Second Trimester


Ah, the joys of pregnancy…

As if our bellies weren’t feeling full enough, what with the whole baby-living-in-there-24/7 thing, constipation during pregnancy can make you feel truly awful. While constipation is one of the most common pregnancy symptoms that can hit during any trimester (and definitely one of the most annoying), it’s also one of the least discussed.

There are several reasons you’re likely to experience constipation at some point in your pregnancy. The first, and most obvious, is that carrying a baby around in an already crowded abdomen can put a lot of pressure on your intestines. As your organs start to shift around to accommodate your growing uterus, things tend to get squeezed which can slow down the movement of stool through the intestinal track.

To add insult to injury, high levels of progesterone that occur during pregnancy tend to relax smooth muscle—which just happens to be the kind of muscle responsible for moving food and waste through your digestive track. As the muscles relax, transit time slows, and things have a tendency to… well, back up.

Another common constipation culprit, both in pregnancy and at other times, is supplementing with elemental iron. This is the form of iron found in most prenatal vitamins and it can cause all sorts of digestive problems in women who are sensitive to it. I’ve written on the ways that prenatal vitamins containing this form of iron can contribute to morning sickness, but they can also slow bowel transit times and contribute to constipation.

Fortunately, there are several easy, natural ways to treat constipation during pregnancy.

Switch Prenatals

If you’re taking a prenatal vitamin that contains iron and are having trouble with constipation, consider switching supplements. Many women who have adequate iron stores going into pregnancy don’t need to supplement with higher levels and can get away with taking a high quality multivitamin along with extra B6, B12, and folate (this is the combo I take during pregnancy). If you’re concerned with anemia or your doctor has suggested taking additional iron, try a food-based prenatal that contains a form of iron that is more easily absorbed by your body and less likely to cause digestive problems.

Just be aware that not all so-called food-based supplements are created equal… Since the term “food-based” is unregulated when it comes to supplements, many brands just throw a couple of true food-based nutrients into their existing mix of synthetic vitamins, slap a new label on the bottle, and jack up the price accordingly. Two brands I trust are Innate Response and New Chapter.

Change Your Diet

In addition to switching your prenatal, be sure you’re you’re getting enough veggies and fruit which contain the fiber and water needed to keep you regular. If you’ve been following the traditional advice for lessening morning sickness in your first trimester (i.e. eat lots of starchy carbs all day long to keep your blood sugar steady and avoid upsetting your stomach), your diet is probably significantly contributing to your constipation. Click here to find out what you should be eating instead to really keep morning sickness at bay.

Drink More Water

Along those same lines, drinking enough water is also necessary to keep things moving in your digestive track. Be sure you’re drinking enough to keep from getting thirsty and if you’re experiencing constipation, try adding in a few extra glasses throughout the day. Walking more can also help with constipation, but be sure to increase your water intake even more as you increase your activity level.

Load Up On Probiotics

Probiotics can also help with constipation. Try adding some full-fat, unsweetened yogurt or kefir to your diet, or add in more fermented traditional foods like sauerkraut, kimchi, kvass, or kombucha.

There’s been a lot of controversy lately over whether or not probiotic supplements can be trusted after one independent research study found that many brands contained ingredients not listed on the label and another found evidence of fungal contamination. Other studies have found that many supplements don’t contain the levels of bacteria they claim to. Since researchers aren’t naming the brands they tested, I can’t currently recommend any widely available supplements and I suggest getting your probiotics from food (kefir is my personal favorite).

There are a few brands of high-quality probiotics I trust that are available through licensed healthcare practitioners. Unfortunately, they all require continuous refrigeration, so shipping on these products can often be two to three times the cost of the product itself. If you can find a local practitioner that carries them though, I like probiotics from Innate Response, Klaire Labs, and Thorne Research.

Supplement With Magnesium

If your diet is up to par, you’re getting enough activity, and you know you’re drinking enough water to prevent getting dehydrated, you might want to try taking powdered magnesium citrate. Most pregnant women are deficient in this mineral and it’s my secret weapon for combatting all sorts of pregnancy symptoms, from morning sickness to insomnia, anxiety, nighttime leg cramps, and more.

To use magnesium citrate to treat constipation in pregnancy, start by taking a half teaspoon in warm water before bedtime and gradually increase your dose until you’re having normal bowel movements that are comfortably soft, but not loose. If you get to the point where you’re taking more than a teaspoon, you can divide your dose so you’re taking half in the morning and half at night. Magnesium can also help with insomnia though, so if you’re having trouble sleeping you might find that taking your entire dose at night helps.

Take magnesium at least two hours away from any calcium supplements or calcium rich foods (i.e. don’t take it with a glass of milk). And although magnesium is usually safe to take at normal dosages during pregnancy, be sure to check with your midwife or OB before adding this (or any) supplement to your daily regimen.

Finally, avoid taking stimulant laxatives during pregnancy, including herbal formulas or teas. Many herbal laxatives contains senna or cascara sagrada, both of which are unsafe to use during pregnancy.

Number five was a lifesaver for me!


I’d be willing to bet that every woman reading this has experienced bloating and water retention at one time or another. Although normal hormonal fluctuations can cause fluid retention at any time, there is no time when this is more obvious than in pregnancy. In fact fluid retention in the form of swollen ankles is probably one of the most well-known symptoms of later pregnancy.

Water retention occurs during pregnancy for a variety of reasons. The first, and the one you’re probably familiar with from your pre-pregnancy days, is fluctuating hormones. The surge in hormones you experience just prior to your period is actually your body getting ready for pregnancy. The rising levels of estrogen and progesterone that occur premenstrually trigger an increase in aldosterone – a hormone that encourages your kidneys to hold onto water.

If you don’t get pregnant during your cycle, these hormone levels drop, signaling the start of your menses and allowing your body to release its premenstrual water weight gain. When you do become pregnant, those hormones stay elevated and you continue to hold onto the fluids you’ve accumulated.

One of the reasons for this increase in fluid retention is that your blood volume increases dramatically during pregnancy. This increase in blood volume really steps up in the second and third trimester, which is why it’s likely that you’ll notice a big increase in swelling during that time. Since your blood is over 80% water by volume, it makes sense that your body would need to hold onto a lot of water in order to increase the production of blood.

Making swelling worse is the increased pressure your growing uterus puts on the blood vessels that carry blood to and from your legs. One of the reasons swelling is usually the most noticeable in the legs, especially during the third trimester, is that this pressure makes it harder for your body to move blood and lymph out of your legs. Gravity doesn’t help this process and if you spend long periods on your feet, you’ll probably notice the swelling gets even worse.

So what can you do to prevent or decrease swelling and fluid retention?

#1 – Drink More Water and Eat More High Water Content Foods
I know this is one of those tips that’s all over the internet, but in this case there’s a reason for it. If you limit your fluid intake, your body will freak out and think you’re in danger of becoming dehydrated. It will compensate by hoarding every ounce of fluid you do take in.

In addition to drinking more water, eating more high water content fruits and vegetables can do wonders for fluid retention. You know the old spa trick of adding cucumber slices to pitchers of water? Well, there’s a reason for it. Not only do many juicy fruits and veggies contain compounds that can act a diuretics, the water and electrolytes contained in them will convince your body that it’s in no danger of dehydration. In addition to cucumber, melons, citrus fruits, greens, and berries are all excellent choices.

#2 – Walk More
Another well-known tip that actually works is to increase exercise, especially walking. The main way your body gets rid of excess fluid left behind in the tissues is through the lymphatic system. Unlike your circulatory system, your lymphatic system doesn’t have it’s own pump. It relies on movement to help move lymph fluid around the body. One of the best ways to accomplish this is walking.

Every time you take a step, all throughout your body muscles contract and relax, and joints flex and extend. All this movement is perfect for helping your lymph system move fluids throughout your body. While standing still or sitting can make fluids pool in your legs and increase swelling, walking actually does the exact opposite. Try getting up and walking around frequently throughout the day to decrease swelling in your legs during late pregnancy.

#3 – Cut Out Sugar and Grains
When most people think of water retention, they don’t usually think of sugar, they think of another white powdered food additive – salt. But unless you have a salt sensitivity or your kidneys aren’t working efficiently due to disease, salt probably has less to do with your tendency to retain water than you think.

A much more likely culprit is sugar. The reason for this is two-fold. One, sugar creates inflammation in the body, causing the release of many anti-inflammatory compounds, including histamine. Among other things, histamine increases the permeability of blood vessels, primarily to allow white blood cells and fluids access to areas of injury (this is one of the reasons you experience swelling when you sprain your ankle or slam your finger in the car door). However in the case of systemic inflammation (like that caused by sugar), this leaking of fluids into the surrounding tissue does not serve a specific function and can increase swelling all over the body.

The second has to do with the way your body stores glucose, one of the building blocks of sugar. If your body has more glucose circulating than it can use at one time, it converts this sugar to glycogen to be stored in muscles and fat cells. In order for the glycogen to make it’s way into the cells, it must first attach itself to several molecules of water. So in order to store extra sugar, your body stores three to four times the amount of water along with it, leading to swelling and fluid retention.

Eating grain products has a similar effect. In addition to being some of the most highly allergenic and inflammation-causing foods we consume, grains (even those “healthy” whole grains we keep hearing so much about) break down into glucose, so they’re processed and stored in the same way as glucose – along with the extra water.

Now I’m not suggesting you go on Atkins while you’re pregnant… Or anytime for that matter. You should continue to eat good for you carbs like fruits and veggies, including starchy veggies like sweet potatoes. But eliminating the excess carbs in sugar and grain products will go a long way toward enhancing your overall health and eliminating fluid retention.

#4 – Epsom Salt Soak and Massage
After trying the things above, if you find you’re still having trouble with swelling, you may want to try an epsom salt foot soak. While plain epsom salt will work, you may want to consider a soak formulated specifically for pregnancy, like this one. The magnesium in epsom salt can sooth inflamed tissues (as well as prevent nighttime leg cramps common in the third trimester) and increase circulation. Most soaks that are formulated for pregnancy include additional herbs and / or essential oils that are known to reduce swelling.

After soaking your feet, massage them gently with oil to further increase circulation. Any high quality oil will work, but again, oils specifically formulated for use during pregnancy (like this one) will usually contain additional ingredients to improve circulation and reduce swelling.

Have you found any of these methods to be effective for reducing or eliminating swelling? In what other ways have you dealt with fluid retention during pregnancy?

Avoiding Swelling and Water Retention in Pregnancy