscle cramps and anxiety.
• Cons: There’s no solid evidence on how long it takes to help with constipation.

5. Glycerin Suppository

• How it Works: Dissolves in the rectum, drawing water into the colon to create pressure and stimulate bowel movement.
• Pros: Fast-acting (15 minutes), safe, non-addictive.
• Cons: Some may feel uncomfortable with suppositories.

6. Sugar-Free Candy (Xylitol)

• How it Works: Xylitol, a sugar alcohol, can cause diarrhea by pulling water into the intestine.
• Pros: Inexpensive, available in various flavors.
• Cons: May cause gas and bloating initially. Can be fatal to dogs. Use caution to keep away from them!

7. Prunes and Prune Juice, if tolerable

• How it Works: Prunes contain sorbitol, which acts like a laxative by adding bulk and water to the stool.
• Pros: Inexpensive, widely available.
• Cons: Some may not like the taste.

8. Enema
   

• How it Works: Injecting liquid (usually saline or mineral oil) through the rectum softens stools and stimulates movement.
• Pros: Fast-acting (within 5 minutes), inexpensive.
• Cons: Uncomfortable and should be used sparingly to avoid dependency.

9. Polyethylene Glycol (Miralax)

• How it Works: Draws water into the colon, softening stools and making them easier to pass.
• Dose: 17 grams (usually one capful) mixed into a liquid once daily.
• Pros: Tasteless, non-addictive, available OTC.
• Cons: Takes 1-3 days to work, may be hard to keep down. Note: there are pending lawsuits surrounding polyethylene glycol for its use in children.

What to Use Sparingly:

• Stimulant Laxatives: Senna and bisacodyl should be used only when absolutely necessary, as the body can become dependent on them.
• Fiber Supplements
• How it Works: Fiber adds bulk to the stool, making it easier to pass, but only if you’re hydrated. Pros: Affordable, available in various forms. Cons: Won’t work if you’re dehydrated and can cause painful cramping.

Prescription Options:

If over-the-counter treatments aren’t helping, speak with your doctor about prescription options.

Examples of these include lactulose and pancreatic enzymes.

Conclusion:

Constipation during pregnancy, especially when dealing with HG, can escalate the disease state, diminishing quality of life and preventing recovery. Try to find the location of the constipation and choose the treatment accordingly. Consult your healthcare provider before starting any new treatment.