Constipation during pregnancy & postpartum with Dietitian Lana Hirth

So in today’s episode, I’m excited to have a chat to Lana Hirth, who is a dietitian in the area of women’s health, pregnancy and postpartum. So Lana likes to focus on that intrapartum nutrition period to help new mums optimizing nutrition so that they can live life to the full. Lana also hosts the New Mums Nutrition Podcast, and she runs a virtual private practice and online master classes.

So in today’s episode, we chat about constipation during pregnancy and that after birth period, because constipation is really common, and it’s something that isn’t talked about that much. I don’t think during pregnancy and after birth, constipation is thought to affect up to 50% of pregnant women at some stage during their pregnancy. That’s 1 in 2 women. So with Lana, we have a chat about some foods that can be included in the diet to help. Lana chats about ways to help relieve constipation during pregnancy and after birth. And she gives a lot of great bits of information, lots of advice, and it is worth listening to, even if you don’t suffer from constipation, because let’s face it, you might if you don’t at the moment, you might in the future. But overall, Lana gives some really great information on diet during pregnancy and postpartum whether or not you have constipation or not.

So before we do jump into this episode, I do want to let you know about 7-day Free Trial of FitNest Mama. And in these free 7 days, you can dive into a whole bunch of on demand Pilates classes and workouts that you’d like specific for pregnancy and postpartum. And there’s also a whole lot of guest expert speakers and Q&A is covering topics, including hypnobirthing, induction, breastfeeding, sex after childbirth, abdominal muscle separation, pregnancy related pelvic pain, caesarean scar massage, mastitis, and more. So all you need to do is head to www.fitnestmama.com/free

Right, let’s get into the show.

Hello, Lana. Thank you for joining me today.

LANA HIRTH

Thank you. It’s such a pleasure to be here.

KATH BAQUIE

So we’re going to be chatting about a fun topic. Not fun, not at all fun, but a really good topic to be talking about in pregnancy because it’s really common. It’s a big issue. And we’re going to be chatting about constipation during pregnancy and postpartum. So it’s a great topic. So thank you. To start off with, could you please introduce yourself for anyone who doesn’t know who you are?

LANA HIRTH

Yeah, so my name is Lana. And I run an online virtual clinic where I can see clients from all over Australia. And I run master classes as well as a host of the podcast, New Mums Nutrition. And so I had been seeing women come into clinic for years who wanted to get healthy, but the reason they wanted to was because they were looking at starting a family soon and they wanted to manage some of their health conditions or just optimize their nutrition or during pregnancy. They wanted to know how to eat well and we were confused about what they were allowed to eat and weren’t allowed to eat. And then afterwards, whether it’s like we’re going to talk about today, constipation or managing what they’re eating for breastfeeding, or helping with their weight management. I just had so many women come see me and I thought this is such an opportunity to help women in this space. And there’s not enough information in this area. And so yeah, I really dove in. And that’s why I started the podcast. And that’s why my clinic is devoted to helping particularly pregnant and postnatal women.

KATH BAQUIE

It’s amazing. Like everything you just said, you’d think that dietitian during pregnancy or postpartum is quite a niche area. But you have just said, so many different things that you can help women with. So yeah, it’s pretty amazing, isn’t it?

LANA HIRTH

Yeah, I think there’s a lot of things, we don’t realize that nutrition can play a really big role in helping not only for the sake of mums who often get neglected, especially when the baby comes along, but also setting that baby up for their long term health. And so if we can help people make it easier, I’m all about making it as easy and practical as possible, then that’s a win.

KATH BAQUIE

Brilliant. So we could probably talk all day about so many different topics, we might have to get you back on the podcast.

LANA HIRTH

Definitely.

KATH BAQUIE

Today, I was hoping to chat to you about constipation, because it’s an area that we perhaps don’t talk about as much. But it’s really common during pregnancy and postpartum. So from your perspective, why do you feel it’s such a big thing in pregnancy and after birth?

LANA HIRTH

That’s a good question. I think there are different things that contribute to constipation during both pregnancy and after birth. But I think first of all, sometimes we get confused about what actually is constipation. And so I think sometimes it’s helpful, because some of my clients will say, “Oh, you know, I don’t go every single day, so I must be constipated.” And so just knowing when we’re talking about constipation, that if you have sort of those separate hard lumps, like a rabbit stalls on that sausage shaped but lumpy, and if you’re straining a lot, or it’s really hard to pass those, they’re still going to feel like you’re not quite empty. If you have that sort of what we call incomplete evacuation. Those are signs that you could be constipated, I think, to be honest, in my experience, women in pregnancy and postpartum, they know when they’re constipated. They’re like, yep, you’re just, you’re ticking all those boxes that to me. And so, particularly in pregnancy, there’s a few things that cause it. One is the hormones that are going in, in people’s body, we have a rise in progesterone, which slows everything down and relaxes everything. But it does that with your muscles, but also your intestines. And that contributes to constipation, and particularly first trimester if you’re getting constipated on your first trimester, blame it on the progesterone, it’s later in pregnancy.

That’s really to do with the baby and the baby size. And as your baby in your uterus grows, it puts pressure on your lower intestines and your rectum, which is where your stools are stored, say that can just make it so much more difficult to have pass. And the third one, let’s come back to more nutrition related. One is nutrition supplements. Some of them contain, especially the prenatal supplements can contain so much iron, that it might not be the right supplement for you, especially if you’re getting quite constipated. And so that’s where I really focus on individually tailoring supplements to each woman, because some supplements have excessive amounts of iron, which can increase risk of constipation. And for some people increase their risk of gestational diabetes as well. It’s really important that that gets managed.

KATH BAQUIE

So you’re saying how can iron and related to gestational diabetes?

LANA HIRTH

Yeah, so there’s some studies that show an increased link of when women have higher iron, particularly in supplemental form, because that’s the easiest way to get excess iron. There’s just a correlation between women who take high iron, and then women who end up developing gestational diabetes. And so I said before I work in postnatal nutrition, but I love the intrapartum nutrition space, which is from when you’ve had your first baby, to your next baby, that time in between there. We can take some really valuable information about your first pregnancy and help you to optimize in your next pregnancy. So particularly those who had gestational diabetes, that might be where a supplement that’s slightly lowering iron, but still making sure that you’re not becoming iron deficient. So it’s very tricky balance that we have to play, that we’re keeping all of that in mind through your postpartum journey. And as you think about baby number two, if that’s an option for you.

KATH BAQUIE

I love the fact that you just mentioned that. Because we’re better at looking after our bodies when we’re pregnant. We’re shocking in that after birth period, because we’re so focused on the baby and we’re tired and all the rest, but then to be able to optimize our body in, as you said, that intrapartum period that in between pregnancy period is, that’s brilliant.

LANA HIRTH

And I think we’re on survival mode, in that fourth trimester. And I think it helps to shape your nutrition priorities to help look after yourself as a mum. But also, I think sometimes we’re more motivated, potentially. So my clients are more motivated, if they know this is going to have an impact on their baby’s health. And we can use that to make a positive impact on both mum’s health and babies.

KATH BAQUIE

Yeah, that’s brilliant. So it’s great to talk about constipation from your perspective, because as a pelvic floor physio, I’m often talking about constipation, but more from a pelvic floor perspective, because we know that chronic constipation, so if you’ve had chronic constipation for a long time, or you’ve been straining on the toilet for a long time, that’s not optimal for that pelvic floor area. And it might be a contributing factor to things such as prolapse, pelvic organ prolapses. So it’s a very interesting area, because we’re all very concerned about pelvic floor strengthening. And generally everyone wants to strengthen their pelvic floor during pregnancy. But that ability to relax and let it go, let your pelvic floor muscles relax and let it go, particularly on the toilet, and breathing and opening the gates, so to speak, so that you can pass about motion is also really important. So from your perspective, what are some of the things that it’s great for pregnant and new mums to do? And what’s also some things for them to avoid? Like, are we able to break it down into those couple of categories?

Yeah, yeah, definitely. Just going back for a minute to what you said about pelvic floor, I think it’s so important, something I look out for my clients to refer them on to a woman’s health physio, like yourself, because there’s so much you can do with food and food plays a really important role. And I heard recently, this great analogy that women’s health physios helped work on the plumbing. But dietitians helped work on the sludge that goes through. And so I just thought that that was a funny analogy, but helps you actually realize that both are really key in helping to manage constipation. And so, you know, from a food perspective, it can be simple, but it also can be complex. So if you’re hearing some of those things in you that I’m about to go through, and you think, “Oh, I’ve tried this and it hasn’t worked.” That’s when it might be more complex. And we might need to take a whole range of different approaches. Because typically what we say for constipation, is thinking about having high fibre. So what are the fibre to bulk out your stalks, having lots of fluid, so making sure that it’s able to flow through, and particularly in pregnancy and postpartum, you have such high fluid requirements. And so that’s where staying hydrated is so important, not only for things like managing the fatigue, during pregnancy and postpartum but also for your bowel health. And then as well, is movement as always I feel like it’s more on the physio end of things.

But that’s one of the things I’ll screen for is fibre, fluid and fate or movement. That’s a really simple way I’ll actually just took off. “Okay, are these things happening? Let’s work on this first before we try anything else.” Because sometimes that can be simple enough to manage it.

KATH BAQUIE

Yeah, love it.

LANA HIRTH

But there are also some additional things and I think some doctors might say, “Oh, try to take in some Metamucil or some fibre.” I don’t know if you’ve heard that before, but that might actually make constipation worse for some people. So if we take something that’s you’ve got constipation, and things are hard to move through the pipes, if we add more bulk to it, it’s just gonna exacerbate the problem. And to be honest with you, most of the time, I see people come with their mindset, “Yeah, I find it really hard to go to the toilet and I feel really bloated and I feel really uncomfortable, that’s because there’s a lot of stuff in there that we’re just not clearing out.” And so, supplements it might be like fibre supplement we might need to think about altering the different type of fibre. And it might be in the food that you’re having. And this is down to more complex end of things. It might be that we think about the types of fibre. And there’s a few different types of fibre and it might be about manipulating the vibe that you’re having to make sure that that’s optimizing and helping clear things out for you before we then work on it, but I will share a hack for people listening today. I think this is fascinating. Kiwi fruits in particular, a great for constipation. 2 Kiwi for today. If you’ve got a really sensitive cut, you might want to start with one kiwi fruit a day, but two Kiwi fruits that have been clinically shown to help with constipation. So there’s a little hack a practical hack for people.

KATH BAQUIE

Is that the fructose?

LANA HIRTH

It’s not so much the fructose. A fructose in particular, would be in things like pears, if people heard of…

KATH BAQUIE

Pear juice?

LANA HIRTH

or pear juice or prunes, that’s particularly due to that all those “p” fruits. The reason for kiwi fruit is it has a particular enzyme in it called actinidin, and so the actinidin helps with digestive movement in the bowels. And so that’s the particular reason why kiwi fruit is different. So you could use a combination of having kiwi fruit and using pears to get things moving.

KATH BAQUIE

Yeah, okay. So correct me if I’m wrong, but the fructose helps to draw the fluid into the bowel to help soften it. Is that correct? So it’s a natural sort of stool softener. Whereas you’re saying a kiwi fruit helps to stimulate things naturally.

LANA HIRTH

Yeah, that’s right. And so fructose is the natural sugar that’s found in fruit. But in particular, there are some fruits that have more fructose than glucose, some fruits have an equal amount of the fruits have higher amounts of fructose than the other sugar, glucose. And so that’s when your body goes, “Okay, well, I need to draw more water in here. And that’s why those fruits help because it’s helping to soften things up.”

KATH BAQUIE

Yup. So interesting. And can I just backtrack a little bit on what you said earlier, for those listening that heard a learner say that Metamucil might not be helpful, I think we should just clarify that. So when we’re looking at our stools, there’s something called the Bristol stool type chart, which is really helpful. So type one and type two are the harder pellets that Lauren was talking about. And then type three, type four is more the sausage life. So type three is a lumpy sausage. Type four is a smooth sausage, I keep going and then type five and six is when it starts to get more liquid. So correct me if I’m wrong, but the Metamucil, that bulking agent, that’s best if you’re more in that softer lump to liquid type 5,6,7. So not when you’ve got the hard pellets, it’s more when you’ve got soft blobs or liquid to help bulk it up. Is that right?

LANA HIRTH

Yeah, so generally speaking, that can be helpful, although for some people, if they have IBS, it can exacerbate the issue. And it might make it worse. And so if you’re someone who has IBS, that’s where some more individualized advice could be really helpful for you. But generally, sometimes it can help even in that type. If you have sort of type forwards like a smooth sort of sausage, then I wouldn’t really recommend that you need any additional help. But if you’re at the time, yeah, if you’ve got those pellets, I would be very cautious. And it’s very rare that I recommend just adding some Metamucil but yes, definitely done that softer. That more liquidy-running and that might help to do that bulking.

KATH BAQUIE

Yeah. Great. And do you always recommend people do this in conjunction with seeing the GP as well?

LANA HIRTH

Yeah, definitely, especially if the constipation is quite chronic, then working as a team together just like a women’s health physio and a dietitian would work together actually, a GP is a really key part in that, particularly looking at your history of, have you always had struggled with constipation, or has it just come out of the blue? Or have come because of pregnancy or postpartum or something else that sometimes that can be a red flag for other things. And so if you’ve had some other dramatic changes at the same time, whether that be some dramatic weight loss or something that’s actually a red flag that we might need to investigate things further. But even in terms of getting you on a really good laxative regime that can be really effective and sometimes we need to clear things out really well and we need not be afraid of taking laxatives to help support as you know as your pelvic floor to help keep things regular to keep you more comfortable. And then we can look at working together at maintaining a normal bowel function for you. Do you experience that as well? Do you often work with GPS at this area?

KATH BAQUIE

Yes. 100%. And I know like, although I’m happy to recommend things, I always know when it’s not my area. And anytime it goes into the medication side of things like, “Oh, look, let’s just go and chat to GP. And just while we’re on that note, what do you think of long term stimulants for the bowels, like clucksten? center? and that sort of thing? I’m putting you on the spot here.

LANA HIRTH

Yeah, that’s a great question. Great that you mentioned keeping your scope of practice because the laxative world, I leave that really to the GPs, to manage that. The general recommendation is long term use is not recommended. It depends from client to client. The long term goal and for most of my clients that I see, is wanting to be able to manage and just have a normal functioning bowel, where they don’t have to rely on all these extra things. And so there may be times where especially those first few weeks’ postpartum, things like medications and dehydration and the supplements and recovering from birth, and not really moving as much can all contribute to this beautiful storm of constipation plus being really sensitive down there as well. And so there is definitely a place but my approach is always if we can get people managing things with food, then I have a food first approach, even when it comes to nutrition supplements. If we can get it from food first and manage things with food, then that’s great. But if we need other things, they’re there to help us.

KATH BAQUIE

Okay, let’s go back to basics. So let’s say a new mum comes and sees you or a pregnant woman and has got issues with constipation. You talked about the “FFF”, the fibre, fluid and feet moving, like what else would you recommend for those women that come to see you?

LANA HIRTH

So for those women who are coming to see me, like, we definitely focus on what to eat, but we’re also thinking about how we eat as well. And so actually making sure we’re eating in a regular pattern is really important. So that there’s predictability for your guts to get into a rhythm of moving things through. And so especially for toileting behaviours, and techniques, which I think is more down your alley of actually how to do that. But in terms of timing of sort of teaching your body to go, the regular time actually eating can really help to promote sort of movement through the digestive system. And so actually, regular meal times is really important in that, and I think some people don’t factor something like that in, because we’re just normally focused on what we need to eat. And that can be really challenging, especially as a new mum, which is why sometimes small snacks can be really, really helpful. Even it’s just that those one handed snacks, and having those small, regular meals to help things go and keep going.

KATH BAQUIE

Yeah, you’re I think that regular timing of the opening of your bowels is something that women tend to look at, I’m being very general here. So I’m happy to say that, but if men need to go, they go. And I reckon they’re really good at sitting on the toilet, relaxing, taking their time, not rushing, and just letting it all happen naturally. Whereas I think women whether or not you have kids, but particularly once you’ve got kids, you know, we’ve got a million things we need to do. And we probably don’t have a long time that we can sit on the toilet. And I tend to think women defer that natural urge to go to the toilet. So they might like after they’ve had their morning, haven’t urged to go to the toilet, but there’s something that is more pressing that needs to be done, like a baby needs to be fed, or they need to get their kids breakfast or get them ready for school or whatever it is. So you put off that urge or you ignore it. And then what can happen is like the longer this stool stays in your system, it waters drawn from it. And then it’s a bit of a cycle. So yeah, so the tip for anyone thinking, listening is if you get the urge, just try to go. I know it’s hard though.

LANA HIRTH

That’s right. That’s right. And so coming back to some of the food things, I think keeping it really practical and talking about fibre. That’s a really general but if I think about specific foods, were thinking things like our whole grains, whether that’s brainy bread, rolled oats, some quinoa rice, maybe some Hawaiian pasta as well. That’s all really important as well as fresh fruit, plenty of vegetables, including things like legumes and even things like nuts and seeds. The different types of foods give us different types of fibre as well; they’ll have different compositions of fibre. So making sure you’re getting a variety of those things is a really key part. And something that I look for in clients to see how we going and are you getting enough serves of fruit, turnips, and enough serves vegetables? And how could we optimize these to help with how your bowels are at the moment?

KATH BAQUIE

And what you say so simple right. In fact, it can be really challenging practically to do that.

LANA HIRTH

Yeah, that’s right. And that’s why I said at the beginning, if we can make it simple and practical for you, then that’s the goal. And so it might sound really like, “Oh, I’ve heard that I need to eat my two servings of fruit.” But actually, oh, if I need to have some more fibre to help with my constipation, and two servings of fruit can help there, especially if you add some kiwi fruit and some pears in then making it more targeted and specific to you is going to help but it does sound really simple and basic.

But I think sometimes, to be honest, we overlook the really simple and basic things. And think that we need special fibre supplements or there are other supplements that may help with constipation. But I use those as more of a last resort because I know these things are far more effective. We’ve got enough when we’re pregnant, and with a newborn, to be worried about having all these fancy meals, and we’ve got so much on our plate, I’d like to say let’s make it as simple as we can when it comes to food, but still make it effective, that’s going to help you to get the results that you want, whether that’s a nice healthy bow, then that’s what we’re hoping for.

KATH BAQUIE

That’s great, what you were just mentioning, I think it really resonate with a lot of people that it doesn’t have to be complicated. But let’s try to factor in during the day, a few things to help. So is there anything that we should be avoiding?

LANA HIRTH

The biggest thing is just thinking that you need to take more fibre supplements to help because I genuinely like to focus on what we can be including to help, and that’s a more positive and more friendly as well. But in terms of things to avoid, for some people, it might be avoiding even the really high fibre foods that potentially could make constipation worse for some people, especially if you’ve had constipation or an offer of you know, 10 years, adding more high fibre foods might be the wrong approach for you. It might be about, so we know nuts are really high in fibre, it might be choosing to have softer fibre foods. So instead of nuts, it might be not paste, you’re still getting the fibre but more in a softer form. Or it might be like having bananas is okay to have that in a in a soft form. Even though it’s got fibre, it’s more of that soft, spongy form, as opposed to this really hard, tough, what we call insoluble fibre that just adds to bulk everything up. That might just make things worse. And so that’s where I said when it comes to constipation, knowing how it’s happened for you to really individualize. But sometimes I think the biggest mistake and that is what I’d love for people to take away from this, is not always about adding more fibre, but because you might just make things worse and feel worse.

KATH BAQUIE

Yeah, brilliant. Okay, well, I think you’ve given a lot of food for thought. And I’m hoping anyone listening who has got a few issues with constipation, might be able to take away a few nuggets and try to incorporate them into your day to day. So thank you, Lana. For those who would like to find you find more of you. How can people find you?

LANA HIRTH

Yeah, so I’m on Instagram, @lanahirthdietitian. You can jump over to the New Mums Nutrition Podcast, and you can find all those details on my website as well at www.lanahurt.com. If you’re wanting more one on one advice, that’s where you can book in with me all the details are there to tap on One-on-One console. So there’s lots of different ways you can get in touch, choose whichever one suits you best.

KATH BAQUIE

Amazing. Thank you and I’ll have all those links in the show notes too.

LANA HIRTH

Perfect.

KATH BAQUIE

Well, thank you, Lana. Thank you for taking the time to chat with me today. It was brilliant. Thank you.

LANA HIRTH

Thank you It’s been such a pleasure and yeah, I’ve just loved being able to chat about the combination of pelvic floor and constipation because I think they just go together so well.

KATH BAQUIE

Oh my gosh, I didn’t even touch on the pelvic floor side of things. Just touch this mint the surface so might have to do another episode soon. Yeah. Okay, thanks Lana. I will chat soon.

LANA HIRTH

Thanks.

KATH BAQUIE

Thanks for listening to the FitNest Mama Podcast, brought to you by the FitNest Mama Freebies found at www.fitnestmama.com/free. So please take a few seconds to leave a review, subscribe, so you don’t miss an episode. And be sure to take a screenshot of this podcast, upload it to your social media and tag me, @fitnestmama, so I can give you a shout out too. Until next time. Remember, an active pregnancy, confident childbirth, and strong postnatal recovery is something that you deserve. Remember our disclaimer, materials and contents in this podcast are intended as general information only and shouldn’t substitute any medical advice, diagnosis or treatment. I’ll see you soon!