Constipation after Childbirth

Etiology and Pathology

Constipation occurring after childbirth in a woman who previously had regular bowel movements is usually due to blood deficiency and dryness following excessive blood loss during labour. When blood and fluids are exhausted, the large intestine is affected and deficiency of fluids in this organ makes the passage of stools difficult. A state of dryness may also occur as a result of profuse spontaneous sweating after childbirth, but this is rare.

Apart from the large intestine, the pathology of constipation after childbirth is also related to the liver when deficient liver-blood fails to moisten the faeces, and to the lungs when deficient lung-qi fails to descend to the large intestine to provide qi for the effort of defaecation.

Identification of Patterns and Treatment

Blood deficiency

  • Constipation after childbirth, difficult defaecation with dry stools, pale complexion, dizziness, blurred vision, tiredness, depression.
  • Tongue: Pale and Thin
  • Pulse: Choppy

Treatment principle: Nourish Blood, strengthen the Liver, moisten the Intestines.

Kidney-Yang deficiency

  • Difficulty in defaecation, exhaustion and sweating after defaecation, stools not dry, sore back and knees, feeling cold, frequent, pale urination.
  • Tongue: Pale and wet
  • Pulse: Deep and Weak

This is a pattern of mostly Kidney-Yang deficiency. Normally, when Kidney-Yang is deficient, the stools are loose. However, it may also have the opposite effect when the deficient Kidney-Yang fails to move Qi in the Intestines and the bowels do not move. In addition, when Kidney-Yang is deficient, internal Cold results and this contracts the muscles in the Lower Burner, again impairing the normal bowel peristalsis.

Treatment principle: Tonify the Kidneys, warm the Lower Burner and moisten the Intestines.

Kidney-Yin deficiency

  • Dry stools, thirst with desire to sip water, dry mouth and throat especially in the evening, sore back and knees, dizziness, tinnitus, night sweating.
  • Tongue: without coating, cracks; Red if there is Empty-Heat.
  • Pulse: Floating-Empty.

This condition is more frequent in older women with Kidney-Yin deficiency. The tongue will lack a coating; in less serious cases it may only partially lack coating or have a rootless coating; and in still milder cases it may have a normal colour with a dry rootless coating. In all these cases, if there is Empty-Heat, the body colour will be Red.

Treatment principle: Nourish Yin, tonify the Kidneys and moisten the Intestines.

Prognosis and prevention

Both acupuncture and herbs are excellent to treat this type of constipation and results should be obtained within 1 week. The Chinese treatment based on nourishing Blood is much better than the Western treatment based on purgatives of the anthraquinone type, such as Cassia (Senakot, Dosalax, Senexone, etc.).

Exercise aimed at improving the tone of the abdominal muscles is essential after childbirth to restore bowel function to normal.

Western viewpoint

From a Western perspective, constipation after childbirth may be due to a combination of factors including a lesser food intake, dehydration during labour, laxity of the abdominal muscles or perineal lacerations that make defaecation painful. Moreover, the progesterone in circulation inhibits smooth muscle motility.

Treatment is based on the administration of bulk laxatives, such as methylcellulose, or purgatives of the anthraquinone type such as Cassia.