Constipation During Pregnancy and After Delivery: Causes, Relief, and When Pelvic Floor Physiotherapy Helps

Medically reviewed by: Dr. Sunita Patel, Pelvic Floor Physiotherapist, Pelvicare Health

Last reviewed: June 2026

Reading time: 12 minutes

Introduction

Constipation is one of the most common — and least talked about — complaints during pregnancy and after delivery. Studies suggest that up to 40% of pregnant women experience constipation at some point during their pregnancy, and a significant number continue to struggle with it for weeks or months after giving birth.

Yet most women are told to simply "drink more water" or "eat more fibre." While these are helpful, they miss a critical piece of the puzzle: the pelvic floor.

Your pelvic floor muscles play a direct role in bowel function. When these muscles are weak, tense, overactive, or damaged — as often happens during pregnancy and childbirth — they can make it difficult, painful, or incomplete to empty your bowels. No amount of dietary changes will fix a pelvic floor problem.

At Pelvicare Health, we treat constipation as part of pelvic floor rehabilitation — not just a digestive issue. This page explains everything you need to know: the causes, safe relief strategies, and how pelvic floor physiotherapy can address the root cause.

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Why Constipation Happens During Pregnancy

Pregnancy changes your body in ways that directly slow down your digestive system. Understanding why helps you choose the right solutions.

Progesterone — The Primary Cause

The hormone progesterone rises dramatically in the first trimester to support your pregnancy. One of its effects is relaxing smooth muscle throughout your body — including the muscles that line your intestines and move food through your digestive system.

When these muscles slow down, digestion slows with them. Food spends more time in your large intestine, where water is absorbed from it. The longer it stays, the harder and drier the stool becomes — making it difficult and painful to pass.

This is why constipation often appears as early as 4–6 weeks of pregnancy, even before your uterus has grown significantly.

Your Growing Uterus

As your pregnancy progresses into the second and third trimesters, your expanding uterus begins to physically compress your intestines, particularly the large intestine and rectum. This compression:

Reduces the space available for your intestines to move freely
Slows the transit time of digested material
Can create a feeling of incomplete bowel emptying, even after passing stool

By the third trimester, many women notice that the straining and discomfort worsen — directly related to the growing pressure on their bowel.

Iron Supplements

Iron is essential during pregnancy to prevent anaemia, but iron supplements are one of the most common causes of worsened constipation in pregnant women. Iron is notorious for hardening stools, particularly in doses above 60mg per day.

If you are taking iron supplements and struggling with constipation, speak to your doctor about:

Switching to a lower-dose, slow-release formulation
Taking iron with vitamin C (helps absorption, allowing lower doses)
Splitting the dose across the day rather than taking it all at once

Reduced Physical Activity

As pregnancy advances, many women naturally become less physically active due to fatigue, discomfort, or medical advice to rest. Physical activity directly stimulates bowel movement. Less movement means a slower bowel.

Dehydration and Dietary Changes

Morning sickness in the first trimester can cause dehydration. Food aversions may lead to a diet lower in fibre-rich vegetables and fruits. Both factors directly worsen constipation.

Why Constipation Happens After Delivery

Postpartum constipation is extremely common and, for many women, more distressing than pregnancy constipation — particularly because it occurs at the same time as perineal soreness, stitches, or caesarean recovery.

Fear and Pain Avoidance

This is one of the most underrecognised causes of postpartum constipation. After a vaginal delivery — especially one involving perineal tears, episiotomy, or stitches — the fear of pain during bowel

movements is entirely rational.

This fear creates a cycle:

Woman avoids passing stool due to fear of pain
Stool remains in the bowel and hardens further
When she finally attempts to go, it is more painful
The fear intensifies and avoidance worsens

Many women hold tension in their pelvic floor muscles as a direct result of this fear — which directly interferes with the muscle coordination needed to empty the bowel.

Pelvic Floor Muscle Damage or Dysfunction

During vaginal delivery — particularly long labours, assisted deliveries (forceps or ventouse), or deliveries involving significant perineal trauma — the pelvic floor muscles and the surrounding nerves can be stretched, torn, or weakened.

The pelvic floor plays an essential role in defecation. When these muscles are not working correctly, you may experience:

Incomplete bowel emptying (feeling like you haven't finished)
Needing to strain excessively to pass stool
Needing to support the perineum externally to empty the bowel
A sensation of obstruction or blockage

This is not a dietary problem. It is a pelvic floor problem.

Caesarean Section Recovery

Women who have had a C-section often assume they will not have postpartum pelvic floor issues since the baby did not pass through the vaginal canal. This is not entirely correct.

After a C-section:

Abdominal surgery directly affects the muscles and nerves around the bowel
Opioid pain medications used post-surgery are strongly constipating
Reduced mobility in the first days after surgery slows bowel transit
The abdominal scar can create fascial tension that affects pelvic floor coordination over time

In addition, many women carry pregnancy — including the third trimester pressure on the pelvic floor — before their caesarean. Pelvic floor dysfunction can exist even without a vaginal delivery.

Hormonal Shifts After Delivery

After delivery, progesterone levels drop rapidly. However, the abrupt hormonal shift, combined with the physical demands of caring for a newborn (dehydration from breastfeeding, disrupted eating, reduced sleep), creates conditions where bowel function takes time to normalise.

Breastfeeding women in particular need significantly more fluids than they realise — inadequate hydration directly worsens constipation.

The Pelvic Floor Connection Most Doctors Miss

Here is what most general practitioners, gynaecologists, and even many midwives do not assess when a woman reports postpartum constipation: the pelvic floor muscles themselves.

How the Pelvic Floor Controls Bowel Emptying

Defecation is not purely a passive process. It requires a precise coordination of muscles:

When the rectum fills, stretch receptors signal the urge to defecate
The internal anal sphincter relaxes involuntarily (you cannot control this)
The external anal sphincter and puborectalis muscle must voluntarily relax to allow stool to pass
The abdominal muscles and diaphragm generate gentle downward pressure
The pelvic floor lowers slightly, creating the correct anorectal angle for passage

If the pelvic floor muscles are too tight, overactive, or failing to relax correctly — a condition called dyssynergic defecation or pelvic floor dyssynergia — the puborectalis muscle contracts instead of relaxing when you try to defecate. This physically blocks the passage of stool, regardless of how soft the stool is.

This is why women with pelvic floor dysfunction often describe constipation as straining to pass soft stool — the stool is not hard, but the muscles are fighting the process.

Signs That Pelvic Floor Dysfunction Is Behind Your Constipation

You may have pelvic floor dysfunction contributing to constipation if you experience:

Straining for more than 10–15 minutes without success, even when stool feels soft
Feeling that the bowel has not fully emptied after passing stool
Needing to change positions, press on the perineum, or insert a finger into the vagina to help empty
Alternating constipation and loose stools without a clear dietary cause
Pelvic heaviness or pressure that worsens after bowel movements
Painful defecation despite soft or normal stool consistency
Leaking stool or urgency to reach the toilet (can coexist with constipation)

If you recognise two or more of these symptoms, you would benefit from a pelvic floor physiotherapy assessment — not just dietary changes.

Safe Relief Strategies During Pregnancy

Dietary Changes

Fibre: Aim for 25–30 grams of dietary fibre per day. Increase gradually — sudden large increases in fibre can worsen bloating and discomfort. Focus on:

Cooked vegetables (broccoli, sweet potato, spinach, carrots)
Legumes (lentils, chickpeas, kidney beans — well-tolerated in pregnancy)
Whole grains (oats, whole wheat roti, brown rice)
Fruits with skin (apples, pears, guava — all widely available in India)
Flaxseeds (ground, 1–2 tablespoons per day) — safe in pregnancy and excellent for bowel regularity

Hydration: 2.5–3 litres of water per day during pregnancy. Warm water first thing in the morning can stimulate bowel movement. Coconut water is an excellent option that provides electrolytes alongside hydration.

Reduce binding foods during periods of constipation: white rice, white bread, bananas (ripe), and excessive dairy can worsen constipation for some women.

Safe Physical Activity

Walking for 20–30 minutes per day is one of the most effective interventions for pregnancy-related constipation. Even 10 minutes after meals helps stimulate bowel motility.

Prenatal yoga poses that are specifically helpful include:

Cat-cow stretches (stimulate abdominal organs)
Child's pose (gentle abdominal compression)
Seated forward folds (with appropriate pregnancy modifications)

Always consult your obstetrician before beginning any new exercise programme during pregnancy.

Bowel Habits and Positioning

Respond to the urge to defecate promptly — ignoring the urge repeatedly trains the bowel to stop sending signals
Use a footstool (or a stack of books) to raise your feet 20–25cm when sitting on the toilet — this creates a squatting angle that relaxes the puborectalis muscle and straightens the anorectal canal, making passage significantly easier
Do not strain — straining increases intra-abdominal pressure and places direct stress on your pelvic floor
Allow 10–15 minutes of relaxed time, rather than forcing

Safe Laxatives in Pregnancy

Always consult your doctor before taking any laxative during pregnancy. Generally considered safe options include:

Ispaghula husk (Psyllium husk / Isabgol): Bulk-forming laxative considered safe throughout pregnancy. Take with large amounts of water.
Lactulose: Osmotic laxative often prescribed during pregnancy. Softens stool without stimulating uterine contractions.

Avoid: Castor oil, senna, bisacodyl, and stimulant laxatives unless specifically prescribed by your doctor — some stimulant laxatives can cause uterine contractions.

Safe Relief Strategies After Delivery

Managing Fear Around Bowel Movements

The first bowel movement after delivery is often the most feared. It is usually not as painful as anticipated — particularly with the measures below. However, if your first bowel movement is extremely painful or you notice something is wrong, contact your midwife or doctor.

Practical steps to reduce fear and pain:

Hold a clean maternity pad gently against your perineum when passing stool — this provides counter-pressure and significantly reduces discomfort
Use a squatting stool as described above
Take an adequate dose of prescribed pain relief approximately 30–45 minutes before attempting a bowel movement
Take your time and breathe — shallow, relaxed breathing helps pelvic floor muscles release

Stool Softeners

Stool softeners (not stimulant laxatives) are widely recommended immediately after delivery:

Docusate sodium: Draws water into the stool to soften it. Generally safe while breastfeeding — confirm with your doctor.
Lactulose: Osmotic action, softens stool without straining. Safe while breastfeeding.

Stool softeners are not laxatives — they do not force a bowel movement but make passing stool significantly less uncomfortable while your perineum heals.

Hydration After Delivery

Breastfeeding significantly increases fluid requirements. Many new mothers are so focused on their baby that they forget to drink. A helpful rule: drink a large glass of water every time you breastfeed. Coconut water, buttermilk (chaas), and dal (high water content) all contribute to hydration.

Gentle Movement

Bed rest is necessary for some recoveries, but gentle walking as soon as your doctor or midwife approves is one of the most effective ways to stimulate bowel function post-delivery. Even short walks around your home matter.

For C-section recovery: your surgical team will advise on when to begin gentle ambulation. Following this guidance carefully is important — both for wound healing and for restoring bowel function.

When to See a Pelvic Floor Physiotherapist

Diet and lifestyle changes help many women — but they do not address the pelvic floor itself. You should consider a pelvic floor physiotherapy assessment if:

Constipation persists for more than 6 weeks after delivery despite dietary changes
You are straining excessively or experiencing pain during bowel movements
You feel incomplete emptying after every bowel movement
You have symptoms of pelvic organ prolapse (heaviness, bulging sensation)
You had a forceps, ventouse, or prolonged second-stage delivery
You experience any degree of faecal leakage or urgency
Your constipation began during pregnancy and has not resolved
You are avoiding bowel movements due to fear or pain

What Pelvic Floor Physiotherapy Involves

A pelvic floor physiotherapy assessment at Pelvicare involves:

A detailed history: Your delivery, symptoms, bowel and bladder patterns, and previous treatments
External assessment: Observation of posture, breathing patterns, and abdominal muscle function
Internal pelvic floor assessment (with your full informed consent): Evaluation of pelvic floor muscle tone, strength, coordination, and the ability to relax — the critical factor in bowel function
Individualised treatment plan: Which may include pelvic floor muscle down training (learning to relax, not just strengthen), bowel retraining strategies, biofeedback, manual therapy, and education

Many women with constipation have been told to "do your kegel exercises." This can make constipation worse if the pelvic floor is overactive or too tight. A physiotherapy assessment identifies whether you need to strengthen or relax — and treats accordingly.

Warning Signs That Need Immediate Medical Attention

While constipation during pregnancy and postpartum is common, certain symptoms require urgent medical review. Contact your doctor or go to hospital immediately if you experience:

No bowel movement for more than 7 days despite laxative use
Severe abdominal pain, particularly if constant rather than cramping
Blood in stool (bright red or very dark/black)
Vomiting alongside constipation and abdominal distension
High fever alongside constipation
Postpartum: foul-smelling discharge from a wound site alongside bowel changes

These may indicate conditions requiring medical or surgical assessment — they are not something pelvic floor physiotherapy can address.

Frequently Asked Questions

Is constipation during pregnancy harmful to the baby?

In most cases, constipation during pregnancy is uncomfortable for the mother but does not directly harm the baby. However, severe straining should be avoided as it places significant pressure on the pelvic floor. Chronic constipation that leads to haemorrhoids or anal fissures can cause significant discomfort. Speak to your doctor or midwife if constipation is severe or persistent.

How long does postpartum constipation last?

For most women, constipation improves significantly within 2–4 weeks after delivery with appropriate dietary and lifestyle measures. Women with pelvic floor dysfunction, perineal trauma, or C-section recovery may find it persists for longer. If constipation has not improved by 6 weeks postpartum, a pelvic floor physiotherapy assessment is recommended.

Can I do pelvic floor exercises for constipation during pregnancy?

Pelvic floor exercises are generally beneficial during pregnancy — but the type of exercise matters. If your pelvic floor is overactive or tense, standard kegel exercises (squeezing and lifting) can worsen constipation. A pelvic floor physiotherapist can assess whether you need strengthening, relaxation, or coordination training specifically.

Can constipation cause pelvic organ prolapse?

Yes — this is a critically important point. Chronic straining and constipation are one of the leading contributors to pelvic organ prolapse. The repeated downward pressure of straining over months or years weakens the pelvic floor support structures. Treating constipation — and the pelvic floor dysfunction behind it — is an important part of prolapse prevention.

Is it normal to feel like I can never fully empty my bowel after delivery?

A persistent feeling of incomplete bowel emptying is not something to normalise or accept. It is a common symptom of pelvic floor dysfunction — specifically, a problem with pelvic floor muscle coordination. It is highly treatable with pelvic floor physiotherapy. Many women live with this symptom for years believing it is an inevitable part of motherhood. It is not.

Can breastfeeding cause constipation?

Breastfeeding itself does not directly cause constipation, but the significantly increased fluid requirements of breastfeeding mean that many new mothers are mildly dehydrated without realising it. Dehydration is a major contributor to constipation. Increasing fluid intake — particularly water and electrolyte-rich drinks like coconut water — alongside breastfeeding almost always helps.

Is Isabgol (Psyllium husk) safe during pregnancy?

Yes — Isabgol (psyllium husk) is considered one of the safest interventions for constipation during pregnancy. It is a bulk-forming agent, not a stimulant laxative, and does not cause uterine contractions. It must be taken with a large glass of water. Start with a small dose (1 teaspoon) and increase gradually to avoid bloating.

My doctor said my constipation is just hormonal — do I really need physiotherapy?

Hormonal changes are a contributing factor — but they are rarely the only factor, particularly if constipation persists into the second trimester of pregnancy or beyond 4–6 weeks after delivery. If pelvic floor muscle dysfunction is present, no amount of hormonal normalisation will resolve incomplete emptying or straining. A physiotherapy assessment identifies whether the pelvic floor is a contributing factor and treats it if so.

Take the Next Step

If constipation is affecting your quality of life during pregnancy or after delivery, you do not have to manage it alone with dietary changes and hoping it resolves.

Pelvicare Health's pelvic floor physiotherapists assess the complete picture — your bowel habits, pelvic floor muscle function, delivery history, and symptoms — to create a treatment plan that addresses the root cause.

Book a consultation at Pelvicare Health:

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