Postpartum Constipation and the First Poo After Birth

Constipation after giving birth is common, and so is the fear of that first poo, especially with stitches. The NHS says you probably won't have a poo for a few days after the birth, but that it is important not to let yourself get constipated. Most of what helps is simple: fluids, fibre, moving, a better position on the toilet, and not straining.

Why am I constipated after childbirth?

The NHS lists constipation as common during pregnancy and after giving birth. There is rarely one cause. The sources we checked point to several things that can stack up in the first days:

• Pain medicines. A Cleveland Clinic obstetrician names opioid pain medications as one cause, and the NHS lists constipation as a possible side effect of medicine in general.
• Iron tablets. The same Cleveland Clinic article mentions iron taken after delivery, which is often given after a significant blood loss.
• Not drinking enough. Breastfeeding can be dehydrating, according to Cleveland Clinic, and not drinking enough fluids is a common cause of constipation on the NHS list.
• Lying and sitting more than usual. The NHS names not moving enough and spending long periods sitting or lying down as a cause.
• Stretched pelvic muscles. Cleveland Clinic explains that the stretching and temporary weakening of the pelvic muscles after birth can make it harder to poo.
• Fear. MedlinePlus notes that some women are worried about bowel movements after delivery, and holding on when you feel the urge makes things harder. The NHS advises not delaying when you feel the urge to poo.

When does the first poo happen after birth?

After a vaginal (normal) delivery, Dr Erica Newlin, an obstetrician writing for Cleveland Clinic, says the first poo may not be very delayed and may come in the first day or two. After a C-section, she says the bowels can take some time to wake up after major surgery, and it can take three or four days.

The NHS puts it more generally: you probably won't have a poo for a few days. Both are ranges, not deadlines. MedlinePlus, in its episiotomy aftercare advice, says to call your doctor if you go four or more days without a bowel movement.

Does pooping after giving birth hurt?

It can be uncomfortable, and being nervous about it is normal. Dr Newlin notes that women are very worried about tearing, but often after delivery it is not quite as bad as they thought it would be. The aim is a soft poo that comes out without pushing.

If you have stitches, the NHS suggests it might feel better if you hold a pad of clean tissue over the stitches when pooing. If you had a higher-grade tear, Cleveland Clinic says it is very important to keep your poo soft to avoid putting pressure on the stitches. After a third- or fourth-degree tear, the RCOG says you will be given laxatives for the first few days so that you don't get constipated.

What helps postpartum constipation?

• Drink plenty of water. MedlinePlus suggests about 8 cups (2 litres) a day to prevent constipation, and the RCOG advises at least 2 litres a day after a third- or fourth-degree tear. Ask if you have been told to limit fluids for another reason.
• Eat fibre. The NHS recommends plenty of fresh fruit, vegetables, salad, wholegrain cereals and wholemeal bread, and suggests increasing fibre gradually.
• Move. The NHS says a daily walk can help you poo more regularly. After a C-section, MedlinePlus says getting out of bed and walking helps your bowels move.
• Change your position. The NHS and RCOG both suggest resting your feet on a low stool so your knees are above your hips.
• Don't hold it in. Go when you feel the urge, and try not to strain.
• Support your stitches with a clean pad or tissue, as above.

Stool softeners and laxatives: ask first

Stool softeners and laxatives are often offered after birth. MedlinePlus says you may receive stool softeners in hospital, and Dr Newlin describes them as a very common medication women take after giving birth. The NHS says a gentle laxative may help if constipation won't go away.

That does not mean any product is right for you. Types matter too: MedlinePlus's going-home advice after a vaginal delivery mentions a stool softener or bulk laxative, not enemas or stimulating laxatives. Ask your midwife, pharmacist or doctor which kind suits you, especially if you are breastfeeding, taking iron, or had a deeper tear or a C-section.

Is piles normal after delivery?

Yes. The NHS says piles (haemorrhoids) are very common after birth but usually disappear within a few days or weeks. Piles are swollen veins inside the rectum or around the anus, and Cleveland Clinic lists pain when you poo, itching, and blood on the toilet paper as typical symptoms. Pregnancy, constipation and pushing too hard when pooing all make them more likely, according to the NHS.

What helps, from the NHS and MedlinePlus:

• Keep your poo soft with fluids and fibre, and do not push too hard.
• Take a warm bath to ease itching and pain.
• Use an ice pack wrapped in a towel to ease discomfort.
• Keep your bottom clean and dry, and pat rather than rub.
• Ask a pharmacist or your midwife about creams or ointments. The NHS says a pharmacist can recommend creams to ease the pain, itching and swelling.

After a C-section, MedlinePlus says any piles you develop should slowly decrease in size.

Bowel or wind control after a tear

For a small number of women, a third- or fourth-degree tear affects bowel control. The RCOG describes the symptoms as sudden, uncontrollable urges to open your bowels and not being able to control passing wind. It also says 6 to 8 in 10 women with these tears have no long-lasting complications after repair. The NHS asks you to tell your midwife or GP if poo is leaking or you are pooing when you don't mean to, whatever kind of birth you had. It is common to feel embarrassed, and it is still worth raising: help includes physiotherapy.

When to call your midwife or doctor

• You go four or more days without a bowel movement (MedlinePlus).
• Constipation that won't go away despite the steps above (NHS).
• Poo leaking, pooing when you don't mean to, or not being able to control wind, especially after a third- or fourth-degree tear (NHS, RCOG).
• Pain around your stitches that gets worse, a bad-smelling discharge, or a wound that seems to open (MedlinePlus).
• Signs of infection such as a fever. MedlinePlus lists a fever over 100°F (37.8°C) after delivery as a reason to call.
• Blood in your poo, or piles that are not improving with home treatment (NHS).
• Get urgent help if you have piles with pus leaking or a very high temperature. Call 999 or your local emergency number for bleeding that won't stop, a lot of blood or large clots, or severe pain (NHS).

If something feels wrong, you do not need to wait until your postnatal check to ask.

MatraBloom does not treat constipation, but its daily check-in and week-by-week recovery timeline, which differs for vaginal and caesarean births, can help you notice when something is not settling as expected and bring it up with your midwife or doctor.

Read more about caring for stitches after birth

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MatraBloom's daily check-in gives you a quick place to note how you are feeling each day, so a problem that is not settling is easier to spot and to mention at your next appointment.

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