Postpartum Diarrhea/Constipation: Causes and Treatment - Health.com

Being a new parent is challenging enough. One of the most common postpartum (six to eight weeks after childbirth) changes is stomach problems. These problems include diarrhea, constipation, hemorrhoids, and fecal incontinence. Your bowel movements should become regular shortly after giving birth.

Changes to bowel movements after pregnancy are caused by uterine contractions, pelvic floor issues, and changing hormones. Some treatments might help if you have trouble returning to regular bowel movements. Here's what you need to know about postpartum diarrhea, constipation, and other bowel problems.

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Changes in bowel movements are not uncommon after giving birth. Fecal incontinence, or the inability to control your bowels, affects anywhere from 5% to 26% of postpartum people. These bowel changes tend to go away fairly quickly.

"Most of the time, the symptoms aren't chronic. Most resolve after a few weeks as your body recovers from childbirth," Rita M. Knotts, MD, a gastroenterologist and assistant professor at the NYU Grossman School of Medicine, told Health.

It might take several days after giving birth to poop, which can be painful. What's normal for one person may not be normal for someone else. Keep in mind that every person has different changes during and after pregnancy.

There are several reasons for postpartum changes to bowel movements, such as:

• Changing hormones: High progesterone levels during pregnancy maintain pregnancy and slow down your gastrointestinal (GI) tract. This might lead to constipation.
• Diet: You likely will be unable to eat solid food during labor, which can make your bowel movements less frequent after childbirth.
• Fear of tearing vaginal stitches: You may notice pain near the perineal area immediately after birth. The perineal area is between the vagina and the anus. This might also cause soreness if you receive perineal stitching after birth. Together, this pain may affect the ability to have regular bowel movements.
• Milk production: Water is needed to increase milk production after childbirth. Decreased water in the gut, which keeps bowel movements regular and softens stool, may lead to constipation.
• Postpartum medications: Pain medications are frequently used during and after birth, which can make your bowels slower, resulting in constipation. Some antibiotics may cause diarrhea.
• Uterine contractions: The uterus expands during pregnancy. It must contract to return to its normal size after childbirth. These contractions may cause loose stool.
• Weak pelvic floor muscles: The pelvic floor is a hammock of muscles and tissues supporting the bladder and bowels. Changes to the pelvic floor can result in constipation and cause hemorrhoids.

With attention, time, and patience, postpartum bowel changes typically disappear. Depending on your bowel changes, some of the following treatments may help.

Constipation

Constipation means having fewer than three bowel movements per week. You may also have symptoms like:

• Dry, hard, or lump stool
• Feeling like not all stool has passed after a bowel movement
• Painful stool that's hard to pass

Eating a high-fiber diet and drinking plenty of water can alleviate postpartum constipation. Fiber supplements, stool softeners, or a laxative can also help. Avoid taking stool softeners and laxatives for long periods. Follow the instructions on the package when it comes to how long to take the medicines.

Diarrhea

Diarrhea means passing loose, watery stool three or more times per day. Other symptoms include:

Postpartum diarrhea is common among people who stretch or tear their rectal muscles during labor. You can often resume bowel regularity by mending your pelvic floor. Starting pelvic physical therapy four to six weeks after delivery and continuing for at least five months may help, Gabrielle Sandler, MD, a clinical assistant professor of obstetrics and gynecology at NYU Grossman School of Medicine, told Health.

You can treat postpartum diarrhea with fiber supplements and bulking agents like psyllium. Anti-diarrheal medicines, like Diamode (loperamide), might also help, said Dr. Sandler.

Fecal Incontinence

Fecal incontinence can result from damage to the perineal area or anus during childbirth. Tearing of the tissues in these areas can weaken the nerves and muscles, causing the bowel to leak. It might also be difficult to control gas.

Adding fiber to your diet and avoiding certain foods—such as alcohol, caffeine, dairy products, and fatty, fried, or greasy foods—can help. A healthcare provider may recommend bowel training or pelvic floor exercises. These exercises help strengthen the anal sphincter muscle. You might require surgery if these treatments fail.

Hemorrhoids

Hemorrhoids are swollen veins in the anus or rectum. You might have symptoms like:

• Anal itching 
• Anal pain while sitting
• Hard, tender lumps near the anus
• Painful bowel movements
• Rectal bleeding

Stool softeners, such as Colace (docusate sodium), may also help. Hydrocortisone creams, suppositories, and sitz baths can reduce swelling, discomfort, and itching.

Talk with a healthcare provider about what might work best for you before you buy over-the-counter (OTC) treatments. An OB-GYN might point out some lifestyle changes that can help. For example, decreased physical activity after childbirth might contribute to digestive system problems.

Changes in bowel movements after pregnancy are normal. Notify a healthcare provider right away if you notice any alarming symptoms, such as those of an infection:

• Fever
• Pain, discharge, or swelling near perineal stitches
• Tears in perineal stitches or near the anus (anal fissures)

Speaking up if you're uncomfortable is key. "Yes, this an issue that you and [a healthcare provider] should discuss prior to birth, given how prevalent it is. If [a healthcare provider] does not bring this up, you should feel empowered to start the conversation," said Dr. Sandler.

Bowel problems, such as diarrhea, constipation, hemorrhoids, and fecal incontinence, are common among postpartum people. These changes are typically due to uterine contractions, pelvic floor issues, and changing hormones. 

Some treatments, like laxatives, stool softeners, and pelvic floor therapy, may help. Consult a healthcare provider right away if postpartum bowel problems last or you develop symptoms of an infection.

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