Effect of Progesterone Therapy versus Diet Modification on Constipation during Pregnancy
Constipation is a very common clinical problem. Pregnant women may experience constipation for the first time or their existing constipation symptoms increase in severity during pregnancy. The reported prevalence of constipation in pregnant women varies between 11% and 38% and occurs mostly during the third trimester, although symptoms can also be present from 12 weeks’ gestation. Constipation due to infrequent bowel movements or difficult passage of stools is a common cause of painful defecation and fecal impaction.
Constipation usually manifested by straining during defecation, lumpy or hard stools, sensation of incomplete evacuation or anorectal obstruction, manual maneuvers to facilitate defecation, and/or less than three defecations per week. The pathophysiology underlying functional constipation is undoubtedly, multifactorial, and not well understood. Progressively, rising progesterone and estrogen levels have suggested as the cause of constipation during pregnancy. Besides discomfort of constipation symptoms, straining during defecating can damage the pudendal nerve and impair the supportive function of the pelvic floor musculature.
Conclusion does not show agreement with the reports suggesting that progesterone is an important risk factor for constipation in women. This study designed to compare the effect of progesterone versus diet modification in the treatment of constipation during pregnancy.
SUBJECTS AND METHODS:
A total of 965 pregnant women with chronic constipation finally analyzed in this study after informed consent and approval of the Local Institute Ethical Committee of Maternity Hospital, Sabah area, Kuwait, from April 2012 to March 2015 [Figure 1]. Pregnant women
Participants divided into two groups; control group (684 women), managed with diet modifications as treatment for their constipation by dietitian and study group (281 women) who developed threatened miscarriage and advised to take 400 mg progesterone vaginally (Cyclogest, Actavis, United Kingdom) daily for ≥1 week each until their bleeding stopped . Diet modification includes increased fiber intake in the form of vegetables (carrots, romaine lettuce, broccoli, beetroot, and cucumbers) and fruits (apples, peaches, and melons).
Unpolished rice contains water-soluble fibers; phylum husk is a natural product that contains several types of fiber. Plenty of water throughout the day and glass of prune juice every morning will prevent constipation. During the treatment phase, the pregnant women filled daily diary containing similar questions as the questionnaire used at baseline evaluation. Data from the defecation diary summarized into weekly outcomes to be able to compare parameters of the study in the studied groups regarding its frequency and its difference from baseline.
Estrogen rather than progesterone may be a detrimental factor of constipation via decreased bowel movement. Progesterone therapy seems to be effective in the treatment of functional constipation during pregnancy. A randomized placebo controlled trial is required to confirm data of this study. The strength of this study is coming from being the first study investigating the use of progesterone in constipated pregnant women. In this study, due to the presence of a control group, the placebo effect of progesterone excluded and because of the controlled design, there is detailed information available on the natural course of constipation during pregnancy. A limitation of this study is the no validated questionnaire used at baseline, which could have caused recall bias resulting in possible underreporting of defecation frequency per week and other defecation-related parameters before the study.