Some of the most common questions I get from clients and practitioners who teach my Feed Your Body, Grow Your Family!™ courses are about enema and pregnancy. Constipation often occurs during pregnancy—the prevalence of constipation is 2 to 3 times higher in pregnant people versus non-pregnant people (1)! But is an enema a safe solution for someone who is pregnant?
Why do pregnant people get constipated?
First, let’s review why pregnancy can lead to constipation. If you haven’t read it yet, check out my constipation symptoms of pregnancy blog. A quick summary includes:
- Hormonal changes during pregnancy can change how often you have bowel movements. In particular, the increased levels of progesterone and relaxin during pregnancy relax the colon, reduce peristalsis, and slow stool’s journey through the colon. These changes may lead to less frequent bowel movements than is healthy or normal for you.
- Some iron-containing multivitamins or à-la-carte iron supplements can cause or worsen constipation.
- A lack of magnesium relative to calcium can cause or aggravate constipation.
- Dehydration can also be a major underlying contributor to constipation.
- Lack of sufficient dietary fiber might be part of the issue.
- Finally, structural changes in pregnancy may simply change your anatomy and make bowel movements more difficult.
Fantastic (and pretty easy!) baseline solutions include increasing your daily water intake and whole-food fiber from recipes like this wildly delicious and dairy-free creamy bean recipe.
But what if constipation doesn’t budge?
Enema and pregnancy
Not much research exists on the use of enemas during pregnancy; most of the papers investigating enemas and pregnancy focus on the use of enemas during the first stages of labor. However, the majority of research I found did not report adverse events (2). Only one paper reported a problematic outcome, and this was a unique case study of an anorexic mother whose repeated use of phosphate enemas may have led to congenital rickets in her baby (3).
These findings are definitely reassuring! However, I still approach enemas with a bit of caution during pregnancy. Regular enemas have the potential to disturb water and electrolytes, an eloquent physiological balance that is even more nuanced during the high-nutrient demands of pregnancy.
Blood osmolality (the concentration of dissolved particles of chemicals and minerals in the blood serum) of pregnant people decreases from about the fifth week of pregnancy until delivery. Levels of sodium and calcium remain decreased even after the baby is born (4). So, enemas or any intervention that affects levels of sodium, calcium, potassium, and magnesium must be carefully considered.
Finally, there is the use of specialty enemas, such as coffee enemas, while pregnant. We don’t understand the exact mechanisms of action of coffee enemas or their safety during pregnancy and postpartum. Because of these unknowns, my position has always been that we don’t yet know how they might affect maternal and fetal health and if they are truly safe.
Additionally, clinical and anecdotal reports relay the use of coffee enemas for detoxification (5).
Coffee enema was initially introduced as a part of the Gerson Therapy, which was developed by Dr Max Gerson in the 1930s for the treatment of degenerative diseases such as skin tuberculosis, diabetes, and most notably, cancer.[5] The mechanism that claimed to treat cancer is through liver and intestinal detoxification by coffee enema—the kahweol and cafestol in coffee enhance the activity of glutathione (GSH) S-transferase (GST), a major antioxidant enzyme that neutralizes free radicals by 600% to 700%. These free radicals are then absorbed by the –SH groups of GSH in the bile, becoming bile salts that are flushed out of the gallbladder into the intestines for excretion through the colon. After detoxification, cancer cells are destroyed by an allergic inflammatory reaction.[6]
While this effect is still unsubstantiated by the research studies to date, it does add more reason for caution during pregnancy.
The bottom line on enema and pregnancy
We simply don’t know enough to recommend enemas as a first-line solution for pregnancy constipation. There are some fantastic remedies that we can try before an enema is needed, and we should focus on the bio-individualized use of these when working with our pregnant clients.
If you’d like to learn more about supporting your clients and family-focused practice, let’s talk! I offer three levels of membership that feature courses filled with practical, research-based information to support your clients and your business.
References
- https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.16559
- https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011448/full?cookiesEnabled
- https://pubmed.ncbi.nlm.nih.gov/1728548/
- https://link.springer.com/article/10.1007/BF02760724